2569例体检成年人单次尿液和肾功能检查结果分析

目的分析2569例体检成年人单次尿液和肾功能检查结果。方法选取2014年9月—2016年9月在北京市丰台区铁营医院进行体检的成年人2569例,分析其单次尿液和肾功能检查结果。结果共204例体检者单次尿液检查结果异常(占7.94%),其中男131例,女73例;单纯蛋白尿55例(占2.14%),单纯血尿61例(占2.37%),蛋白尿伴血尿24例(占0.94%),白细胞尿64例(占2.49%)。参照肾脏早期评估项目(KEEP)标准检出肾功能减退6例(占0.23%),其中男4例,女2例;参照美国全国健康与营养调查Ⅲ(NHANES Ⅲ)标准检出肾功能减退8例(占0.31%),其中男7例,女1例。结论临床需重视体检成年人单次尿液和肾功能检查结果,以期早期发现慢性肾脏病(CKD)。     

2569例体检成年人单次尿液和肾功能检查结果分析

目的分析2569例体检成年人单次尿液和肾功能检查结果。方法选取2014年9月—2016年9月在北京市丰台区铁营医院进行体检的成年人2569例,分析其单次尿液和肾功能检查结果。结果共204例体检者单次尿液检查结果异常(占7.94%),其中男131例,女73例;单纯蛋白尿55例(占2.14%),单纯血尿61例(占2.37%),蛋白尿伴血尿24例(占0.94%),白细胞尿64例(占2.49%)。参照肾脏早期评估项目(KEEP)标准检出肾功能减退6例(占0.23%),其中男4例,女2例;参照美国全国健康与营养调查Ⅲ(NHANES Ⅲ)标准检出肾功能减退8例(占0.31%),其中男7例,女1例。结论临床需重视体检成年人单次尿液和肾功能检查结果,以期早期发现慢性肾脏病(CKD)。     

社区健康体检人群慢性肾脏病流行病学调查

目的 分析在遵医附院行健康体检的成人慢性肾脏病(CKD)的流行病学特点.方法 随机抽取2010年10月至2011年10月该院健康体检人群2 200例,进行问卷、体格检查及实验室检查,结果异常者3个月后复查,分析CKD、蛋白尿、血尿和eGFR相关危险因素.结果 在2 096例资料完整的体检人群中,蛋白尿检出率2.8％,血尿检出率7.7％,女性高于男性(P＜0.05),与年龄正相关;血肌酐升高检出率4.7％,eGFR ＜60 ml·min-1·1.73 m-2检出率为2.3％,随年龄增长肾功能呈下降趋势;肾脏B超影像学异常检出率16.2％.总体检人群中CKD患病率为27.4％,性别间无差异(P＞0.05),但随年龄增长CKD患病率升高,若剔除肾脏B超影像学异常,总CKD患病率14.9％.系统性疾病人群并发CKD明显高于一般人群,年龄、性别、高脂血症、高空腹血糖、高尿酸血症及肾结石、肾囊肿是CKD的危险因素.结论 健康体检有助于发现早期CKD,CKD诊断指标有待统一.     

定西市区健康体检人群尿酸、血糖及血脂水平分析

目的了解甘肃省定西市健康体检人群的尿酸、血脂和血糖水平,为预防心脑血管疾病等慢性病提供参考。方法对2015年1月至2016年10月在我院进行健康体检的5 693名体检人员的体检资料进行统计分析,了解不同性别、年龄、职业健康体检人群肥胖、尿酸增高、血糖代谢异常、血脂代谢异常情况。结果健康体检人员共5 693名,其中男3 496名,女2 197名,尿酸增高1 231例(21.62%),血糖代谢异常307例(5.39%),血脂代谢异常986例(17.32%);男性尿酸增高、血糖代谢异常、血脂代谢异常检出率均显著高于女性,差异有统计学意义(P0.01)。不同年龄段健康体检人群尿酸增高、血糖代谢异常、血脂代谢异常检出率比较差异有统计学意义(P0.01),46~岁年龄段人群尿酸增高、血糖代谢异常、血脂代谢异常检出率最高。不同职业健康体检人群尿酸增高、血糖代谢异常、血脂代谢异常检出率比较差异有统计学意义(P0.01)。肥胖健康体检人群尿酸增高、血糖代谢异常、血脂代谢异常检出率显著高于非肥胖人群,差异有统计学意义(P0.01)。结论定西市健康体检人群尿酸增高、血糖代谢异常、血脂代谢异常的检出率很高,46~岁年龄段人群检出率最高。注意饮食习惯,多饮水,定期进行健康体检,积极锻炼,避免肥胖,积极控制尿酸、血脂、血糖水平,才能有效降低心脑血管疾病等慢性病的发病率。     

