益肾化湿泄浊方对气虚湿浊型CKD3～4期患者的临床疗效观察

目的:观察健脾益肾化湿泄浊方治疗气虚湿浊型CKD3～4期患者的临床疗效.方法:选取我院诊治的CKD3～4期患者共70例,分为对照组35例、治疗组35例.对照组予以基础治疗;治疗组在基础治疗上加用中药健脾益肾化湿泄浊方,两组均治疗2个月.观察指标:肾功能(BUN、Scr、eGFR),血Alb、U-TP,凝血功能(Fg、D...     

杨洪涛教授中药联合肾康栓治疗CKD3期单中心回顾配对队列研究

目的:基于单中心回顾配对队列探讨中药联合肾康栓序贯治疗CKD3期患者疗效。方法:共纳入129例CKD3期患者,其中对照组77例,干预组52例,经1∶1倾向得分匹配,匹配得49对患者,分为24对CKD3a期患者与25对CKD3b期患者。在常规治疗的基础上,对照组采用纯中药治疗,干预组采用中药联合肾康栓治疗,连续治疗16周,期间每隔4周检测两组患者的eGFR、CREA、BUN、UA、24 h-UTP、TP、Alb、ALT、AST、TC、TG。结果:干预组总有效率高于对照组(P<0.05);CKD3a及3b两期两组治疗后eGFR均显著升高(P<0.01)、CREA均显著降低(P<0.01),以干预组更明显(P<0.01);干预组两期患者BUN、24 h-UTP均显著降低(P<0.01),且干预组改善CKD3b期BUN更明显(P<0.01);两组治疗CKD3a期后UA均降低(P<0.05),以干预组更明显(P<0.01)。结论:在常规治疗基础上,中药联合肾康栓较之单纯中药能更有效地改善CKD3a及CKD3b期患者肾功能相关指标,优化疗效,值得推广...     

CKD5期患者血液透析前后中医证候学变化观察

目的：观察CKD5期患者在血液透析前后各时点中医证候分布差异。方法：选择开始进入血液透析的患者84例,根据中医辨证分型观察透析前后各时点的证候变化规律。结果：透析前正虚证以脾肾阳虚为主,其次为气阴亏虚、阴阳两虚,实性证候主要为瘀血、水气、湿浊证多见。血液透析后,阴虚证更为突出,湿热证呈先增后减趋势,水气、湿浊明显减少,血瘀证无变化。证候积分逐渐减少,以实性积分减少更为明显。透析后虚性积分明显高于实性积分。结论：血液透析治疗患者,应以培本固元,护卫阴液为根本,重视活血化瘀,兼顾利水、化湿、降浊。     

CKD患者残存肾功能的意义及保护策略

残存肾功能（ residual renal function, RRF）是指肾组织受损后健存肾单位的残留功能,包括清除毒素、调节体内水电解质和酸碱平衡以及多种内分泌功能。2006年K／DOQI的RRF定义为：GFR≥5．0ml·min^-1·1．73m^-2,或尿量≥100ml／d。对慢性肾脏病（CKD）患者,尤其是终末期肾病（ESRD）和进入透析治疗的患者而言,     

阿司匹林对鼻内镜手术围术期出血影响的临床观察

目的探讨阿司匹林对鼻内镜手术围术期出血的影响。方法回顾性分析2018-10—2021-03于郑州大学第一附属医院鼻科行鼻内镜手术并长期口服阿司匹林的67例患者的临床资料。根据围术期阿司匹林用药情况分为持续用药组(31例)和停药组(36例)。选取同期行鼻内镜手术未口服阿司匹林的中老年患者为对照组(30例)。记录术中出血量、血栓弹力图、术后出血情况及并发症,并对影响长期口服阿司匹林患者行鼻内镜手术的危险因素行Logistic回归分析。结果(1)3组患者中两两间的最大振幅(MA)、凝血综合指数(CI)差异均有统计学意义(P<0.05)。3组术后均有1例发生出血,行数据方差分析,3组间差异无统计学意义(P>0.05)。(2)鼻窦炎伴鼻息肉患者中,以及单纯鼻窦炎患者中,3组患者两两间的术中出血量差异均无统计学意义(P>0.05)。当显著性水平为0.05时,影响鼻内镜手术的独立危险因素为停用阿司匹林和BMI值。结论阿司匹林对鼻内镜手术围术期出血无明显影响,长期口服阿司匹林患者鼻内镜手术前可不停用阿司匹林。     

