少量蛋白尿紫癜肾炎的临床病理特点分析

目的 了解表现为少量蛋白尿的成人紫癜性肾炎患者的肾脏病理特征、临床表现及其预后.方法 对2009年至2012年确诊为紫癜性肾炎,且表现为少量蛋白尿(＜1g/24h)患者的临床和病理资料进行回顾分析.同时比较青年组(＜35岁)与中老年组(≥35岁)的情况.结果 入选37例,男21例,女16例,年龄31±15岁;临床表现为蛋白尿伴镜下血尿占81％ (30/37),单纯蛋白尿占19％ (7/37);其中肾功能异常13％(5/37);其中25例行肾活检,有新月体形成者为52％ (13/25);小管萎缩48％ (12/25);间质纤维化16％ (4/25);血管病变28％(7/25).与青年组相比,中老年组有更高的尿酸、血脂水平及高血压发生率,肾脏病理显示更重的间质病变及小血管病变.35例患者在随访终点时已完全缓解.结论 成人紫癜性肾炎即使表现为少量蛋白尿,仍建议明确病理类型,对于急性病变需予以及时治疗以改善肾脏预后.中老年患者注意控制血压及血脂以延缓肾病进展.     

单独用血浆交换术治疗IgA肾病

二例IgA肾病,伴有血清IgA水平增高,单独用血浆交换术治疗。第一例是一7岁的女孩,患有局灶及节段增殖型过敏性紫癜性肾小球肾炎,有30％的上皮新月体形成。病者临床表现为肾病综合征,肾功能正常。血IgA升高至3.4g/升(正常值为1.2±0.5g/升),第二例为一64岁男性,患有膜增殖型肾小球肾炎和酒精性肝硬化。临床表现为严重的肾病综合征及血清肌酐高达310微克分子/升,IgA为7.4g/升(正常值为2.7±1.8g/升)。治疗有效的     

成人与儿童紫癜性肾炎的临床病理特点及预后分析

目的：探讨成人与儿童紫癜性肾炎的临床病理特点及疾病转归的差异。方法：收集温州医学院附属第一医院肾内科住院确诊为紫癜性肾炎（HSPN）的成人患者（≥18岁）36例,38例紫癜性肾炎患儿为温州医学院附属儿童医院住院病人,分析比较二者的临床病埋改变及疾病的转归。结果：（1）所有患者均有血尿。成人紫癜性肾炎临床分型为单纯性血尿2例．血尿＋蛋白尿23例,肾病综合征11例;儿童患者单纯性血尿6例,血尿＋蛋白尿22例,肾病综合征10例;两组比较无统计学差异（P〉0．05）。成人紫癜性肾炎合并高血压14例,合并肾功能损害9例;而所有儿童患者均无高血压或肾功能损害。（2）成人紫癜性肾炎病理分级：Ⅰ级3例、Ⅱ级2例、Ⅲ级28例、Ⅴ级2例、Ⅵ级1例,而儿童患者Ⅱ级31例、Ⅲ级7例,两组比较具有统计学差异（P〈0．001）。（3）27例成人紫癜性肾炎患者随访结果A组10例、B组14例、C组3例,30例儿童紫癜性肾炎的随访结果A组15例、B组13例、C组2例,两组预后无统计学差异（P〉0．05）。结论：成人与儿童紫癜性肾炎临床分型以血尿＋蛋白尿最多见,与儿童患者相比,成人临床表现偏重,合并高血压及肾功能损害较多见。成人紫癜性肾炎病理分级以Ⅲ级多见,而儿童病理分级以Ⅱ级多见,提示成人紫癜性肾炎病理较儿童严重。在本研究观察期内,我们发现成人与儿童紫癜性肾炎的预后均较好,二者预后无统计学差异。     

IgA肾病中西医结合诊断及治疗建议

IgA肾病(IgAN)系指肾小球系膜区以IgA为主的免疫球蛋白沉积为免疫病理特征的一组肾小球疾病,临床多数以血尿为主要临床表现,或伴有蛋白尿,甚至大量蛋白尿,或呈肾病综合征,少数病人有急进性肾炎综合征.近时研究发现其病理与临床表现呈多样化,其中20%～40%患者,病情进行性发展,在经历5～25年后,最终导致终末期肾衰竭(ESRF).     

肾炎康复片治疗紫癜性肾炎40例疗效观察及病例分析

紫癜性肾炎(HSPN)临床表现不一,病理改变轻重不同,是青少年临床常见的继发性肾小球疾病之一.我们采用肾炎康复片(天津同仁堂股份有限公司生产)治疗了40例紫癜性肾炎,结果报告如下.     

