贵阳市维持性血液透析患者生活质量调查

目的了解贵阳市终末期。肾脏疾病（end stage renal disease,ESIm）接受维持性血液透析患者的一般状况、病因构成和生活质量现状。方法收集贵阳市12个血液透析中心ESRD血液透析患者756例患者的一般资料、透析方法、肾脏病和生活质量问卷（KDQOL-SF36量表）等信息并进行分布特征描述。结果756例患者中,男女之比为1．45：1．00;平均年龄（49．1±14．7）岁,原发病前三位分别为慢性肾小球肾炎407例（占53．84％）、糖尿病肾脏病132例（占17．46％）、高血压。肾损害124例（占16．40％）;患者月均总医疗费用为（6072．55±3381．01）元;不同透析时间的血液透析患者’肾脏病和透析相关生活质量各维度得分具有显著差异（P〈0．05）。结论贵阳市维持血液透析患者中,其原发病以慢性肾小球肾炎为主;透析时间〉60个月的血液透析患者生活质量、一般健康相关生活质量各维度得分较低。     

肾脏病心血管危险因素及其控制

心血管疾病（CVD）是慢性肾脏病（Chronic Kidney Disease,CKD）最常见的并发症,也是引起其死亡的首位病因。据美国肾病数据系统资料,CVD死亡率约占总末期肾脏病（ESRD）的50％,是普通人群的10～20倍。欧美国家CKD患者中冠状动脉疾病（CAD）发生率占40％。国内侯凡凡报道,慢性肾脏病患者CAD的患病率为16．5％,左心室肥厚（LVH）为58．5％,     

新乡地区2012年维持性血液透析患者原发疾病调查

目的 了解新乡地区维持性血液透析患者原发疾病构成,为早期控制原发疾病、延缓肾功能进展提供依据.方法 收集2012年1月至3月新乡地区4家综合医院364例维持性血液透析3个月以上患者的临床资料,进行统计学分析不同原发疾病所占比例,与国内外不同地区、不同时期统计数据进行对比.结果（1）364例患者中慢性肾小球肾炎150例（占41.2％）,糖尿病肾脏疾病98例（占26.9％）,高血压肾损害43例（占11.8％）,多囊肾病19例（占5.2％）,梗阻性肾病14例（占3.8％）,风湿病6例（占1.6％）,血液病1例（占0.3％）,其他33例（占9.1％）;（2）与全国不同省份地区相比,尿毒症原发疾病前3位一致,仅有个别地区（2010年广州统计资料）显示糖尿病肾脏疾病比例已占据第1位,但不同地区的统计数据显示前3位原发病所占比例并不相同,说明尿毒症患者原发病疾病谱存在地区差异;（3）通过与1999年、2000年～2005年、2006年～2010年、2011年后不同时间段全国各地区透析登记资料对比,10余年来慢性肾小球肾炎、高血压肾损害所占比例没有统计学差异（P＞0.05）;而糖尿病肾脏疾病所占比例与1999年、2000年～2005年、2006年～2010年相比具统计学差异（P＜0.05）,与2011年后相比没有统计学差异（P＞0.05）,说明随着时间的推移,糖尿病肾脏疾病在尿毒症中所占比例发生了明显变化,尤其是近5年登记资料糖尿病肾脏疾病正在逐渐成为尿毒症患者的主力军.结论（1）目前新乡地区维持性血液透析患者原发疾病前3位为慢性肾小球肾炎、糖尿病肾脏疾病、高血压肾损害,与全国各地市统计数据基本相同;（2）过去和现在国内尿毒症患者仍以慢性肾小球肾炎占首位,但糖尿病肾脏疾病、高血压肾损害比例明显升高;（3）不同地区间疾病谱存在差异;（4）现阶段的工作重点需要向控制糖尿病、高血压转移,最终才能延缓终末期肾脏疾病人群.     

中医药治疗糖尿病肾病研究现况

糖尿病肾病（diabetic nephropathy,DN）是糖尿病最常见的并发症之一,也是导致肾衰竭的重要病因。糖尿病肾病占我国终末期肾脏病（end-stage renal disease,ESRD）的16.4%,可能未来会成为我国ESRD的首位病因。     