丹参对梗阻性黄疸患者肾功能的影响

目的:研究丹参对梗阻性黄疸患者围手术期肾功能的影响.方法:80例患者随机分为两组,试验组40例除常规治疗外给予丹参注射液40 mL静脉给药5 d,对照组40例给予常规治疗.于术前1 d,术后第2、6 d分别抽取两组患者清晨空腹血样及采取24 h尿样,检测血样尿素氮(BUN),肌酐(Cr)及24 h尿肌酐水平,计算肌酐清除率(Ccr).结果:术后2 d,Cr较术前升高,Ccr较术前降低,BUN与术前无差异.术后第6 d,丹参组Cr、BUN、Ccr与术前无差异,而对照组Cr仍较术前增高,Ccr仍较术前降低.结论:丹参对梗阻性黄疸患者围手术期肾功能有促进恢复作用.     

胃癌根治手术对老年病人围术期肾功能的影响

目的观察胃癌根治手术对老年病人围术期肾功能的影响。方法全身麻醉下择期行胃癌根治手术的病人40例分为两组,每组20例:老年组(Ⅰ组)年龄≥65岁,中年组(Ⅱ组)年龄<65岁,分别于麻醉诱导前(T0)、手术开始后1h(T1)、术后第1天(T2)、第3天(T3)和第5天(T4)留取血、尿标本,测定血肌苷(Cr)、尿素氮(BUN)和尿中Cr、βN乙酰(基)D氨基葡萄糖苷酶(NAG)、α1微球蛋白(α1MG)、微量白蛋白(Alb)的含量。结果两组各时点血Cr和BUN均在正常范围内。两组尿NAG/Cr和α1MG/CrT1～T4时明显高于T0时(P<0.01)。Ⅰ组尿NAG/CrT0、T4时明显高于Ⅱ组(P<0.05)。两组尿Alb/CrT1、T2时显著增加(P<0.01),且Ⅰ组明显高于Ⅱ组(P<0.05),Ⅰ组T4时恢复至术前值,而Ⅱ组T3时恢复至术前值。结论胃癌根治手术围术期老年病人肾功能损伤较中年人明显。     

补充n-3多不饱和脂肪酸对糖尿病患者肾功能指标影响的Meta分析

目的采用Meta分析法系统评估补充n-3多不饱和脂肪酸(n-3 PUFAs)对糖尿病患者肾功能指标的影响,为糖尿病慢病管理提供理论依据。方法全面检索数据库,包括Pubmed、Cochrane Library、Embase及中国知网、万方、维普数据库。文献检索起止时间均从建库至2018年8月31日,收集糖尿病患者口服n-3 PUFAs的随机对照试验,评价文献质量,提取有效数据后,采用RevMan 5.3软件进行数据分析。结果共纳入11项RCT研究,614名研究对象。Meta分析显示,与对照组相比,补充n-3 PUFAs可降低糖尿病患者尿白蛋白排泄[MD=-2.65,95%CI(-4.67,-0.62),P=0.01]和血肌酐水平[MD=-2.60,95%CI(-4.98,-0.22),P=0.03],并延缓肌酐清除率下降[MD=9.23,95%CI(4.37,14.09),P=0.0002]。但两组糖尿病患者的尿素氮、尿酸及肾小球滤过率差异均无统计学意义(P0.05)。结论 n-3 PUFAs可降低糖尿病患者的尿白蛋白排泄和血肌酐水平,延缓肌酐清除率下降,但对尿素氮、尿酸及肾小球滤过率均无显著改善。     

Effect of Sirolimus Withdrawal in Patients with Deteriorating Renal Function

Sirolimus has been an important addition to immunosuppressive regimens utilized in kidney transplantation. However, sirolimus can potentiate calcineurin inhibitor (CNI) nephrotoxicity by some still uncertain mechanisms. Studies have demonstrated that withdrawal of a CNI under sirolimus immunosuppression can improve renal function. However, it has yet to be demonstrated that withdrawal of sirolimus from such a regimen can also improve renal function and reverse progressive functional deterioration. We studied 17 patients who developed deterioration of renal function while on a CNI and sirolimus. Once an established deterioration in renal function was noted, sirolimus was withdrawn from the regimen and replaced with mycophenolate mofetil. Out of 17 patients with a negative slope in 1/cr, 15 demonstrated a positive treatment effect (change to a positive slope). On aggregate, renal function improved by 18% (creatinine 2.75-2.24 mg/dL), LDL cholesterol improved, as did hematocrit values after withdrawal. The majority of patients on a CNI and sirolimus regimen who experience deterioration in renal function demonstrate improvement in renal function after withdrawal of sirolimus. This strategy may be particularly useful in those patients where CNI withdrawal is considered to be of high immunologic or metabolic risk.     