老年健康体检人群血尿酸水平及高尿酸血症的分布特点

目的分析老年健康体检人群血尿酸(SUA)水平及高尿酸血症(HUA)的分布特点。方法选取2 753例老年健康体检者,对所有的体检者进行空腹静脉血检查,并将HUV与年龄、性别、高血压、糖尿病及心血管疾病等进行单因素分析,将相关因素与HUV的检出率进行多因素分析。结果 60～70岁男性人群SUA水平明显高于70岁及以上人群(P0.05),70岁及以上女性人群SUA水平明显高于60～70岁人群(P0.05);60岁以上男性人群的SUA水平明显高于60以上女性人群(P0.05);不同年龄老年健康体检人群HUA检出率差异有统计学意义(P0.05),不同性别老年健康体检人群HUA检出率差异有统计学意义(P0.05);2 753例健康体检者共检出HUA282例,男223例,女59例;男性HUA检出率(13.75%)明显高于女性(5.22%,P0.05)。男性、年龄、超重、高血压、高三酰甘油、低密度脂蛋白胆固醇升高是引发HUA的危险因素(P0.05)。结论男性HUA发生率明显高于女性;超重,三酰甘油异常、高血压、低密度脂蛋白胆固醇异常等人群中,发生HUA的风险较高,在预防HUA中需对上述因素提高警惕。     

唐山市体检人群脂肪肝患病率调查分析

目的探究唐山市体检人群脂肪肝患病率情况,以期为脂肪肝的预防和调治提供合理依据。方法采集2014年3月-2016年2月唐山市12 808例体检人群资料,其中脂肪肝有3540例。统计年龄、性别、BMI、空腹血糖(FBG)、TC、TG、LDL-C以及肝脏超声检查结果。计数资料组间比较采用χ2检验;计量资料组间比较采用t检验。结果 7151例男性体检者中脂肪肝2750例(38.46%),5657例女性体检者中脂肪肝790例(13.96%),男性与女性患病率比较差异有统计学意义(χ2=947.25,P0.01)。不同年龄段(18~29岁、30~39岁、40~49岁、≥50岁)男女间脂肪肝检出率比较差异均有统计学意义(χ2值分别为337.58、474.06、449.38、12.86,P值均0.01)。男性、女性在不同BMI[肥胖(BMI≥28)、超重(24≤BMI28)、正常(BMI24))]间脂肪肝的检出率比较差异有统计学意义(χ2值分别为1104.01、500.23,P值均0.01)。分别对肥胖(BMI≥28)、超重(24≤BMI28)、正常(BMI24)体检者中男性与女性脂肪肝检出率进行比较,差异均有统计学意义(χ2分别为71.24、87.97、323.84,P值均0.01)。男性、女性体检者中肥胖及超重人群脂肪肝检出率均显著高于正常人群(P值均0.01)。脂肪肝组与非脂肪肝组FPG、TC、TG、LDL-C比较,差异均有统计学意义(t值分别为17.482、13.698、22.133、27.334,P值均0.001)。男性体检者中,脂肪肝与非脂肪肝体检者间FPG、TC、TG、LDL-C水平比较,差异均有统计学意义(t值分别为11.288、8.652、11.671、20.118,P值均0.01);女性体检者中,脂肪肝与非脂肪肝体检者间FPG、TC、TG、LDL-C水平比较,差异均有统计学意义(t值分别为16.816、5.532、15.154、18.507,P值均0.01)。结论唐山市成人体检人群脂肪肝患病率为男性明显高于女性。导致脂肪肝的主要因素可能是超重或肥胖、高脂血症、糖代谢异常。     