老年肾脏病肾活检的诊断价值与风险评估

目的探讨肾活检在老年肾脏病中的诊断价值与风险评估。方法回顾性分析我科住院行肾活检,且年龄≥60岁的123例老年肾脏病患者的临床病理资料及安全性。结果肾活检术成功率100％,肾活检取材肾小球数目均≥10个,共有6例出现轻度并发症,其中一过性肉眼血尿2例（占1．6％）,肾周小血肿4例（占3．2％）,余无严重并发症。123例患者中原发性肾小球疾病为105例（占85．4％）,而继发性肾脏病为18例（占14．6％）。在原发性肾小球疾病中最常见的病理类型是膜性肾病26例（占26．0%）,IgA。肾病25例（占25．0％）,其次为系膜增生性肾小球肾炎19例（占19％）。而继发性肾脏病中病理类型以糖尿病肾脏病11例最多见（占47．8％）。最常见的临床表现是肾病综合征（占39．8oA）和慢性肾小球肾炎（占33．3％）。临床诊断与肾活检结果尚存在差异（P〈0．05）。结论肾活检在老年性肾脏疾病患者中应用的成功率高而并发症少且大多较轻,其病理结果对明确诊断和决定治疗方案具有重要指导意义。     

多囊肾病的诊治进展

多囊肾病（polycystic kidney disease,PKD）是人类最常见的单基因遗传性肾脏疾病。据欧美国家报道,PKD是终末期肾脏病的第4位病因。据我国上海地区统计,PKD所致的透析患者占整个透析人群的5．6％,位于慢性肾小球肾炎、糖尿病肾脏病和良性肾小动脉硬化之后,也位居第4位。     

老年肾脏病患者的临床特点及病理改变分析

目的 探讨老年肾脏病患者的临床及病理特点。方法 回顾性分析我科56例老年肾脏病患者（年龄≥60岁,老年组）的临床和肾脏病理资料,并与同期住院的280例中青年肾脏病患者（年龄18～59岁,中青年组）资料进行对比。结果 ①老年组起病首发症状依次分别为肾病综合征、高血压、急性肾损害、慢性肾功能不全（32．1％、28．6H、14．3％、14．3％）;②老年组贫血发病率明显高于中青年组发病率（32．1%18．2％,P〈0．05）,低白蛋白血症、肾小球滤过率降低、高血压及高脂血症并发症更为常见（P〈0．05）。③老年组以原发性肾小球疾病为主（占71．4%,病理以膜性肾病（占19．6％）和IgA肾病（占17．9％）最常见。继发性肾脏疾病以高血压肾病（占41．7％）最常见。以急性肾损害为临床表现的老年患者,病理以急性。肾小管坏死（占37．5％）和新月体性肾炎（占37．50%）为多见。结论老年肾脏病患者的临床表现、肾脏病理与中青年不同,值得进一步研究。     

糖尿病肾病发病机制的研究进展

糖尿病肾病(diabetic nephropathy,DN)是糖尿病最主要的微血管病变之一,在美国等发达国家,DN早已成为终末期肾脏病的首位病因.根据《中国肾脏疾病年度科学报告》[1],我国DN已超越慢性肾小球肾炎、高血压肾小动脉硬化,一举成为慢性肾脏病(chronic kidney disease,CKD)最常见的病...     

TGF-β1与糖尿病肾病的关系及中医药研究进展

糖尿病肾病（diabetic nephropathy,DN）是糖尿病血管并发症中最常见的慢性并发症,其临床发病率占糖尿病患者的30%-40%,常见于病史超过10年的患者。据美国、日本及许多西欧国家统计资料表明,DN已经上升为终末期肾脏病（end-stage renal disease,ESRD）首位病因[1]。     

肾实质性高血压的发病机制与针刺降压的相关研究进展

所谓肾性高血压系指肾实质病变和肾血管病变所引起的高血压,在继发性高血压中占首位。美国国家健康和营养调查Ⅲ（NHANESⅢ）数据显示：20岁以上普通人群11％患有慢性肾脏病（CKD）。我国资料显示：20岁以上人群中CKD患病率为7％～13％,且我国与发达国家不同的是,CKD患者中以原发性肾小球疾病占多数。在原发性肾小球疾病中,肾性高血压的发病率为75％～80％;多囊肾病中肾性高血压的发病率为60％,慢性间质性肾炎中肾性高血压的发病率为35％;由此可见,肾性高血压发病率高,     

