Cardiovascular complications of chronic renal failure - an updated review

Chronic kidney disease (CKD) is a worldwide public health problem. Cardiovascular disease (CVD) is frequently associated with CKD, which is important because individuals with CKD are more likely to die from CVD than to develop kidney failure. CVD in CKD is treatable and potentially preventable and CKD appears to be a risk factor for CVD. In order of incidence and frequency systemic hypertension, left ventricular failure, congestive cardiac failure, ischemic heart disease, anaemic heart failure, rhythm disturbances, pericarditis with or without effusion, cardiac tamponade, uraemic cardiomyopathy are various cardiovascular complications encountered in patients with chronic renal failure. A patient may present with one or more complications of cardiovascular system. The survival rate and prognosis to a great extent depends on proper management of these complications. Use of regular dialysis and renal transplant has changed the death pattern in developed countries but it is still a major problem in developing country. The aim of this article is early detection of CKD and proper management of it thereby preventing the major cardiovascular complications.     

妊娠期高血压并发症的发生规律及临床诊疗

当前在临床治疗中,妊娠期高血压并发症的发生率比较高,且容易引起胎盘早剥、肾功能衰竭、DIC、妊娠期高血压疾病性心脏病、产后大出血等并发症发生。本文主要针对妊娠期高血压并发症的发生规律及临床诊疗方法进行分析,选取了广东省茂名市茂南区新坡卫生院收治的175例妊娠期高血压疾病患者作为研究对象,采用回顾性的方式分析患者的临床资料,总结妊娠期高血压并发症的发生规律及临床诊疗方法。参与本次调查研究的妊娠妇女3200例中,有175例发生妊娠期高血压疾病,妊娠期高血压疾病的发生率为5.47%,轻度子痫前期71.43%（125/175）,重度子痫前期28.57%（50/175）。主要的并发症包括胎盘早剥4例;肾功能衰竭3例;弥散性血管内凝血（DIC）3例;妊娠期高血压疾病性心脏病3例;产后大出血3例;给予患者进行对症治疗后症状得到改善。     

慢性肾小球疾病患者妊娠成功的因素分析

慢性肾小球疾病合并妊娠患者共１０例，进行保胎治疗。其中６例妊娠成功，４例失败。对慢性肾小球疾病妊娠成功的因素及措施进行了分析。     

云南慢性肾衰竭患者病因与转归分析

目的探讨云南慢性肾衰竭患者的病因与转归.方法对我院2005年1月至2009年12月期间住院的436例慢性肾衰竭患者进行病因和转归的统计分析,探讨云南地区慢性肾衰竭住院患者的主要发病年龄、病因排序、疾病分期、主要并发症、治疗方式和转归.结果云南地区慢性肾衰竭住院患者以中青年（14～59岁）为主（55.5%）,病因排序以慢性肾小球肾炎为主（48.4%）,疾病分期以尿毒症期为主（49.54%）,并发症以肾性贫血（71.1%）和肾性高血压（62.39%）为主,治疗方式以血液透析为主（50.69%）.转归为：死亡64例（14.68%）,死亡原因以重症肺部感染为主（28.12%）.结论慢性肾脏疾病（CKD）的发病率逐年上升,并呈现进行性加重,最终发展为终末期肾病（ESRD）,需行肾脏替代治疗（透析和移植）,由于种种原因能够进行肾脏替代治疗的患者仅占10%～15%,因此要重视引起慢性肾衰竭常见病因的防治,减少ESRD的发生.     

