Mass balance: a quantitative guide to clinical nutritional therapy. II. The dialyzed patient.

The concepts of mass balance are extended to the nutritional management of the patient with chronic renal failure on dialysis. The use of these concepts permits estimation of protein catabolism from calculated rates of urea generation, using measurement of blood urea levels. Protein catabolic rate will equal intake in the stable patient (zero nitrogen balance), allowing for accurate nutritional screening in a large dialysis population for whom these values are available without individual dietary surveys. This has resulted in a four-fold reduction in routine monitoring of protein nutrition in such patients, freeing the dietitian to concentrate on specific problems. These concepts also comprise a key aspect of the National Cooperative Dialysis Study which seeks to maintain BUN at different levels in four carefully controlled modes of dialysis therapy. With these methods, the monitoring and control of BUN and protein intake has made the dietitian a pivotal member of this study staff.     

The effect of different intravenous nutritional regimens on renal function during acute renal failure in the rat

Acute renal failure in the surgical patient is accompanied by a state of hypermetabolism and increased catabolism. Nutritional therapy is therefore directed at the preservation of body cell mass and protein synthesis for repair of wounds and damaged renal tubuli and for maintenance of host defense mechanisms. We examined the effect of two levels of protein intake (18.4 +/- 1.4 and 30.8 +/- 2.4 mg N/100 g BW/day) and three different amino acid formulations (Freamine III, Nephramine, and a made-up mixture of Nephramine + Freamine HBC) on renal function following mercury chloride-induced acute renal failure in the rat. All animals suffered severe renal failure manifested by increased plasma urea and creatinine levels, decreased creatinine clearance, and increased fractional excretion of sodium. On day 4 of acute renal failure, rats receiving low dose amino acids had better-preserved renal function than those receiving high dose amino acids. However, the type of solution infused did not affect recovery of renal function.     

Treatment of patients with chronic renal insufficiency; a guideline for internists

Early optimalization of the treatment of patients with chronic renal insufficiency can reduce morbidity and deaths. For each patient with a raised serum creatinine concentration, the creatinine clearance should be measured or calculated. When this is abnormal, the cause thereof should be investigated. Chronic renal insufficiency is often progressive, even when the initiating factors are no longer present. Progression can be delayed by treating the high blood pressure, proteinuria and hyperlipidemia by means of a restricted protein diet and advice not to smoke. Acute deterioration of an existing chronic renal dysfunction through dehydration and underfill or through the use of certain medications or toxic substances such as radio-opaque media should be avoided. In patients with chronic renal insufficiency specific attention should be paid not only to hypertension, lipid disturbances, smoking and weight, but also to the calcium-phosphate balance, anaemia and homocysteine levels. The blood pressure, oedema and weight of patients with a clearance between 30-59 ml/min should be checked 2-3 times a year, in addition to laboratory tests for Hb, Ht, creatinine, urea, potassium, calcium, phosphate, pH, bicarbonate and lipid spectrum. It is recommended that when creatinine clearance (< 50 ml/min) falls a nephrologist should be consulted at least once with respect to the strategy to be followed. Symptoms of chronic renal insufficiency can occur when the creatinine clearance is < 30 ml/min. This relates to: sodium retention, imbalances in the calcium and phosphate levels, anaemia, uraemia, water retention, potassium retention and metabolic acidosis. Referral should take place at a creatinine clearance of < or = 30 ml/min.     

