Causes and Prognosis of Acute Renal Failure in Elderly Patients

In this retrospective study, 287 patients with acute renal failureobserved between 1980 and 1985 were divided into 2 groups, accordingto age: group 1 of 65 years or more (n = 100) and group 2 between17 and 64 years (n = 187). In both age groups the whole spectrumof causes of acute renal failure was found, but within thatspectrum a higher incidence of post-renal failure, acute renalvascular disease and of hypovolaemic acute renal failure wasnoted in group 1 versus group 2. On the other hand, pigment-inducedacute renal failure was lower in group 1 (4%) versus group 2(13%). The overall survival was 54% in the elderly versus 56% in theyounger patients (NS). A close relationship between survivaland the number of postadmission complications was found in bothgroups. Interestingly, the presence of severe hypokalaemia (<3.5mmmol/l) and metabolic alkalosis (plasma HCO₃>30 mmol/l)was associated with a very high mortality of 73% and 86% respectivelyin the elderly patients. Complete or incomplete recovery ofrenal function was the same in both age groups. It is concludedthat age alone should not be used as a discriminating factorin therapeutic decisions concerning acute renal failure in anolder patient.     

健脾益肾方治疗慢性肾衰竭62例临床观察

目的:观察中药健脾益肾方与氯沙坦联用对慢性肾衰竭患者蛋白尿、肾功能、血浆白蛋白、血红蛋白的影响.方法:将患者随机分为两组.治疗组给予健脾益肾方每日1剂,氯沙坦100 mg,每日1次;对照组仅予氯沙坦100 mg,每日1次,疗程12周,治疗前后检查慢性肾衰竭患者24 h尿蛋白定量、肾功能、血浆白蛋白、血红蛋白.结果:健脾益肾方与氯沙坦联用能更显著地降低蛋白尿及血清肌酐、尿素氮水平,明显升高血浆白蛋白及血红蛋白水平(P<0.05或P<0.01).结论:健脾益肾方与氯沙坦联用对慢性肾衰竭患者有较好的治疗作用.     

Mortality in Elderly Patients with Acute Renal Failure

In a retrospective study, we identified 55 elderly patients with acute renal failure (ARF) admitted to our hospital during an 8-year period from 1985 to 1993. Information about the etiology, complications, laboratory data, and treatment course were obtained from the clinical history. Of the 200 patients with ARF admitted to the hospital during this period, 28% were patients more than 60 years old (41 male and 14 female) with an average age of 68.5 ± 7 years. The main causes of ARF were sepsis, volume depletion, low cardiac output, arterial hypotension, nephrotoxicity by antibiotics, and obstructive uropathy. The global mortality of elderly patients with ARF was 53%. The mortality rate of the different types of the ARF were: prerenal 35%, intrinsic 64% (oliguric 76%, nonoliguric 50%), and postrenal 40%. Mortality as a result of sepsis occurred in 18 patients (62%), by cardiovascular disease in 4 patients (13%), by acute respiratory failure in 2 patients (7%), and by other causes in 5 patients (18%). In the cases of sepsis, Pseudomonas was detected in 7 cases (39%), Escherichia coli in 2 cases (11%), Gram-negative nonspecific in 3 cases (17%), Klebsiella in 1 case (5%), and in 5 cases (16%), the hemoculture was negative. The patient survival rate was 47% (26 of 55 patients). Of these patients, 19 recovered their normal renal function (73%), but 7 patients remained with renal failure (27%). In conclusion, the global mortality in the elderly patients without considering the types of ARF was 53%. The oliguric form had the highest mortality rate with 76%. The main causes for mortality were sepsis with 62%, cardiovascular disease with 13%, and other causes 18%.     

慢性肾衰竭小鼠模型的建立及生物学特征

目的：通过制备小鼠慢性肾衰竭（CRF）模型,观察小鼠的生物学特征,有助于研究CRF的发病机制,预防终末期肾病的发生.方法：30只6-8周龄C57雄性小鼠适应性饲养1周后,5/6肾切除法（5/6 NX）切除模型组左肾上下极,1周后切除右肾,6周后处死.动态观察小鼠一般情况、血清常规和生化指标、测量体重和血压变化,检测肾脏组织病理学的变化.结果：与假手术组和正常对照组相比,模型组小鼠6周后出现体重减低、血清高尿素氮、高肌酐、高磷、贫血、血压升高和尿量增多（均P〈0.05）.肾脏病理发现残肾单位代偿性肥大,系膜基质增生,胶原沉积增多.结论：5/6 NX是理想的CRF小鼠模型制作方法,CRF小鼠具有营养不良,高血压和钙磷代谢紊乱等特征.     