Epidemiological study of the end stage renal disease patients in Gansu province

Objective To investigate the clinical features and treatment of the end stage renal disease (ESRD) patients in Gansu province. Methods Based on the Chinese national renal data system, the investigation and analysis were made on the epidemiological literature of ESRD patients in 22 hospitals of Gansu from 2012 to 2013 by retrospective investigation. Results (1) In Gansu, the number of living ESRD patients was 4379, the point prevalence rate of ESRD was 169.6 per million. Their average age was (47.46±15.57) years, 30 to 59 years old patients accounted for 70.0%, and the male-female ratio was 1:1.15. The prevalence rate was higher in less-educated population and manual laborers. (2) As the leading cause of ESRD, chronic glomerulonephritis accounted for 43.0%, followed by diabetic nephropathy (31.0%), hypertensive nephropathy (11.0%) and allergic diseases (6.9%). (3) The current treatment of ESRD: 51.2% of the patients received hemodialysis, 4.4% received peritoneal dialysis, 1.1% received renal transplantation, 32.2% received no treatment, and 11.1% died. (4) The causes of patients not taking dialytic treatments: economic reasons accounted for 61.0%, lack of blood dialytic conditions accounted for 24.0%, patients ceasing treatment accounted for 3.1%, family factors accounted for 2.3%, religious reasons accounted for 1.8%, other reasons accounted for 7.8%. Conclusions The point prevalence rate of ESRD in Gansu was 169.6 per million. 30 to 59 years old patients were the main population. The major cause of ESRD was chronic glomerulonephritis, followed by diabetic nephropathy and hypertensive nephropathy. 32.2% of ESRD patients did not receive any renal replacement therapy, which was caused mainly by economic difficulties and the lack of dialytic equipments.     

血液透析患者原发病因及高血压和贫血状况的多中心调查

目的调查佛山地区血液透析患者的原发病因及高血压、贫血状况。方法收集2012年佛山市21家医院2610例血液透析患者的基本情况、原发病因、合并高血压、贫血状况、血白蛋白水平等有关临床资料进行分析。结果佛山地区21家医院2610例血液透析患者中,其原发病分别为原发性肾小球肾炎1278例（占48．9％）、糖尿病肾脏疾病505例（占19．3％）和高血压肾损害219例（占8．4％）。梗阻性肾病、痛风性肾病、多囊肾病、狼疮肾炎、小管间质性。肾病、其他原因及原因未明者分别为191例（占7．3％）、65例（占2．5％）、60例（占2．3％）、39例（占1．5%）、26例（占1．0％）、89例（占3．4％）、138例（占5．3％）。血液透析患者高血压患者1804例,其发病率达86．6％,治疗率为83．7％,血压控制低于140／90mm Hg水平者1227例（占47.0%A）,血压控制不达标1383例（占53％）。高血压控制常需多种降压药联合应用,仅269例（占14．9％）患者应用1种降压药,应用2、3、4和5种或5种以上者分别为529例（占29．3％）、606例（占33．6％）、312例（占17．3％）和86例（占4．9％）。血红蛋白（hemoglobin,Hb）〈110g／L的患者1832例（占70．2％）,Hb≥110g／L者仅778例（占29．8％）。有493例（占18．9％）患者血浆白蛋白水平低于35g／L,有647例（占24．8％）患者血浆白蛋白水平高于40g／L。结论血液透析患者的病因主要是原发性肾小球肾炎、糖尿病肾脏疾病、高血压肾损害、梗阻性肾病,高血压和贫血控制不达标仍较突出。     

The incidence of treated end-stage renal disease in New Zealand Maori and Pacific Island people and in Indigenous Australians.

BACKGROUND: Although Indigenous Australians, New Zealand Maori and Pacific Island people comprise an unduly high proportion of patients treated for end-stage renal disease (ESRD) in the two countries, no population-based age- and disease-specific rates have been published. METHODS: From data provided to the Australia and New Zealand Dialysis and Transplant Registry (ANZDATA), truncated age- and sex-standardized incidence rates were calculated for treated ESRD due to all causes and by primary renal disease, in four broad age groups of Maori, Pacific Island people and all 'other' New Zealanders and Indigenous and non-indigenous Australians, for the period 1992-2001. RESULTS: The incidence of ESRD did not differ in persons aged 0-14 years. In adults, Maori and Pacific Island people had similar rates of ESRD, a little more than half those of Indigenous Australians except in persons aged 65 years and over in whom the rates were nearly equal, but two to ten times the rates in 'other' New Zealanders and non-indigenous Australians. The excess of ESRD in Indigenous Australians was due principally to type II diabetic nephropathy and glomerulonephritis (all common types except lupus nephritis), but was seen also in respect of type I diabetic nephropathy, hypertensive renal disease and analgesic nephropathy, while the excess in Maori and Pacific Island people was confined to type II diabetic nephropathy, hypertensive renal disease and glomerulonephritis (especially lupus nephritis and type I mesangiocapillary glomerulonephritis, but not mesangial IgA disease). CONCLUSIONS: The incidence and pattern of treated ESRD differs quantitatively and qualitatively between Maori, Pacific Island people and other New Zealanders, and Indigenous and non-indigenous Australians.     

Rate of change of end-stage renal disease treatment incidence 1978-1987--has there been selection?