Use of urea kinetics in the nutritional care of the acutely ill patient

In acutely ill patients nitrogen balance is often assessed clinically from measurements of protein intake and urinary urea nitrogen. We have utilized urea kinetic modeling to measure urea generation rates, protein catabolic rates and nitrogen balance in 19 acutely ill patients with varying degrees of renal dysfunction and have studied the effect of varying caloric intake on protein balance during a period of fixed protein intake. In patients with measured creatinine clearances equal to or greater than 50 ml/min there was a highly significant correlation between nitrogen balance estimates derived from urea kinetic modeling and those obtained from urinary urea nitrogen (R = 0.939; p less than 0.001). When creatinine clearance measurements were between 20 to 50 ml/min the correlation between the two estimates was poorer (R = 0.337; p less than 0.001). In patients whose creatinine clearance was below 20 ml/min the correlation between measurements was worse still (R = 0.229; p less than 0.002). To determine the effects of increasing caloric intake on protein catabolic rate seven acutely ill patients were studied. When caloric intake was increased from 27.8 to 34.2 kcal/kg/day while on a fixed protein intake of 1.27 g/kg/day there was a significant fall in protein catabolic rate from 1.39 to 0.99 g/kg/day (p less than 0.002). As urea kinetic modeling takes into account changes in blood urea nitrogen, extrarenal losses of urea and the urinary urea pool, it is the preferred method for measuring protein balance in acutely ill patients particularly those with poor renal function. Serial monitoring of protein catabolic rates permits easy continuous assessment of the effect of increasing caloric intake on protein sparing during parenteral hyperalimentation.     

Intérêt et limites de la 3-méthylhistidine pour la mesure du catabolisme musculaire

3-methylhistidine has long been used as a marker of muscle protein breakdown. Although certain factors such as exogenous intake and gastrointestinal synthesis may limit its validity, recent publications suggest that 3-methylhistidine is still a valuable index of muscle protein catabolism. The use of the 3-methylhistidine (μmol/l)/creatinine (mmol/l) ratio can limit interindividual variations and provide useful information, even when 24 h urine collection is incomplete. Although in clinical practice the measurement of urinary urea or nitrogen is the main parameter used to quantify the hypercatabolic response to acute illness, the 3-methylhistidine/creatinine ratio is of value when 24 h urine collections are incomplete, as well as in hypercatabolic patients with severe protein-calorie malnutrition and for evaluating the quality of nutritional support. Needless to say, this parameter remains crucial for the determination of muscle protein catabolism in clinical research.     

Associations of renal function with polymorphisms in the delta-aminolevulinic acid dehydratase, vitamin D receptor, and nitric oxide synthase genes in Korean lead workers

We analyzed data from 798 lead workers to determine whether polymorphisms in the genes encoding delta-aminolevulinic acid dehydratase (ALAD), endothelial nitric oxide synthase (eNOS), and the vitamin D receptor (VDR) were associated with or modified relations of lead exposure and dose measures with renal outcomes. Lead exposure was assessed with job duration, blood lead, dimercaptosuccinic acid (DMSA)-chelatable lead, and tibia lead. Renal function was assessed with blood urea nitrogen (BUN), serum creatinine, measured creatinine clearance, calculated creatinine clearance and urinary N-acetyl-beta-D-glucosaminidase (NAG), and retinol-binding protein. Mean (+/- SD) tibia lead, blood lead, and DMSA-chelatable lead levels were 37.2 +/- 40.4 microg/g bone mineral, 32.0 +/- 15.0 microg/dL, and 767.8 +/- 862.1 microg/g creatinine, respectively. After adjustment, participants with the ALAD(2) allele had lower mean serum creatinine and higher calculated creatinine clearance. We observed effect modification by ALAD on associations between blood lead and/or DMSA-chelatable lead and three renal outcomes. Among those with the ALAD(1-2) genotype, higher lead measures were associated with lower BUN and serum creatinine and higher calculated creatinine clearance. Participants with the eNOS variant allele were found to have higher measured creatinine clearance and BUN. In participants with the Asp allele, longer duration working with lead was associated with higher serum creatinine and lower calculated creatinine clearance and NAG; all were significantly different from relations in those with the Glu/Glu genotype except NAG (p = 0.08). No significant differences were seen in renal outcomes by VDR genotype, nor was consistent effect modification observed. The ALAD findings could be explained by lead-induced hyperfiltration.     