Transient Improvement of Hypertension-Induced Chronic Renal Failure with Mycophenolate Mofetil Treatment

A young female with essential hypertension developed progressive azotemia; renal biopsy showed hypertensive nephrosclerosis with considerable tubulointerstitial disease and cellular infiltration. The addition of mycophenolate mofetil (MMF) to her antihypertensive treatment resulted in a dramatic improvement of renal function during the following three months. When the patient discontinued MMF treatment, end-stage renal failure rapidly developed. This patient represents the first report of the beneficial use of MMF in non-immune chronic renal disease and demonstrates that significant functional improvement may be obtained with the addition of MMF to the treatment of hypertensive nephrosclerosis for patients in whom there is significant tubulointerstitial inflammatory infiltration.     

缬草油防治慢性肾衰竭的实验研究

目的：研究神农缬草挥发油对慢性肾衰竭大鼠的防治作用。方法：选择雄性Wistar大鼠50只，随机分为三组：缬草油组、肾衰竭组和对照组。于16周时进行生化测定及组织学检查。同时采用免疫组化及原位杂交方法检测肾脏标本转化生长因子β1及纤维连接蛋白的变化。结果：缬草油组血肌酐、尿素氮、24h尿蛋白及肾皮质MDA均显著低于肾衰竭组。病理检查表明缬草油组肾小球硬化数量较肾衰竭组明显减少，并且肾组织转化生长因子β1及纤维连接蛋白表达亦较肾衰竭组低。结论：缬草油具有延缓大鼠肾衰竭模型肾功能恶化的作用。     

慢性肾炎致慢性肾衰竭患者心衰发生相关危险因素分析

目的：了解慢性肾炎致慢性肾衰竭患者血压、血红蛋白、血清白蛋白、血脂、血肌酐、电解质及尿素氮、胱抑素C、同型半胱氨酸及高敏C反应蛋白等指标与心力衰竭发生之间的关系,分析并探讨相关危险因素。方法：回顾性分析我院343例慢性肾炎致慢性肾衰竭患者心衰发生及其同期血压等指标变化情况,了解其规律及相互关系。结果：（1）343例患者有77例合并发生心衰（22．4％）,其中19岁～39岁占20．5％,40岁～59岁占22．8％,〉60岁占33．3％;合并发生心衰多为CKD5期患者（97．4％）。（2）血压、血红蛋白、CO2CP、血肌酐、高敏C反应蛋白在有无心衰发生组存在统计学差异（P〈0．01）,其中血压、血肌酐、光抑素C、高敏C反应蛋白等与心衰发生呈负相关（P〈0．05）,而年龄、钙磷、血清白蛋白及血脂、尿素氮、同型半胱氨酸组间无统计学差异。结论：慢性肾炎致慢性肾衰竭患者心力衰竭发生率很高,其发生可能与高血压、贫血、酸中毒、血肌酐及微炎症状态等因素有关。     

低蛋白饮食对慢性肾衰竭患者透析前临床状态的影响

目的 :探讨低蛋白饮食对慢性肾衰竭 (CRF)患者透析前临床状态的影响。方法 :CRF患者 4 4例。治疗 (T)组 :11例 ,实施以低蛋白饮食 (0 .6 g·kg-1·d-1)为主的综合治疗 11～ 2 0个月直至透析 ;对照 (C)组 :2 3例 ,未经饮食限制的CRF患者。采用尿尿素氮监测患者蛋白饮食的依从性 ,观察T组治疗前后营养状况变化 ,比较T、C二组患者的透析前临床状态。结果 :(1)T组患者实际蛋白摄入量为 (0 .6 4± 0 .10 ) g·kg-1·d-1;(2 )T组治疗前后营养状况无明显变化 ;(3)与C组相比 ,T组患者透析前营养状况良好 ,且恶心、水肿和出血倾向发生较少。结论 :以低蛋白饮食为主的综合治疗不引起营养状况恶化 ,并改善CRF患者透析前的临床状态     