自身免疫性肝病继发肾脏损害的临床病理分析

目的:分析自身免疫性肝病(ALD)继发肾脏损害的临床病理及转归，旨在提高对该类疾病的认识。方法:回顾性分析2010年07月—2021年07月我院24例临床诊断为ALD继发肾脏损害的患者，原发性胆汁性肝硬化(PBC)19例，自身免疫性肝炎(AIH)5例。尿检异常型定义为0.5 g≤24 h尿蛋白量<3.5 g、血清白蛋白>30 g/L。结果:中老年女性为主，21.5%PBC、40%AIH患者合并其他自身免疫性疾病，高丙种球蛋白血症及低补体血症发生率分别为68.4%、60%和31.6%、60%。ANA阳性发生率最高，其次是着丝点抗体及SSA/SSB抗体。PBC患者临床表现差异大，肾病综合征型患者急性肾衰竭发生率高，尿检异常型患者高血压发生率高，肾小管酸中毒组无1例合并高血压及镜下血尿。所有PBC患者尿NAG酶升高，62.5%尿渗透压下降。病理类型以IgA肾病最常见，其次是系膜增生性肾炎、慢性间质性肾炎、膜性肾病。66.7%系膜增生性肾炎、50%IgA肾病合并慢性间质性肾炎。AIH患者表现为蛋白尿、镜下血尿、血肌酐升高，肾病理为IgA肾病，其中1例合并慢性间质性肾炎。给予糖皮质激...     

成人紫癜性肾炎的临床病理分析及转归

目的：了解深圳地区成人紫癜性肾炎的临床特征及其与肾脏病理的联系;探讨其转归及影响因素。方法：回顾性分析2001年1月～2009年12月间经我院临床及肾活检确诊的紫癜性肾炎52例,对其临床资料、病理特征及转归进行统计分析。结果：（1）成人紫癜性肾炎多好发于30岁以下,40岁以后患者高血压的发生率较高。（2）临床分型以蛋白尿＋血尿型（59.6%）最多见,其次为单纯性血尿（21.2%）和肾病综合征型（19.2%）;病理分级以Ⅱ级（44.2%）及Ⅲ级（36.5%）多见。（3）肾小管间质病变与肾小球慢性病变及活动病变的相关系数分别为0.587（P〈0.01）和0.260（P〉0.05）;蛋白尿越多的患者,其肾小球活动病变积分就越高。（4）多因素分析显示疗效与肾小球硬化率及肾小管间质病变呈负相关。结论：深圳地区成人紫癜性肾炎发病相对年轻,临床以蛋白尿＋血尿型多见,病理以Ⅱ、Ⅲ级常见;蛋白尿的严重程度与肾小球活动病变关系密切;影响疗效的主要因素为肾小球慢性病变及肾小管间质病变程度。     

成人毛细血管内增生性紫癜性肾炎的临床病理及转归

目的:探讨以弥漫性毛细血管内皮细胞增生为主要病理表现的成人紫癜性肾炎(DEP-HSPN)的临床、病理及预后。方法:回顾性分析本院近5年来经肾活检确诊的8例成人DEP-HSPN临床、病理和预后资料,并分别与同病理级别非DEP-HSPN患者进行比较,同时分析影响紫癜性肾炎疗效的因素。结果:(1)DEP-HSPN患者起病急,临床表现重,6例表现肾病综合征,4例患者存在肉眼血尿,4例起病时即存在肾功能下降。7例病理分级为Ⅲ级,1例为Ⅳ级,光镜主要表现为弥漫性毛细血管内皮细胞和系膜细胞增生,可合并细胞性新月体及肾小球内炎性细胞浸润。(2)同为Ⅲ级的DEP-HSPN和非DEP-HSPN患者比较,DEP-HSPN患者病程较短,临床多见肉眼血尿,24 h尿蛋白量高,较多影响肾功能。(3)治疗后平均随防(14.43±7.21)月,其中2例临床痊愈,3例蛋白尿<1 g/d和(或)镜下血尿,2例蛋白尿>1 g和(或)镜下血尿,1例GFR<60 ml/min,治疗反应较同级别的非DEP-HSPN慢,但随访末期GFR<60 ml/min比例差异无统计学意义。(4)多因素分析显示肾小球慢性病变积分及血浆白蛋白水平影响疗效。结论:DEP-HSPN起病较急,临床表现较重,并较多影响肾功能。治疗反应相对慢。     

强直性脊柱炎相关IgA肾病临床病理分析

目的了解强直性脊柱炎（AS）相关IgA肾病的临床病理特点。方法自1997年1月至2006年12月10年间在北京协和医院接受肾活检确诊为IgA肾病的AS患者10例，回顾性分析其临床及病理特点。结果男性9例，女性l例，平均年龄（28．6＋6．8）岁（16～53岁）。4例患者表现为无症状镜下血尿；6例表现反复血尿合并蛋白尿，其中2例有发作性肉眼血尿。平均尿蛋白量（24h）为（1．56±1．53）g（0．02-5．26g）。2例患者有血压升高。所有患者的血肌酐水平均在正常范围。光镜下，8例患者呈轻度系膜细胞增生，IgA肾病Lee氏分级均为Ⅰ或Ⅱ级；另外2例呈中重度系膜增生性改变，IgA肾病Lee氏分级分别为Ⅲ级和Ⅵ级。结论AS相关IgA肾病临床表现为隐匿性肾炎或慢性肾小球肾炎，病理改变以轻度系膜增生为主。     