The effect of different intravenous nutritional regimens on renal regeneration during acute renal failure in the rat

Acute renal failure in the surgical patient is accompanied by a state of hypermetabolism and increased catabolism. Nutritional therapy is therefore directed at the preservation of body cell mass and protein synthesis for repair of wounds, repair of the damaged renal tubuli and maintenance of host defense mechanisms. We examined the effect of two levels of protein intake (18.4 ± 1.4 and 30.8 ± 2.4 mg N/100 g BW/day) and three different amino-acid formulations (Freamine III^®, Nephramine^® and a made-up mixture of Nephramine^® ± Freamine^® HBC) on renal regeneration following mercury chloride-induced acute renal failure in the rat. All animals suffered severe renal failure manifested by increased plasma urea and creatinine levels, decreased creatinine clearance and increased fractional excretion of sodium. Incorporation of ³H-thymidine into renal DNA on day 4 of acute renal failure was similar in all six groups studied, irrespective of the amount or composition of amino-acids infused. Renal regeneration during acute renal failure in the rat seems not to be affected either by the quantity or quality of amino-acids infused. However, although not reaching statistical significance, increased amounts of a standard TPN formulation may depress renal regeneration.     

Nephropathy in Chronic Lead Poisoning

This paper presents a study of renal function in 102 patients with lead poisoning admitted to the Occupational Diseases Clinic in Bucharest during the past 10 years; nearly half the patients had no history of lead colic. Every possible cause of renal damage, other than lead, was excluded by a careful differential diagnosis.

Renal function was investigated by repeated determinations of blood urea, creatinine and uric acid, urea clearance, and endogenous creatinine clearance tests.

Significant decreases of the clearance values (less than 50 ml./min. urea clearance and less than 80 ml./min. creatinine clearance), persistent high blood urea (more than 50 mg./100 ml.), and high blood creatinine (more than 1·2 mg./100 ml.) were found in a significant number of cases. These signs of impaired renal function were more frequent in the group of patients with chronic lead poisoning who had had several episodes of colic and an occupational exposure of more than 10 years. A high blood pressure was also found more frequently in this group of patients.

Undercompensated and decompensated renal failure was found in 17 patients, most of whom had been exposed to lead for more than 10 years and had a history of several attacks of colic. Arterial hypertension accompanied the chronic renal failure in 13 patients, the renal impairment generally preceding the rise in blood pressure by several years.

The duration of occupational lead exposure, the high absorption in the past, and the long period of observation of these patients, most of whom were repeatedly hospitalized, may explain the relatively high incidence (17 cases) of nephropathy with chronic renal failure in the present group.

Impairment of urea clearance seems to be the earliest sign, at a time when the creatinine clearance is still normal. As the duration of exposure lengthens and the patient is subjected to active episodes of poisoning the creatinine clearance also deteriorates. Persistent urea retention and high creatininaemia may follow in time, accompanied rather frequently by arterial hypertension. A study of some of the cases followed for several years demonstrated this progressive evolution of lead nephropathy.

A functional and transitory impairment of renal function is very probably caused by an impairment of intrarenal circulation, resulting from marked vasoconstriction of the renal vessels, forming part of the generalized vasoconstriction of lead poisoning. Prolonged exposure and frequently recurring episodes of acute poisoning may lead to progressive impairment of renal function and to the development of organic lesions.

Special attention should be paid to renal function tests in all cases with prolonged exposure to lead in order to prevent the development of severe lead nephropathy.