益肾泻浊方对慢性肾衰竭大鼠肾细胞凋亡的影响

目的 :研究益肾泻浊方对 5 /6肾切除慢性肾衰竭 (CRF)大鼠肾细胞凋亡的影响。方法 :改良肾大部分切除术建立大鼠 (Wistar)大鼠CRF模型 ,随机分为模型组、西药依那普利组、中药益肾泻浊方组和假手术正常组。运用ClinicalSystem 70 0自动生化分析仪检测大鼠血清尿素氮 (BUN)、肌酐 (Cr) ;末端脱氧核苷酸转移酶介导的生物化的dNTP切口末端标记法 (TUNEL)检测细胞凋亡。结果 :CRF大鼠血清BUN、Cr升高 (P <0 .0 1) ,中药组和西药组血清BUN、Cr均可降低 (P <0 .0 1,P <0 .0 5 ) ;结果提示模型组大鼠肾小球和肾小管 -间质区细胞凋亡增加 (P <0 .0 1) ,西药和中药可减少肾小球和肾小管 -间质细胞凋亡 (P <0 .0 1) ,中药组肾小球细胞凋亡少于西药组 (P <0 .0 5 )。结论 :益肾泻浊方延缓CRF进展的作用机理部分与抑制肾细胞凋亡有关。     

慢性肾功能衰竭病人的性功能障碍

慢性肾功能衰竭病人性功能障碍十分常见 ,且已成为影响其生活质量的一个重要问题 ,却很少得到关注。其病因包括生理、心理和器质性因素。本文就近年来有关慢性肾功能衰竭病人性功能障碍的发病情况、主要表现形式、评定方法、发病的危险因素和治疗方法等进行了综述。     

益肾降浊冲剂治疗慢性肾衰竭的临床观察及对血清瘦素的影响

目的：观察益肾降浊冲剂治疗慢性肾衰竭（CRF）的临床疗效及治疗前后血清瘦素（leptin）水平的变化情况。方法：选择CRF患者40例，随机分为治疗组20例，对照组20例。治疗组用益肾降浊冲剂治疗，对照组用单味大黄治疗，观察尿素氮、肌酐、肌酐清除率、白蛋白、血红蛋白、瘦素等指标及临床症状的变化。结果：治疗组临床疗效优于对照组（P〈0．05），治疗组降低血清瘦素水平明显优于对照组（P〈0．01），患者血清瘦素与肌酐清除率显著负相关、与血肌酐有显著正相关（P〈0．01）。治疗组改善CRF患者临床证候疗效优于对照组（P〈0．01）。结论：益肾降浊冲剂对CRF辨证属脾肾气虚证为主者，起到改善症状，改善肾功能并能延缓CRF进展；临床疗效优于单味大黄。益肾降浊冲剂能降低CRF血清瘦素水平，可能是其获得疗效的机制之一。     

Erythropoiesis in the Anaemia of Chronic Renal Failure: The Response to CAPD

Fifteen patients with chronic renal failure commencing CAPDtreatment were studied by a sensitive ferrokinetic technique.All were severely anaemic with a low red cell volume (RCV).Plasma volume (PV) was raised in twelve. Mean red cell lifespan(MRCL) was reduced in eleven subjects, and marrow iron turnover(MIT) was inappropriately low but this was not related to erythropoietinlevels. Six patients were restudied after several months CAPD. PV fellin four and RCV increased in all six. MRCL rose to normal inthree. The other three subjects had an increase in MIT. Erythropoietinlevels did not change significantly. The major cause of uraemicanaemia is a failure of erythropoiesis to match fully the demandsof red cell destruction.     

肾活检在老年急性肾衰竭临床应用的探讨

目的：探讨肾活检术对老年急性肾衰竭的应用价值,提高老年急性肾衰竭的诊治水平。方法：66例不明原因老年急性肾衰竭均行实时超声引导肾自动穿刺活检术,分析其成功率、并发症,总结肾活检后诊断和治疗的修正率。结果：66例肾活检取材均成功;其中取材不良4例（6.1%）,取材良好62例（93.9%）;3例出现轻度并发症（4.5%）,其中肉眼血尿2例,肾周血肿1例,未出现严重并发症;66例中病因误诊19例,26例治疗方案有较大调整。结论：老年急性肾衰竭患者行经皮肾脏穿刺活检术安全且成功率高;相当部分老年急性肾衰竭病因被误诊,对不明原因老年急性肾衰竭应及时行肾活检术,以免延误诊治。     