广东省阳江市健康体检人群代谢综合征患病现状调查

目的调查广东省阳江市健康体检人群代谢综合征(MS)患病现状。方法采用随机分层抽样方法于2013年12月—2015年9月抽取广东省阳江市30岁以上的健康体检者981例作为调查对象,采用自制问卷采集调查对象的相关信息;所有调查对象进行体格检查、实验室检查,分析MS患病情况。结果共发放问卷981份,回收有效问卷966份,有效率为98.5%。966例健康体检人群中185例诊断为MS,MS患病率为19.2%,其中男性MS患病率为21.6%(100/464),女性MS患病率为16.9%(85/502),男性与女性MS患病率比较,差异无统计学意义(P0.05)。青年组男性MS患病率高于女性(P0.05),而中年组、老年组男性与女性MS患病率比较,差异无统计学意义(P0.05)。966例健康体检者中检出腹型肥胖330例(34.2%),血糖升高160例(16.6%),血压(BP)升高475例(49.2%),高水平三酰甘油(TG)290例(30.0%),低水平高密度脂蛋白胆固醇(HDL-C)125例(12.9%)。不同性别健康体检者腹型肥胖、高水平TG检出率比较,差异无统计学意义(P0.05);不同性别健康体检者血糖升高、BP升高、低水平HDL-C检出率比较,差异有统计学意义(P0.05)。不同性别健康体检者0项MS指标异常检出率比较,差异有统计学意义(P0.05);不同性别健康体检者1项MS指标异常、2项MS指标异常、3项MS指标异常、4项MS指标异常和5项MS指标异常检出率比较,差异无统计学意义(P0.05)。结论广东省阳江市健康体检者MS患病率较高,且不同性别、年龄健康体检者MS表现不同,需进行有针对性的干预。     

NCEP/ATPⅢ及CDS代谢综合征诊断标准在高血压人群中的诊断一致性分析

目的比较美国国家胆固醇教育计划成人组第三次报告(NCEP/ATPⅢ)及中华医学会糖尿病学分会(CDS)制定的代谢综合征(MS)诊断标准在高血压人群中的诊断一致性。方法选择高血压患者7 485例,男2 875例、女4 610例;<50岁1 380例,50~60岁2 680例,>60岁3 425例。采用NCEP/ATPⅢ和CDS标准诊断MS,比较其对不同性别、年龄研究对象MS的诊断一致性。结果 NCEP/ATPⅢ和CDS标准MS检出率分别为40.1%(2 998/7 485)、42.4%(3 175/7 485)(P<0.01)。NCEP/ATPⅢ标准对女性MS检出率高于男性,CDS标准对女性MS的检出率低于男性(P均<0.01)。两种标准对各年龄组MS检出率变化趋势相似,均随年龄增高而增高(P均<0.01)。结论 CDS标准在高血压人群中MS检出率相对较高,更有利于早期控制MS的危险因素。     