利多卡因硬膜外阻滞对妇科病人肾功能的影响

麻醉药可抑制肾功能,NAG、γ-GTP为麻醉中测定肾功能的良好指标。本组麻醉后30minNAG指数36.32±8.12与麻醉前比P<0.01,γ-GTP指数75.32±14.76(P<0.05),其指数变化与用药量相关,测定中并发现尿蛋白,初步证明利多卡因硬膜外阻滞对肾功能的影响与用药量有关。     

肾维宁冲剂对慢性肾衰竭患者机体细胞免疫和肾功能的影响

目的:探讨中药肾维宁冲剂对慢性肾衰竭(氮质血症期)患者机体细胞免疫功能和肾功能的影响.方法:将62例慢性肾衰竭(CRF)患者随机分成两组,治疗组32例予肾维宁冲剂,对照组30例予包醛氧淀粉.观察两组治疗前和治疗后3个月CD 3、CD 4、CD 8、CD 4/CD 8、IL-1、IL-2、IL-6和BUN、Scr、Ccr水平的变化.结果:治疗组治疗后CD 3、CD 4、CD 8、CD 4/CD 8、IL-2和Ccr均显著上升(P＜0.05),CD 8、IL-1、IL-6、BUN、Scr则明显下降(P＜0.05).对照组治疗前后对比,仅BUN明显下降(P＜0.05),其余无统计学差异(P＞0.05).结论:肾维宁冲剂具有提高CRF患者CD 3、CD 4、CD 8、CD 4/CD 8、IL-2、Ccr水平,降低CD 8、IL-1、IL-6、BUN、Scr水平的作用.有效地改善患者的细胞免疫功能和肾功能.     

抗纤灵冲剂对慢性肾衰竭肾功能及纤维化指标影响的临床研究

目的 :研究抗纤灵冲剂对慢性肾衰竭 (CRF)患者肾纤维化、肾功能的作用。方法 :观察抗纤灵冲剂对慢性肾衰竭患者的肾功能指标即血清肌酐 (Scr)、尿素氮 (BUN)和纤维化指标即血清层粘连蛋白 (LN)、纤维连结蛋白(FN)、Ⅲ型前胶原 (PC -Ⅲ )、Ⅳ型胶原 (C -Ⅳ )的影响。结果 :与服用包醛氧淀粉的对照组患者比较 ,抗纤灵冲剂有明显的降低慢性肾衰竭患者的血清Scr、BUN、LN、PC -Ⅲ、C -Ⅳ和升高FN的作用 ,二者有统计学意义 (P <0 .0 5 )。结论 :该方能改善肾纤维化、延缓慢性肾衰竭的进程。     

小剂量多巴胺对腹腔镜围手术期肾功能及血流动力学的影响

目的探讨小剂量多巴胺对腹腔镜围手术期患者肾功能及血流动力学的影响。方法拟在腹腔镜下行全子宫切除手术40例,采用随机数字表随机分为多巴胺组（20例）和对照组（20例）。2组均采用静吸复合全身麻醉,多巴胺组在气腹前10min开始静脉持续泵注多巴胺（每分钟5μg/kg）直到手术结束,2组气腹前（T1）、气腹后60min（T2）和解除气腹后30min（T3）抽静脉血检测尿素氮（BUN）、肌酐（Cr）、尿酸（UA）,并记录心率（HR）、平均动脉压（MAP）,测量术中尿量。结果多巴胺组BUN、Cr、HR、MAP各时点无明显变化,UA于T2、T3时点明显降低,与T1及对照组相同时点的UA值比较差异有显著性（P〈0.05）,术中尿量明显多于对照组[（396±51）mlvs（121±15）ml,t=22.836,P=0.000];对照组气腹后60min（T2）HR减慢、MAP降低,与气腹前（T1）及同时间点多巴胺组比较差异有显著性（P〈0.05）。结论小剂量多巴胺可以降低血尿酸及增加尿量,改善肾功能,同时还可以有效维持患者血流动力学稳定。     