褐藻多糖硫酸酯对腺嘌呤致大鼠肾间质纤维化的干预作用及其机制探讨

目的：观察褐藻多糖硫酸酯（FPS）对大鼠慢性肾衰竭模型肾间质纤维化的干预作用,并初步探讨其机制。方法：将Wistar雄性大鼠随机分为3组,即：（1）正常对照组（n=15）;（2）CRF模型组（n=24）,进食含0.75%腺嘌呤的饲料;（3）CRF＋FPS治疗组（n=24）,在进食含0.75%腺嘌呤饲料的同时每天给予FPS 200mg.kg-1.d-1灌胃。持续喂养6周。于第2、4、6周末收集大鼠血、尿标本,应用自动分析仪测定血肌酐、白蛋白和24h尿蛋白;并留取肾组织,Masson染色切片分析肾间质纤维化程度,免疫组化方法半定量分析肾组织中α平滑肌肌动蛋白（α-SMA）的表达。结果：CRF＋FPS治疗组大鼠24h尿蛋白均明显低于同期CRF模型组（P〈0.05）,白蛋白水平6周时明显高于CRF模型组（P〈0.01）,但两组间血肌酐水平无统计学差异（P〉0.05）。CRF＋FPS治疗组大鼠肾组织Masson染色间质纤维化指数评分也明显低于同期CRF模型组（P〈0.01）,该肾组织α-SMA蛋白表达2、4、6周均明显低于同期CRF模型组（P〈0.05）。结论：FPS治疗可以减少腺嘌呤致肾衰竭大鼠的尿蛋白排泄,减轻肾间质纤维化程度,其机制可能与抑制肾小管上皮细胞-间充质细胞转化有关。     

兔慢性肾衰竭加速性动脉粥样硬化病理形态学变化

目的：通过结扎兔肾动脉分支建立慢性肾衰竭模型,观察主动脉病理变化。方法：新西兰白兔60只,随机分为慢性肾衰竭组（CRF组）和假手术组（Sham组）。CRF组结扎左肾动脉分支同时切除右肾,术后动态观察兔主动脉、残余肾的病理形态学变化和肾功能等指标。结果：CRF组兔术后血清BUN、Scr逐渐升高,肾脏病理逐渐出现明显的肾小球硬化和肾间质纤维化;主动脉逐渐出现内皮细胞脱落、脂纹、粥样斑块等动脉粥样硬化的表现。结论：通过结扎兔左肾外动脉分支和切除右肾一次完成的方法可成功建立CRF加速性动脉粥样硬化模型。     

中药对慢性肾衰竭氮质血症及肾血流参数的影响

目的 :探讨中药参麦注射液及复方丹参注射液对慢性肾衰 (CRF)病人血尿素氮、肌酐的治疗作用及其延缓CRF的机制。方法 :1992年～ 1999年本院肾科住院病人 148例 ,BUN11～ 42mmol/L ,Scrl177～ 44 2 μmol/L ,Ccr10～ 2 5ml/min之间。入院后随机分为两组 ,参麦组 (SMI) 76例 ,复方丹参组 (FDI) 72例 ,分别使用参麦注射液或复方丹参注射液 2 0ml,加入 5 %葡萄糖液中静脉滴注 ,每日 1次 ,15d为一疗程。定期复查血象、肝肾功能、彩色多普勒能量图 (CDPI) ,检测肾血流参数、收缩期峰值 (Vmax)、舒张末期流速 (Vmin)、肾血管阻力指数 (RI) ,随访 3年 ,并作相关分析。结果 :治疗后两组病人临床症状均有明显改善 ,BUN、Scr均有降低 ,但参麦组更为明显 ,总有效率 93.4% ;RI与BUN相关系数分别为 0 .78,0 .6 1;Vmin与BUN、Scr的相关系数分别为 - 0 .91、- 0 .75 ;3年后 ,SMI组 86 .4%的病人病情稳定 ,未进入尿毒症期 ;FDI组有 6 2 .4%的病人Scr稳定在 177～ 44 2 μmol/L之间。 结论 :中药SMI、FDI均是治疗CRF有效药物 ,SMI更为明显 ,其改善氮质血症及延缓CRF的进展机制与改善肾动脉血流参数Vmax、Vmin及RI有关。彩色多普勒能量图不仅对肾血流参数的诊断很有价值 ,而且对治疗效果的监测和指导用药也很有意义。     