     

氨基胍和维生素C对糖尿病大鼠肾功能的保护作用

目的观察氨基胍、维生素C对糖尿病大鼠肾脏的保护作用。方法利用链脲佐菌素腹腔注射法诱导建立Ⅰ型糖尿病大鼠模型,将实验用SD大鼠随机分为正常对照组、糖尿病组、氨基胍治疗组、维生素C治疗组、维生素C和氨基胍联合治疗组。治疗16周。观察治疗期间及治疗后大鼠的一般状况、血糖、尿素氮、血肌酐,内生肌酐清除率、24h尿蛋白排泄率。结果①造模组大鼠均出现肾脏功能损害;②氨基胍、维生素C对血糖无影响,但能改善基本状况,降低糖尿病大鼠的尿素氮、血肌酐、24h尿白蛋白排泄率,增加内生肌酐清除率;③两种药物联合用药具有协同作用。结论氨基胍、维生素C无降糖作用,但具有确切的肾脏保护作用,联合用药有协同作用。     

Parenteral nutrition with essential amino acids in pretransplantation anephrics.

The effect of intravenous hyperalimentation with essential amino acids and hypertonic dextrose on nitrogen metabolism, total body urea and creatinine was studied in 16 patients with end-stage renal disease prior to and after bilateral nephrectomy, splenectomy and appendectomy. Parenteral essential amino acids and hypertonic dextrose are effective in lowering blood urea nitrogen in anephric patients who are incapable of improving renal function. The inclusion of essential amino acids in hypertonic dextrose increases nutritional value far beyond that which can be attributed to the caloric concentration of the amino acids themselves.     

Renal function and hyperfiltration capacity in lead smelter workers with high bone lead.

OBJECTIVE--The study was undertaken to assess whether the changes in urinary excretion of eicosanoids (a decrease of 6-keto-PGF1 alpha and PGF2 and an increase of thromboxane) previously found in lead (Pb) exposed workers may decrease the renal haemodynamic response to an acute oral protein load. METHODS--The renal haemodynamic response was estimated by determining the capacity of the kidney to increase the glomerular filtration rate (in terms of creatinine clearance) after an acute consumption of cooked red meat (400 g). A cross sectional study was carried out in 76 male Pb workers (age range 30 to 60 years) and 68 controls matched for age, sex, socioeconomic state, general environment (residence), and workshift characteristics. RESULTS--The Pb workers had been exposed to lead on average for 18 (range 6-36) years and showed a threefold higher body burden of Pb than the controls as estimated by in vivo measurements of tibial Pb concentration (Pb-T) (geometric mean 66 v 21 micrograms Pb/g bone mineral). The geometric mean concentrations of Pb in blood (Pb-B) and Pb in urine (Pb-U) were also significantly higher in the Pb group (Pb-B: 430 v 141 micrograms Pb/l; Pb-U: 40 v 7.5 micrograms Pb/g creatinine). These conditions of chronic exposure to Pb did not entail any significant changes in the concentration of blood borne and urinary markers of nephrotoxicity, such as urinary low and high molecular weight plasma derived proteins (beta 2-microglobulin, retinol binding protein, albumin, transferrin), urinary activities of N-acetyl-beta-D-glucosaminidase and kallikrein, and serum concentrations of creatinine, beta 2-microglobulin, urea, and uric acid. All participants also had normal baseline creatinine clearances (> 80 ml/min/1.73 m2) amounting on average to 115.5 in the controls v 121.3 ml/min/1.73 m2 in the Pb group. Both control and Pb exposed workers showed a significant increment in creatinine clearance (on average 15%) after oral protein load suggesting that the previously found changes in secretion of urinary eicosanoids apparently has no deleterious effect on renal haemodynamics in the examined Pb workers. CONCLUSIONS--The finding that both baseline and stimulated creatinine clearance rates were not only significantly higher in the Pb workers but also positively correlated with Pb-T, suggests that moderate exposure to Pb may be associated with a slight hyperfiltration state, which has been found to attenuate the age related decline in baseline creatinine clearance by a factor of two. Although the relevance of this effect for the worker's health is unknown, it can be concluded that adverse renal changes are unlikely to occur in most adult male Pb workers when their blood Pb concentration is regularly kept below 700 micrograms Pb/l. One should, however, be cautious in extra-polating this conclusion to the general population because of pre-employment screening of the Pb workers for the absence of renal risk factors.     