药源性急性肾衰竭22例临床分析

目的探讨药源性急性肾衰竭的原因及引起急性肾衰竭的药物种类,为临床合理用药提供参考。方法对我院收治的22例药源性急性肾衰竭患者的资料进行回顾性分析。统计药源性急性肾衰竭患者的原发病、合并症、使用药物、给药途径。结果药源性急性肾衰竭患者的原发病主要为呼吸道感染,占41.2%,其次为发热,占13.8%;无合并疾病者占45.6%,合并高血压者占22.9%;导致药源性急性肾衰竭的药物主要有抗生素、甘露醇及化疗类药物等。结论抗生素类、甘露醇及化疗类药物是我院引起急性肾衰竭的主要常见药物,应及时予以诊断治疗,并停用可疑药物。     

Delayed complications of renal transplantation and their prevention

The complications of cadaveric renal transplantation in a group of 10-year survivors are presented. Fifty-two (44%) of 119 graft recipients survived more than 10 years, 48 with their original allograft. The major causes of death in the others were bacterial (24%) and other (10%) infections, cerebral (12%) and myocardial (7.5%) vascular disease. Serious morbidity in the survivors included infectious episodes (55%), skin cancer (40%), vascular disease (30%), cataracts (45%) and aseptic necrosis of bone (13%). Only six (12%) patients had no complications. Although complications were frequent, 34 patients (72%) were fully rehabilitated to work or household duties. Several recipients have become parents. Prevention of the late complications of transplantation must be aimed at reducing the known risk factors early in the course of renal failure. These include hypertension, obesity, cigarette smoking and sun exposure.     

慢性肾功能衰竭血液透析急性并发症的原因分析及处理

目的探讨慢性肾功能衰竭患者血液透析时急性并发症的原因及预防。方法对行血液透析的慢性肾功能衰竭患者38例6640例次血液透析中产生的各种并发症归类进行统计学处理。结果常见的急性并发症是低血压、高血压、肌肉痉挛、心律失常、腹痛、发冷发热。结论血液透析中急性并发症如果及时发现和处理常无需中断透析。     

老年高血压的临床特点及治疗策略

高血压严重影响老年人的健康,是老年人发生脑卒中、冠心病、心肌梗塞、充血性心衰、肾功能衰竭等疾病的主要危险因素之一。但我国高血压病的预防率、控制率、治疗率均较低,并且发病率、并发症及死亡率高。本文就老年高血压的特点及治疗作一综述,旨在为老年高血压患者的临床诊治提供一定帮助。     

高血压肥胖发病机制研究进展

原发性高血压是全球范围内的重大公共问题 ,能导致全身各主要脏器的严重损害 ,引起脑血管意外、冠心病、心力衰竭、肾功能不全等并发症。体重超重和肥胖作为原发性高血压病最重要的危险因素之一 ,日益引起人类的关注。本文对高血压肥胖的发病进行了综述 ,给医务工作者提供近年来关于高血压肥胖的国内外研究概况 ,以便更好地预防和治疗高血压肥胖     

移植肾动脉狭窄的超声诊断研究进展

 肾移植是当前终末期肾病最理想的治疗方法,虽然外科技术的提高及免疫抑制剂的应用使得肾移植术后的并发症有所下降,但血管并发症仍是导致移植肾功能障碍和肾移植失败的主要原因。移植肾动脉狭窄（transplant renal artery stenosis,TRAS）是肾移植术后最常见的血管并发症,其可导致药物难以控制的高血压及肾功能损害。因此,肾移植术后长期随访,早期发现TRAS并及时干预至关重要。大量的研究表明,相较于其他影像学方法,常规超声及超声造影（contrast-enhanced ultrasound,CEUS）在肾移植术后的监测及TRAS的诊断方面有其独到的优势,为临床及时干预提供可靠的依据。本文就常规超声及CEUS在诊断TRAS方面的应用进展作一综述。     

Acute and chronic renal failure

Renal failure is defined as a deterioration of kidney function that results in the retention of nitrogenous waste products. It is increasingly prevalent in older populations, individuals with diabetes or hypertension, and postoperative patients. Therefore, podiatric physicians caring for these populations can expect to encounter this condition frequently. This article describes the epidemiology, causes, complications, and appropriate evaluation of renal failure relevant to a practicing podiatric physician. Also highlighted are treatment considerations, renal dosing of medications, and prevention of contrast nephropathy.     