不同类型IgA肾病的流行病学及临床特点分析

目的:分析不同类型IgA肾病(IgAN)患者流行病学及临床表现的特点。方法:回顾性分析我院收治的759例IgAN患者。根据其临床表现、病理特点将其分为孤立性镜下血尿型、尿检异常型、反复发作肉眼血尿型、血管炎型、大量蛋白尿型、高血压型等七型。对各类型患者进行流行病学、临床表现的回顾性分析。结果:IgAN患者759例,平均起病年龄(30·0±10·0)岁,男女性别比为0·98:1。其中,孤立性镜下血尿型占2·8%,反复发作肉眼血尿型13·2%,尿检异常型42·9%,新月体型7·2%,大量蛋白尿型10·9%,高血压型18·9%。各类型IgAN患者的临床表现有显著不同:孤立性镜下血尿型以镜下血尿为唯一临床表现,临床表现较轻。尿检异常型为IgAN中最多见的一种类型,47%的患者在体检中发现,因而起病隐匿。反复发作肉眼血尿型起病年龄为24岁,与平均年龄相比差异显著(P<0·001),69%的患者在起病前有上呼吸道感染或腹泻等前驱症状。血管炎型以血尿为主要临床表现,起病时常合并有大量蛋白尿[(3·35±2·90)g/24h],肾功能不全(SCr1·23±1·05)mg/dl。大量蛋白尿型青年男性多见,起病即表现为大量蛋白尿[(5·26±3·37)g/24h],与其他各型相比有显著区别(P<0·05),常合并有高血压、肾功能不全等预后不良因素。高血压型亦以男性多见(男∶女1·87∶1),与平均男女比例相比有显著区别(P<0·001),起病年龄平均为33岁,显著高于其他各组,63.2%的患者起病即有肾功能损伤。结论:不同类型IgAN在流行病学、临床表现等方面均有显著不同,提示它们在发病机制、治疗方法上均有所区别。     

142例尿检异常患者肾活检病理特点及其临床意义

目的:观察体检发现尿检异常患者的肾脏临床和病理情况,了解其预后. 方法:体检发现尿检异常患者共142例,其中定期随访者40例.内生肌酐清除率(Ccr)<80ml/min为肾功能不全. 结果:临床表现为血尿合并蛋白尿者多见,占55.7%;肾活检时已有肾功能不全者占26.1%.病理类型以IgA肾病最多,占46.4%;肾小球轻微病变14.1%,局灶增生性肾小球肾炎13.4%,膜性肾病6.3%,非IgA系膜增生性肾炎5.6%,硬化性肾炎和薄基膜肾病各2.8%,局灶节段性肾小球硬化和IgM肾病各2.1%,微小病变1.5%,膜增生性肾炎0.7%.40例患者平均随访13～60(25.8±14.1)个月,7例肾功能明显恶化者蛋白尿多加重. 结论:尿检异常患者的肾脏病变有时与临床表现并不相符,应尽早行肾活检明确病理性质,部分病例病变重、预后差,应长期随访.     

Living Donor Kidney Transplantation: Improving Efficiencies in Live Kidney Donor Evaluation–Recommendations from a Consensus Conference

The education, evaluation, and support of living donors before, during, and after donation have historically been considered the roles and responsibilities of transplant programs. Although intended to protect donors, ensure true informed consent, and prevent coercion, this structure often leaves referring nephrologists unclear about the donor process and uncertain regarding the ultimate outcome of potential donors for their patients. The aim of this article is to help the referring nephrologist understand the donor referral and evaluation process, help the referring nephrologist understand the responsibilities of the transplant program, and offer suggestions about how the referring nephrologist can help to improve efficiencies in the process of donor education and evaluation. A partnership between referring nephrologists and transplant programs is an important step in advancing living kidney donation. The referring nephrologists are the frontline providers and are in a unique position to offer education about living donation and improve efficiencies in the process. Understanding the donor referral and evaluation process, the responsibilities of the transplant program, and the potential role referring nephrologists can play in the process is critical to establishing such a partnership.     

同种异体双肾移植8例报告

目的：利用部分“边缘肾”，或因血型特殊局部地区无适合受体的供肾进行双肾移植，探讨双肾移植的l临床疗效。方法：自2001年3月至2002年10月，我们共利用该类“边缘肾”与“无人要的肾脏”为8例患者进行了双肾移植。采用右下腹“L”型切口，来自8个供体的16个肾脏被分别移植于8例受者的右侧髂窝内。免疫抑制方案为皮质激素 霉酚酸酯 环孢素A，剂量同单肾移植。结果：在1-12个月的随访期内发生急性排斥(AR)2例共2次(25％)，1只肾由于肾动脉栓塞失功。5例随访12个月肾功能均正常。结论：双边缘肾移植有助于充分利用日趋紧张的肾源，提供给患者更多的有效肾单位。肾移植的免疫抑制方案，AR发生率，与单肾移植效果相同。     