Effect of the correction of metabolic acidosis on nutritional status in elderly patients with chronic renal failure.

BACKGROUND: Metabolic acidosis (MA) is a frequent complication in advanced chronic renal failure (CRF). Currently, there is good evidence that MA contributes to malnutrition in CRF patients. METHODS: We evaluated the effect of correcting MA on nutritional status after 6 months of oral sodium bicarbonate supplementation in 18 patients aged 73 +/- 6 years with CRF to maintain serum bicarbonate levels at 24 +/- 2 mmol/L. The following parameters were measured: dietary record, energy intake, dietary protein intake (DPI), mini-nutritional assessment (MNA), serum albumin level, prealbumin level, prognosis inflammatory and nutritional index (PINI), and protein catabolic rate (nPCR). RESULTS: No significant changes in body weight or systolic and diastolic blood pressure were observed. Serum albumin and prealbumin levels showed a significant increase. nPCR decreased significantly. DPI, energy intake, PINI, and MNA score did not change significantly. No patient reported side effects or fluid retention during the study. CONCLUSION: Correction of MA improves serum albumin and prealbumin concentration, and it is not associated with any significant change in DPI, but induces a decrease in nPCR values. Whereas nPCR may provide an index of protein catabolism, it does not differentiate between dietary sources of protein or net catabolism of endogenous proteins. In the absence of dietary changes, the decrease in nPCR values may be attributed to a decrease in whole body protein degradation.     

低热卡肠外营养对术后病人代谢反应的影响

目的等氮量不同热卡的肠外营养支持,对手术创伤病人代谢反应的影响。方法53例胃癌根治术病人,随机分为标准热卡组27例,低热卡组26例,术后1～7天进行等氮量不同热卡的肠外营养支持。监测术前3天,术后第1、3、7天体温、血糖、血清白蛋白、前白蛋白、24小时尿尿素氮和尿肌酐的排泄量和应激代谢相关激素的变化。结果两组病人术后第1天,体温、血糖、应激代谢相关激素、尿尿素氮和尿肌酐排泄量较术前升高（P＜0．05）。术后第3天,两组体温、血糖、尿尿素氮和尿肌酐排泄量、胰岛素、醛固酮仍高于术前水平（P＜0．05）,两组相比低热卡组升高水平较低（P＜0．05）。术后第7天,低热卡组除24小时尿素氮和尿肌酐排泄量仍较术前高（P＜0．05）外,体温、血糖及应激代谢相关激素恢复到术前水平。标准热卡组血糖、尿尿素氮和尿肌酐排泄量、胰岛素和醛固酮水平仍较术前升高（P＜0．05）,与低热卡组相比差异有显著性（P＜0．05）。两组病例血浆白蛋白、前白蛋白、胰高血糖素和皮质醇激素变化比较差异无显著性（P＞0.05）。结论对中重度手术创伤病人,提供20Kcal·kg-1·d-1左右的非蛋白热卡,更符合其代谢特点,有利于创伤应激反应的恢复。     