原发性膜性肾病合并IgA肾病两例报告并文献复习

目的 探讨原发性膜性肾病合并IgA肾病的临床表现以及病理特点,并指导临床治疗.方法 分析本院经过临床以及肾脏病理(包括光镜、免疫荧光和电镜)确诊的2例原发性膜性肾病合并IgA肾病患者的临床和病理资料,并进行文献复习.结果 两例患者均为青壮年男性,年龄分别为44岁和38岁,血压及肾功能均正常.例1表现为肾病综合征伴镜下血尿;例2表现为无症状性蛋白尿.两例患者临床上均除外继发性肾脏病,根据蛋白尿程度选用不同的治疗方案,效果良好.结论 原发性膜性肾病合并IgA肾病发病率较低,临床表现无特异性,兼具有膜性肾病和IgA肾病的病理特点.临床表现更似于膜性肾病,治疗方面则需要进行个体化的治疗.     

Body composition assessment and methodology in nonathletic and athletic adolescent and adult males and females

The purpose of this review is to outline methodology for assessing body composition utilizing anthropometric and densitometric techniques. The objective of body composition assessment is to measure body fat and lean body mass. The quantity of these components varies due to growth, physical activity, dietary regimens, and aging. Anthropometric techniques incorporate selected skinfolds, circumferences, skeletal widths, or other variables to estimate body composition within k2.0-4.0%. These techniques are adequate for field testing of groups or individuals, but are population specific. Densitometry measures body volume irrespective of physique, sex, or age. This laboratory technique estimates body composition within 1.0-2.0%, is more difficult to administer, but is not population specific. Some limitation exists with any present technique due to biological variability and incomplete research of reference body composition in children, females, and the aged. J Orthop Sports Phys Ther 1984;5(6):336-347.     

Perioperative and long-term morbidity and mortality after above-knee and below-knee amputations in diabetics and nondiabetics

We performed a retrospective review of a vascular surgery quality assurance database to evaluate the perioperative and long-term morbidity and mortality of above-knee amputations (AKA, n = 234) and below-knee amputations (BKA, n = 720) and to examine the effect of diabetes mellitus (DM) (181 of AKA and 606 of BKA patients). All patients in the database who had AKA or BKA from 1990 to May 2001 were included in the study. Perioperative 30-day cardiac morbidity and mortality and 3-yr and 10-yr mortality after AKA or BKA were assessed. The effect of DM on 30-day cardiac outcome was assessed by multivariate logistic regression and the effect on long-term survival was assessed by Cox regression analysis. The perioperative cardiac event rate (cardiac death or nonfatal myocardial infarction) was at least 6.8% after AKA and at most 3.6% after BKA. Median survival was significantly less after AKA (20 mo) than BKA (52 mo) (P < 0.001). DM was not a significant predictor of perioperative 30-day mortality (odds ratio, 0.76 [0.39-1.49]; P = 0.43) or 3-yr survival (Hazard ratio, 1.03 [0.86-1.24]; P = 0.72) but predicted 10-yr mortality (Hazard ratio, 1.34 [1.04-1.73]; P = 0.026). Significant predictors of the 30-day perioperative mortality were the site of amputation (odds ratio, 4.35 [2.56-7.14]; P < 0.001) and history of renal insufficiency (odds ratio, 2.15 [1.13-4.08]; P = 0.019). AKA should be triaged as a high-risk surgery while BKA is an intermediate-risk surgery. Long-term survival after AKA or BKA is poor, regardless of the presence of DM.     

Postoperative nausea and vomiting and opioid-induced nausea and vomiting: guidelines for prevention and treatment

Postoperative nausea and vomiting (PONV) causes patient discomfort, lowers patient satisfaction, and increases care requirements. Opioid-induced nausea and vomiting (OINV) may also occur if opioids are used to treat postoperative pain. These guidelines aim to provide recommendations for the prevention and treatment of both problems. A working group was established in accordance with the charter of the Sociedad Espa?ola de Anestesiología y Reanimación. The group undertook the critical appraisal of articles relevant to the management of PONV and OINV in adults and children early and late in the perioperative period. Discussions led to recommendations, summarized as follows: 1) Risk for PONV should be assessed in all patients undergoing surgery; 2 easy-to-use scales are useful for risk assessment: the Apfel scale for adults and the Eberhart scale for children. 2) Measures to reduce baseline risk should be used for adults at moderate or high risk and all children. 3) Pharmacologic prophylaxis with 1 drug is useful for patients at low risk (Apfel or Eberhart 1) who are to receive general anesthesia; patients with higher levels of risk should receive prophylaxis with 2 or more drugs and baseline risk should be reduced (multimodal approach). 4) Dexamethasone, droperidol, and ondansetron (or other setrons) have similar levels of efficacy; drug choice should be made based on individual patient factors. 5) The drug prescribed for treating PONV should preferably be different from the one used for prophylaxis; ondansetron is the most effective drug for treating PONV. 6) Risk for PONV should be assessed before discharge after outpatient surgery or on the ward for hospitalized patients; there is no evidence that late preventive strategies are effective. 7) The drug of choice for preventing OINV is droperidol.