系膜IgA沉积的供肾移植后的转归

目的 :探讨接受系膜IgA沉积的供肾移植后的临床转归。　 方法 :对供肾进行常规活检 ,比较系膜IgA沉积供肾 (IgA供肾组 ,n =83)与系膜无IgA沉积供肾 (无IgA供肾组 ,n =2 5 9)移植后的转归 ,以及两组之间性别、年龄、透析时间、供肾冷热缺血时间、补体依赖性微量淋巴细胞毒、群体反应性抗体水平和原发病的分布。　 结果 :2 4 3%的受者接受了IgA沉积的供肾。IgA沉积供肾组术后浮肿、蛋白尿、血尿、低白蛋白血症、高血压和移植肾功能延迟恢复的发生率明显高于无IgA供肾组。肾移植 3个月内 ,IgA沉积供肾组急性排斥反应发生率明显高于无IgA沉积供肾组 ,分别为 31 3%和 19 3%(P <0 0 0 1)。临界改变发生率分别为 37 3%和 16 2 %(P <0 0 0 1)。随着移植时间推移 ,IgA沉积供肾组IgA沉积例数逐渐减少 ,术后 1、3和 6个月仍有系膜IgA沉积者分别为 2 6例(31 3%)、9例 (10 8%)和 2例 (2 4 %) ,至 6个月时与对照组比较差异不明显。两组间 1年肾存活率差异不显著 ,分别为 93 8%和 95 6 %,3年存活率分别为 86 7%和 88 3%。　 结论 :系膜IgA沉积的供肾移植后移植肾功能延迟恢复和急性排斥反应的发生率明显高于无IgA沉积供肾组 ,但不影响远期肾存活率 ,且系膜区IgA沉积可以逐渐消失。     

Clinical and Genetic Analysis of Patients with Cystinuria in the United Kingdom

Background and objectives

Cystinuria is a rare inherited renal stone disease. Mutations in the amino acid exchanger System b^0,+, the two subunits of which are encoded by SLC3A1 and SLC7A9, predominantly underlie this disease. The work analyzed the epidemiology of cystinuria and the influence of mutations in these two genes on disease severity in a United Kingdom cohort.

Design, setting, participants, & measurements

Prevalent patients were studied from 2012 to 2014 in the northeast and southwest of the United Kingdom. Clinical phenotypes were defined, and genetic analysis of SLC3A1 and SLC7A9 combining Sanger sequencing and multiplex ligation probe–dependent amplification was performed.

Results

In total, 76 patients (42 men and 34 women) were studied. All subjects had proven cystine stones. Median age of presentation (first stone episode) was 24 years old, but 21% of patients presented after 40 years old. Patients had varied clinical courses, with 37% of patients having ≥10 stone episodes; 70% had evidence of CKD, and 9% had reached ESRD as a result of cystinuria and its complications. Patients with cystinuria received a variety of different therapies, with no obvious treatment consensus. Notably, 20% of patients had staghorn calculi, with associated impaired renal function in 80% of these patients. Genetic analysis revealed that biallelic mutations were present in either SLC3A1 (n=27) or SLC7A9 (n=20); 22 patients had only one mutated allele detected (SLC3A1 in five patients and SLC7A9 in 17 patients). In total, 37 different mutant variant alleles were identified, including 12 novel mutations; 22% of mutations were caused by large gene rearrangements. No genotype-phenotype association was detected in this cohort.

Conclusions

Patients with cystinuria in the United Kingdom often present atypically with staghorn calculi at ≥40 years old and commonly develop significant renal impairment. There is no association of clinical course with genotype. Treatments directed toward reducing stone burden need to be rationalized and developed to optimize patient care.     

Relationship between cortical and medullary thickness and glomerular filtration rate among living kidney donors

The relationship between the kidney cortex and medulla is not well understood in healthy populations. This study characterised the relationship between cortical/medullary thickness and measured glomerular filtration rate (GFR) in 390 living kidney donors. A positive relationship was observed between medullary, but not cortical, thickness and GFR. We propose that this reflects a correlation between juxtamedullary nephron number and GFR.     