Effect of green tea on kidney tubules of diabetic rats

It has been documented that green tea (GT) and its catechin components improve renal failure and inhibit the growth of mesangial cells. In the present study we examined the long-term effect of GT extract on streptozotocin (STZ)-induced diabetic nephropathy and on the glycogen accumulation in the kidney tubules. Male Sprague-Dawley rats were randomly assigned to normal control groups (2, 6, 8 and 12 weeks) and five diabetic groups (n 10) of comparable age. A GT diabetic group received 16 % concentration of GT for 12 weeks post-diabetes induction as their sole source of drinking water. GT treatment significantly (P < 0.01) reduced the serum glucose, glycosylated protein, serum creatinine and blood urea N levels by 29.6 (sem 3.7), 22.7 (sem 5.2), 38.9 (sem 10) and 41.7 (sem 1.9) %, respectively, compared with the diabetic group of comparable age. In addition, the GT-treated group showed a significant 44 (sem 10.8) % higher creatinine clearance (Ccr) compared with the untreated diabetic group. Likewise, GT reduced the urea N, creatinine, glucose and protein excretion rates by 30 (sem 7.6), 35.4 (sem 5.3), 34.0 (sem 5.3) and 46.0 (sem 13.0) % compared with the 12 weeks diabetic group. Administration of GT to 12 weeks diabetic rats significantly (P < 0.001) prevented (99.98 (sem 0.27) % less) the accumulation of glycogen in the kidney tubules. These results indicate that in STZ diabetes, kidney function appears to be improved with GT consumption which also prevents glycogen accumulation in the renal tubules, probably by lowering blood levels of glucose. Therefore, GT could be beneficial additional therapy in the management of diabetic nephropathy.     

葛根素对糖尿病肾病大鼠细胞间黏附分子-1基因表达的调控

目的观察葛根素对糖尿病大鼠肾小球细胞间黏附分子ICAM-1基因表达的调控。方法利用链脲佐菌素腹腔注射法诱导建立1型糖尿病大鼠模型,将实验用SD大鼠随机分为正常对照组、糖尿病组、葛根素治疗组。治疗16周。观察治疗期间及治疗后大鼠的一般状况、血糖、尿素氮、血肌苷,内生肌苷清除率、24 h尿蛋白排泄率,原位杂交检测肾组织CD54基因表达。结果造模组大鼠均出现肾脏功能有损害;葛根素能改善基本状况,降低糖尿病大鼠的尿素氮、血肌苷、24 h尿白蛋白排泄率,增加内生肌苷清除率,细胞间黏附分子mRNA表达显著下调。结论葛根素具有确切的肾脏保护作用。     

Full protein alimentation and nitrogen equilibrium in a renal failure patient treated with continuous hemodiafiltration: a case report of 67 days of continuous hemodiafiltration.

Standard care for patients with renal failure while in an intensive care unit involves traditional hemodialysis or peritoneal dialysis and protein restriction. We present a case of a patient with renal failure supported with continuous arteriovenous hemofiltration with dialysis (CAVH-D) who was given full protein alimentation. Total daily urea clearance was measured from the CAVH-D output. Protein load was 196 +/- 34 g/day while receiving total parenteral nutrition and 164 +/- 30 g/day while receiving enteral alimentation. Serum blood urea nitrogen was controlled between 40 and 75 mg/dL, except during septic episodes. Nitrogen balance was estimated based upon known alimentation protein load and measurable and estimated nitrogenous losses. The patient was potentially in nitrogen equilibrium during most of the dialysis period. The cumulative nitrogen balance was positive by 5.2 g after 67 days of dialysis. Volume of alimentation was 3.49 +/- 0.7 liters/day. With CAVH-D, the renal failure patient can receive full alimentation without volume or protein load limitations. Furthermore, nitrogen balances can be estimated easily while the patient is on CAVH-D.     

叶黄素对糖尿病大鼠肾损伤的缓解作用

目的研究叶黄素对糖尿病大鼠肾损伤的影响并探讨其可能机制。方法采用四氧嘧啶诱导大鼠糖尿病模型,灌胃给予叶黄素4w,测定大鼠血浆叶黄素水平、肾重、肾脏指数、BUN、SCr、CCr、24h尿蛋白及肾组织SOD、GSH-Px活性、GSH、MDA含量、TNF-α、IL-6水平。结果叶黄素5mg/kg.bw和20mg/kg.bw剂量组大鼠肾重、肾脏指数、BUN、SCr、CCr、24h尿蛋白均低于糖尿病大鼠组,差异有统计学意义(P<0.05);而肾组织SOD与GSH-Px活性、GSH含量高于糖尿病大鼠组(P<0.05),MDA含量低于糖尿病大鼠组(P<0.05),肾组织TNF-α、IL-6低于糖尿病大鼠组(P<0.05)。结论叶黄素能缓解糖尿病大鼠的肾功能损害,其机制可能与叶黄素升高抗氧化酶活性,降低肾组织的氧化应激水平以及减少促炎性细胞因子的表达有关。     