慢性肾衰竭急剧加重危险因素分析

目的　探讨慢性肾衰竭急剧加重因素及临床特点。方法　对 86例患者的病因、年龄、基础肾脏病及相关药物等进行分析。结果　在导致慢性肾衰竭急剧加重的因素中 ,老年组以肾毒性药物 ,严重感染等为主要原因 ,青壮年组以恶性高血压 ,原发病活动及急性左心衰等常见。 86例中 1 7例患者因原发病活动而导致慢性肾衰竭急剧加重 ,1 0例患者与药物相关。结论　慢性肾衰竭急剧加重的因素多种多样。老年者要警惕严重感染 ,药物性肾损害 ,青壮年患者积极控制高血压 ,原发病的活动及急性左心衰 ,对于预防慢性肾衰竭急剧加重具有十分重要意义。     

Acquired reactive perforating collagenosis associated with sick euthyroid syndrome

Acquired reactive perforating collagenosis is a rare skin disorder associated with several systemic diseases, particularly diabetes and chronic renal failure. A 52-year-old Saudi female patient with a known case of diabetes mellitus type II, chronic renal impairment, hypertension, peripheral vascular disease, congestive heart failure, stroke and left hemiplegia presented with multiple pruritic skin eruption on the trunk and extremities. We believe that this is the first case of acquired reactive perforating collagenosis in association with sick euthyroid syndrome to be reported.     

Admission of hypertensive patients at the University of Benin Teaching Hospital, Nigeria

BACKGROUND: There is a suggestion of an identifiable impact of hypertension on all cause mortality in rural Africa. There is however paucity of hard data on the impact of morbidity or modality from this disease. OBJECTIVE: To determine the contribution of hypertension (HT) to adult morbidity and mortality at the University of Benin Teaching Hospital (UBTH) in Benin City, Nigeria. DESIGN: Retrospective study. SETTING: University of Benin Teaching Hospital. SUBJECTS: Adult hypertensive admissions (HTA) in Benin City, Edo state, Nigeria during the period January 2000 to December 2002. RESULTS: There were a total of 2,852 adult medical admissions during the study period out of which 575 were because of hypertension related morbidity. Only 302 (52.5%) of these were previously diagnosed as hypertensives). The most common hypertensive complication was cerebrovascular accident followed by congestive cardiac failure and chronic renal failure in order of decreasing frequency. The annual adult mortality rate from medical admissions was 5.6%. Mortality due to hypertensive complications constituted 10.5% of overall hospital adult mortality and 16.1% of deaths from medical causes. The annual mortality rate among HTA was 22.1% (252/1000) with a male:female ratio of 2:1. CONCLUSION: The contribution of systemic hypertension to adult morbidity and mortality is very significant. There is need for more concerted effort to create hypertension awareness, and to achieve good control and prevention of hypertensive complications.     

相关的肾外血管疾病对动脉粥样硬化性肾血管疾病的影响

动脉粥样硬化性肾血管病(ARVD)是一种衰老性疾病，虽然可能没有临床症状，但它是弥漫性血管疾病的一种表现，许多ARVD患出现肾外血管疾病的临床表现。ARVD是高血压和慢性。肾功能衰竭(CRF)常见原因，也是老年终末期肾功能衰竭(ESRF)患接受透析程序治疗的最常见肾病诊断之一。在这些患中，肾损害的原因仍然是有争议的问题。ARVD患死亡率高，尤其是那些有肾功能衰竭。本综述了相关的肾外血管疾病与ARVD之间的相互关系，以及对ARVD患肾功能和死亡率的影响，同时也回顾了最新的ARVD患肾功能不全的可能发病机制的有关证据。     

系统性红斑狼疮高血压的临床分析

１７６例系统性红斑狼疮（ＳＬＥ）病人,其中６１例合并高血压,占３４．７％,其中４０例为一过性高血压,占６５．６％,２１例为持续性高血压,占３４．４％,一过性高血压可由肾病综合征,急性肾功能洽,狼疮活动、甲基强的松龙冲击及孢胞素Ａ治疗引起,持续性高血压则主要由慢性肾功能不全引起。伴有抗心磷脂（ＡＣＬ）抗体者易发生高血压。随病程延长及年龄增大,高血压患病率增加,合并高血压者死亡率增加。     

Clinical studies in 500 patients with aortoarteritis.