Cardiovascular Disease Assessment Prior to Kidney Transplantation

Cardiovascular disease is highly prevalent and the leading cause of mortality in patients with chronic kidney disease, end-stage kidney disease, and kidney transplantation. However, kidney transplantation offers improved survival and quality of life, with an overall reduction in cardiovascular disease events; therefore, it remains the optimal treatment choice for those with advanced kidney disease. Pretransplantation cardiovascular assessment is performed prior to wait-listing and at routine intervals with the principal goal of screening for asymptomatic cardiac disease, intervening when necessary to improve long-term patient and allograft survival. Current clinical practice guidelines are based on expert opinion, with a lack of high-quality evidence to guide standardized screening practices. Recent studies support de-escalation in screening with avoidance of preemptive revascularization in asymptomatic patients, but they fail to provide clear guidance on how best to assess the cardiovascular fitness of this high-risk group. Herein we summarize current practice guidelines, discuss key study findings, highlight the role of optimal medical therapy, and evaluate future directions for cardiovascular disease assessment in this population.     

Forced expression of laminin beta1 in podocytes prevents nephrotic syndrome in mice lacking laminin beta2, a model for Pierson syndrome

Pierson syndrome is a congenital nephrotic syndrome with ocular and neurological defects caused by mutations in LAMB2, the gene encoding the basement membrane protein laminin β2 (Lamβ2). It is the kidney glomerular basement membrane (GBM) that is defective in Pierson syndrome, as Lamβ2 is a component of laminin-521 (LM-521; α5β2γ1), the major laminin in the mature GBM. In both Pierson syndrome and the Lamb2(-/-) mouse model for this disease, laminin β1 (Lamβ1), a structurally similar homolog of Lamβ2, is marginally increased in the GBM, but it fails to fully compensate for the loss of Lamβ2, leading to the filtration barrier defects and nephrotic syndrome. Here we generated several lines of Lamβ1 transgenic mice and used them to show that podocyte-specific Lamβ1 expression in Lamb2(-/-) mice abrogates the development of nephrotic syndrome, correlating with a greatly extended lifespan. In addition, the more Lamβ1 was expressed, the less urinary albumin was excreted. Transgenic Lamβ1 expression increased the level of Lamα5 in the GBM of rescued mice, consistent with the desired increased deposition of laminin-511 (α5β1γ1) trimers. Ultrastructural analysis revealed occasional knob-like subepithelial GBM thickening but intact podocyte foot processes in aged rescued mice. These results suggest the possibility that up-regulation of LAMB1 in podocytes, should it become achievable, would likely lessen the severity of nephrotic syndrome in patients carrying LAMB2 mutations.     

Different Aspects of Kidney Function in Well-Controlled Congenital Hypothyroidism

Objective: Congenital hypothyroidism (CH) increases the prevalence of kidney and urogenital malformations. There are limited studies considering different aspects of kidney function in well-controlled CH patients. We evaluated some features of kidney function in euthyroid children with CH who have been receiving thyroxine hormone since early life.Methods: This cross-sectional study was conducted in Isfahan, Iran, on 74 children aged 2-15 years old (36 CH patients and 38 healthy children). Inclusion criteria for CH patients were euthyroidism at the time of the survey and initiation of replacement therapy during the early neonatal period. Kidney ultrasound evaluation was performed in all participants. Serum biochemistry included urea, creatinine, sodium (Na), potassium (K), magnesium, calcium, and cystatin C levels. Urine electrolytes, fraction excretion (FE) of electrolytes and microalbumin, and glomerular filtration rate (GFR) were also determined.Results: The male/female ratio was 0.8/1 and 1.5/1 in the patient and control groups, respectively. Mean age and height did not differ significantly between the two groups. Ultrasound evaluation of the kidney revealed that the anteroposterior diameter of the right kidney was significantly higher in CH patients as compared to healthy subjects. No significant difference was observed between GFRs in patients with CH and healthy children. The mean values for FENa and FEK were significantly higher in the patient group.Conclusions: Increased FENa and FEK may be a manifestation of impaired tubular maturation in CH. More longitudinal studies are needed to evaluate kidney function in CH patients. Conflict of interest:None declared.