伴有慢性肾衰竭的马兜铃酸肾病与IgA肾病的配对研究

目的:了解伴有慢性肾衰竭的马兜铃酸肾病患者与IgA肾病患者的临床病理差异.方法:分析11例马兜铃酸肾病患者的临床病理资料,并与经肾活检确诊的IgA肾病患者进行配对比较.结果:两组患者的年龄、性别、血肌酐水平无明显差异(P>0.05),马兜铃酸肾病患者镜下血尿发生率低于IgA肾病患者(P<0.05).在血肌酐水平无明显差异时,马兜铃酸肾病患者血红蛋白浓度明显低于IgA肾病患者(P<0.01),尿蛋白定量和肾脏的长径少于IgA肾病患者(P<0.05).间质纤维化程度重于IgA肾病患者(P<0.05),而间质炎细胞浸润少(P<0.05).结论:伴有慢性肾衰竭的马兜铃酸肾病患者临床发展隐匿,与IgA肾病比较,肾小管间质损伤是造成肾功能损害的主要原因,因此要重视对马兜铃酸肾病的早期防治.     

慢性肾衰竭现代文献中药复方用药规律初探

目的：通过对治疗慢性肾衰竭的现代中医文献收集调研,运用统计分析方法初探治疗慢性肾衰竭现代临床中药复方的组方原则及用药规律。方法：收集整理1994年～2006年间发表于医学期刊上治疗慢性肾衰竭中药复方,运用频数分析、聚类分析等统计方法探究现代中医临床治疗慢性肾衰竭中药用药规律。结果：共筛选出符合条件的文献58篇,收集中药复方58首。频数分析发现治疗慢性肾衰竭常用药为补虚药、活血化瘀药、利水渗湿药、清热药及泻下药;而聚类分析发现补虚药、活血化瘀药和利水渗湿药常配伍出现。结论：通过现代文献分析,初步揭示了治疗慢性肾衰竭中药复方的用药规律。     

Reduction of Blood Pressure Retards the Progression of Chronic Renal Failure in Man

The effect of blood pressure reduction on the progression rateof chronic renal failure (CRF) was studied in 28 patients withCRF of diverse aetiology entering a prospective study (observationtime 7–24 months, mean 16 months). Endogenous creatinineclearance was 12–66 ml/mm (mean 30±3 ml/mm). Weaimed to keep the blood pressure below 160/90 mmlHg. Dietaryprotein was not restricted. The progression rate of CRF wasassessed from the regression coefficients of the regressionsof creatinine clearance and the inverse of s-creatinine, respectively,on time. Progression rate and the means of all recordings ofmean arterial blood pressure (MAP) and urinary protein excretion,respectively, in each patient during the prospective phase werecompared with retro spective data from the proceeding period(observation time 4–25 months, mean 19 months). The patientsreceived various combinations of antihypertensive drugs includingdiuretics, beta-blockers and vasodilatory drugs. In 19 patientsMAP decreased from 109±2 to 102±2 mmHg (groupI), whereas MAP increased from 105±2 to l08±2mmHgin nine patients (group II). In group I proteinuria was significantlylower (P<0.05) and the progression of CRF was approximately50% slower (P.<0.01) in the prospective phase than in theretrospective phase; no changes were observed in group II. Calculatedfor all patients, significant correlations were observed betweenthe change in MAP and the change in progression rate and proteinexcretion, respectively. These results indicate that loweringof blood pressure results in decreased proteinuria and retardationof the progression of CRF irrespective of the aetiology.     

Extent and Severity of Coronary Disease and Mortality in Patients with End-Stage Renal Failure Evaluated for Renal Transplantation

The purpose of this study is to explore the relationship between coronary artery disease (CAD), transplantation status and subsequent mortality in end-stage renal disease (ESRD) patients undergoing evaluation for renal transplantation. Two hundred fifty-three ESRD patients at high risk for CAD underwent coronary angiography as part of a renal transplant evaluation. The cohort was divided into three groups: Group 1 (n = 127) had no vessels with ≥50% stenosis, Group 2 (n = 56) had one vessel with ≥50% stenosis and Group 3 (n = 70) had two or more vessels with ≥50% stenosis. Long-term survival was determined; median follow-up was 3.3 years. The baseline characteristics were similar except for older age and higher proportion of diabetes mellitus, dyslipidemia and peripheral vascular disease in Groups 2 and 3 patients as compared to Group 1. Survival was worse in Group 3 compared to Group 1 (p < 0.0001). Each of the three subgroups had better survival with renal transplantation than those who did not undergo transplantation (p < 0.0001). Although the degree of CAD is related to subsequent mortality, transplantation is associated with better survival regardless of the extent and severity of CAD. Thus, the presence of CAD should not exclude ESRD patients from consideration for this therapy.