手足口病患儿心肌与肾脏损害的试验观察

目的 观察比较手足口病(HFMD)患儿和健康儿童心肌酶谱、肾功能和尿视黄醇结合蛋白的水平,了解手足口病对患儿心肌损伤和肾脏损害,为临床诊断和治疗提供参考依据.方法 对40例手足口病患儿(观察组)分别进行血清心肌酶谱、血肌酐、尿素氮和尿视黄醇结合蛋白检测;对照组为30例健康体检儿童.结果 观察组患儿心肌酶谱和肾功能均有不同程度改变,乳酸脱氢酶增高20例占50.0%,谷草转氨酶增高7例占17.5%,磷酸肌酸激酶增高2例占5.0%,磷酸肌酸激酶同工酶增高22例占55.0%,尿素氮增高1例占2.5%,尿视黄醇结合蛋白增高23例占57.5%,观察组患儿心肌酶谱和肾功能与对照组比较,差异有统计学意义(P<0.01).结论 手足口病患儿心肌酶谱、血尿素氮和尿视黄醇结合蛋白的结果 明显高于对照组;手足口病患儿在心肌损伤的同时还存在肾小管的损害;心肌酶谱、肾功能和尿视黄醇结合蛋白的检测有利于早期脏器损害的评估,为临床诊断和治疗提供参考.     

创伤及感染时GH-IGF-IGFBP轴的变化及其临床意义

创伤和感染病人往往存在高分解代谢,包括蛋白质合成减少、分解增加,形成明显的负氮平衡.如何逆转高分解反应曾经过漫长的探索.除了营养支持外,人们希望通过抗分解激素减轻甚至是逆转高分解状态.新近研究提示,在基础和应激条件下,生长激素-胰岛素样生长因子-胰岛素样生长因子结合蛋白(GH-IGF-IGFBP)轴对调节肌肉蛋白质代谢起着核心作用.该文作者就其在创伤及感染时的变化及其临床意义作一综述.     

测定血、尿β_2微球蛋白对新生儿窒息后早期肾损害的诊断价值

目的:检测新生儿血、尿β2微球蛋白的含量,分析β2微球蛋白的变化对于新生儿窒息引起的早期肾损伤的临床诊断价值。方法:选取足月窒息新生儿分为两组,重度窒息组30例和轻度窒息组40例作为观察组,同时选取正常足月新生儿20例作为对照组。采用放射免疫法在不同的时间点分别对3组新生儿血、尿β2微球蛋白含量进行检测对比,并与常规检测肾功能的指标——血尿素氮、血肌酐和尿白蛋白比较。结果:窒息新生儿血、尿β2微球蛋白、血尿素氮、血肌酐和尿白蛋白均高于对照组(P<0.05),重度窒息组的血、尿β2微球蛋白、血尿素氮、血肌酐和尿白蛋白高于轻度窒息组(P<0.05),提示窒息程度越重肾功能受损程度越严重;血、尿β2微球蛋白在早期的含量变化(24 h内)较血尿素氮、血肌酐和尿白蛋白更为明显。结论:新生儿窒息会导致肾功能损害,血、尿β2微球蛋白、血尿素氮、血肌酐和尿白蛋白可以作为早期判断肾功能受损的指标,但血、尿β2微球蛋白较血尿素氮、血肌酐和尿白蛋白更为灵敏,尤其是尿液标本采集方便、无损伤,因此尿β2微球蛋白作为早期判断窒息后肾功能是否受损的常规检测项目更为合适。