黄芪对梗阻性黄疸围手术期肝肾功能的保护作用

目的:研究黄芪注射液对梗阻性黄疸围手术期肝肾功能的保护作用.方法:以经手术证实的64例梗阻性黄疸为研究对象,34例为实验组(黄芪组),术后给予黄芪注射液30 mL加入生理盐水中静脉滴注7～10 d.对照组30例给予常规治疗.结果:术后3 d病人肌酐(Cr)、谷草转氨酶(AST)较术前明显增高,总胆红素(TBIL)、肌酐清除率(Ccr)明显降低;术后7 d,TBIL较术前明显降低,Cr及AST与术前比较差异无显著性,但对照组Ccr较术前仍明显降低,黄芪组内皮素(ET-1)较术前明显降低.两组同时段比较,黄芪组Cr、AST较对照组明显降低,Ccr较对照组明显增高.结论:黄芪注射液对梗阻性黄疸围手术期病人的肝肾功能起保护作用,可能与降低ET-1有关.     

Subtyping CKD Patients by Consensus Clustering: The Chronic Renal Insufficiency Cohort (CRIC) Study

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Effects of Intravenous Aspirin on Prostaglandin Synthesis and Kidney Function in Intensive Care Patients

The effects of intravenous acetylsalicylic acid (1.0 g bolus)on renal function and prostaglandin synthesis were evaluatedin a prospective, controlled study in eight patients in an intensivecare unit. Four of these patients had congestive heart failure.Administration of acetylsalicylic acid caused significant antidiuresis(–56%), antinatriuresis (–82%), renin suppression(–26%) and decreased GFR (–41%). All of these changeswere completely reversible within 1–2 hours and tendedto be more pronounced in the patients with congestive heartfailure. Urinary excretion of prostaglandin E was depressedprofoundly (–93%) and did not return to more than 45%of control 6 h after the administration of acetylsalicylic acid. We conclude that intravenous acetylsalicylic acid affects kidneyfunction in a manner similar to other prostaglandin synthesisinhibitors. Its effects are, however, short-lived. The inhibitionof urinary PGE₂ excretion outlasts GFR depression, antidiuresis,antinatriuresis and renin suppression by several hours.     

Incidence of Demodex Folliculorum in Patients with End Stage Chronic Renal Failure

Background. Demodex folliculorum (DF), found in the pilosebaceous unit, is the most common ectoparasite in humans. It has been implicated in various clinical lesions such as pustular folliculitis, papulopustular scalp eruption, perioral dermatitis, and skin lesions of immunosuppressed patients on chemotherapy or with acquired immunodeficiency syndrome (AIDS). Objective. We aimed to determine DF carriers and location of DF among patients on chronic dialysis because of end stage renal failure (ESRF), to compare them with healthy controls, and to examine the relationship between DF incidence and dialysis method and symptoms. Methods. Sixty-seven patients on dialysis and 67 healthy controls were taken into the study. The patient groups were classified according to the diseases causing ESRF [diabetes mellitus (DM), polycystic disease (PCD), glomerulonephritis (GN), hypertensive nephrosclerosis (HTNS), others (OT), unknown etiology (UE)], and mode of dialysis. Five standardized skin surface biopsies (SSSB) were taken. The determination of five and more living parasites/cm² area was diagnosed as infestation. Results. The mean mite count in the ESRF group, 6.12/cm², was significantly higher than that in controls, 0.31/cm², (Independent Samples Test, p = 0.000). The DF positivity according to primary disease causing ESRF revealed that it was most frequent in DM with 12 patients (44.4%), followed by UE with nine patients (33.4%). Conclusions. Our findings indicate that the DF number is increased in ESRF patients on dialysis treatment. We recommend that demodicidosis should be included in the differential diagnosis of facial eruptions in patients with ESRF.     

Phase 3 Randomized Study Comparing Vadadustat with Darbepoetin Alfa for Anemia in Japanese Patients with Nondialysis-Dependent CKD

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