Five hundred patients with aortoarteritis were studied in this series. The long-term administration of small dosage of corticosteroid is effective in treating this disease in its active stage. The patients with renal vascular hypertension should be treated by percutaneous transluminal renal angioplasty or by surgery if indicated. About one third of the pulsations of the involved arteries were improved. The incidence of complications was 17% and the mortality rate was 11% in this series. Cerebral thrombosis was found as a common complication and hemorrhage as a common cause of death. Three patients died of heart failure without aortic regurgitation. Five-year and ten-year survival rates were 93.1% and 91.1% respectively.

     

糖尿病肾病患者到肾科就诊时临床特点分析

目的分析糖尿病肾脏患者初次到肾病专科就诊时的临床特点,探讨糖尿病患者到肾病专科就诊的时机。方法回顾2006年1月—2008年6月首次到肾内科就诊,并取得较完整临床资料糖尿病肾病患者138例,男66例,女72例,平均年龄（61±11）岁。观察到肾科就诊的原因、肾功能情况、并发症、治疗用药情况及随访情况等。结果87.15%的患者是由内分泌医生介绍转诊,就诊原因为肾功能衰竭64例（46.38%）,顽固性水肿54例（39.13%）,大量蛋白尿20例（14.49%）。就诊时52.17%需要进行肾脏替代治疗。就诊时合并症：高血压123例（89.13%）,贫血95例（68.84%）,冠心病56例（40.58%）,糖尿病心肌病53例（38.46%）,心功能不全49例（35.51%）,感染43例（31.16%）,心律失常24例（17.39%）,高血压心脏病18例（13.04%）。随访维持性血透58例患者至2008年6月已有17例死亡。结论大部分患者就诊较晚,部分已为肾功能衰竭,合并症多,影响长期肾脏替代治疗和寿命。糖尿病患者应早期到肾病专科就诊。     

急性心肌梗死合并心源性休克的预后因素分析

目的探讨影响急性心肌梗死(AMI)并心源性休克患者的预后因素。方法将135例AMI患者按是否合并心源性休克分为休克组53例、非休克组82例,对比两组患者心血管疾病危险因素、临床特征及介入治疗情况、并发症发生率及近期病死率。结果休克组有高血压病、年龄>70岁患者显著增多;冠脉多支病变明显高于非休克组;行主动脉内球囊反搏(IABP)治疗多于非休克组;并发急性肺水肿、肺炎、早期急性肾衰竭多;但两组近期病死率无显著性差异。结论急性心肌梗死并心源性休克,以高龄、高血压患者及冠脉多支病变多见,易并发急性肺水肿、肺炎、早期急性肾衰竭,尽早应用IABP及血运重建可改善预后。     

动脉粥样硬化性肾动脉狭窄的研究进展

动脉粥样硬化性肾动脉狭窄(ARAS)是一慢性缺血进展性肾病(CIRD),是中老年人终末期肾病(ESRD)常见原因之一。在冠状动脉粥样硬化性心脏病、充血性心力衰竭、周围血管病和慢性肾衰竭人群中具有较高的患病率。临床上常表现难治性高血压、肾功能不全和肺水肿,部分患者可无症状直至出现ESRD,容易误诊。经肾血管介入治疗或外科手术治疗多数患者病情可缓解,但预后往往较差。充分认识和重视引起的慢性肾脏病,早期诊断,及时治疗,更好地保护肾功能,减少和延缓ESRD的发生和进展,改善预后。