End-stage renal disease (ESRD) treatment rates in the United States have increased steadily since 1973. Decreasing selection against elderly patients with a poor prognostic primary cause of ESRD (i.e., diabetic nephropathy) may partly account for this increase in rates. To test this hypothesis, we calculated log ESRD treatment incidence (ESRDI) rates by four major primary causes of ESRD (diabetic nephropathy (DN), hypertensive nephropathy (HN), glomerulonephritis (GN), and cystic kidney disease (PC); two age groups (old (O), greater than 65 and young (Y), 15 to 44 yr of age) for black and white, male and female, new ESRD patients from 1978 to 1987. As predicted, summary log ESRDI slopes (produced by analysis of covariance) occurred in the following decreasing order, ODN (0.19), OGN = OHN = YDN (0.134). YHN = YPC = YGN (in white patients) = slope not significantly different from 0. Log ESRDI slopes for young black males and females with GN increased significantly between 1978 and 1987, possibly as a result of an increased incidence of GN. In conclusion, decreasing selection may be a factor in the continuing increase in the U.S. ESRD population.     

The incidence of end-stage renal disease in India: a population-based study

Chronic kidney disease (CKD) and end-stage renal disease (ESRD) are emerging public health problems in developing countries, and need changes in health-care policy. ESRD incidence data are not available from large parts of the developing world including South Asia. We report the ESRD incidence in a large urban population in India. ESRD incidence was estimated for four consecutive calendar years (2002-2005) among 572 029 subjects residing in 36 of the 56 wards of the city of Bhopal. These subjects are beneficiaries of free health care in a hospital established after the 1984 Union Carbide Industrial Accident. Crude and age-adjusted incidence rates were calculated. A total of 346 new ESRD patients were diagnosed during the study period; 86 in 2002, 82 in 2003, 85 in 2004, and 93 in 2005. Average crude and age-adjusted incidence rates were 151 and 232 per million population, respectively. The mean age was 47 years, and 58% were males. Diabetic nephropathy was the commonest (44%) cause of ESRD. This study provides the first population-based ESRD incidence data from India and reveals it to be higher than previously estimated. Diabetic nephropathy is the leading cause of ESRD. Changes are required in health-care policy for optimal care of CKD patients and efficient resource utilization for management of those with ESRD.     

Impact of HLA on the Underlying Primary Diseases in Turkish Patients with End-Stage Renal Disease

The number of patients with end stage renal disease (ESRD) is increasing faster than the number of renal transplantations performed per year worldwide. Of the primary diseases leading to ESRD, diabetic nephropathy is the leading cause. The purpose of the present study is to investigate the association of HLA with the primary diseases leading to ESRD in Turkish patients. A total of 3230 individuals comprising 587 ESRD patients and 2643 healthy controls were enrolled into the study. Class I HLA-A, -B typing was performed by CDC method, while class II HLA-DRB1 typing was performed by low resolution PCR-SSP. We found a significant negative association between almost all A locus antigens and primary disease groups classified as chronic glomerulonephritis and hypertensive nephrosclerosis (p?<?0.05). HLA-B58 and HLA-DRB1*03 significantly correlated with amyloidosis and diabetic nephropathy, respectively. Determination of HLAs as risk factors for primary diseases leading to ESRD might be beneficial in preventing progression to ESRD and recurrence of the primary disease post-transplantation.     

温州市1999-2006年血液透析状况及其变化调查

目的 了解温州市1999-2006年血液透析状况及其变化。 方法 收集1999年1月至2006年12月温州市18家医院血液透析中心的数据，回顾性研究温州市终末期肾脏疾病（ESRD）血液透析(HD)患者发病人数、患病人数和死亡人数，原发疾病构成及其相关因素的变迁。 结果 温州市血液透析患者年发病人数、患病人数逐年增加，年死亡人数相对稳定。各年度患者男性均多于女性，但男女比例有逐年下降趋势；青年组、老年组有增长趋势。慢性肾炎导致的ESRD的比例虽然在逐年下降，但仍然是ESRD血液透析的主要病因。糖尿病和高血压所占比例在逐年上升。血液透析患者透析龄的构成比，1~2年组逐年下降，<1年、2~3年、3~4年组均相对稳定，4~5年、5~10年、>10年组均呈增长趋势。肾移植及改作腹膜透析人数逐年均有所增长。心血管事件居死因之首,占19.9%；第2、3位为脑血管意外与全身衰竭，各占10.8%；第4位为出血性疾病，占4.7%；第5位为感染性疾病，占4.3%。1999-2006年心血管、脑血管事件构成比均相对稳定；全身衰竭、出血性疾病则波动较大；感染、营养不良所占比例有下降趋势。 结论 温州市血液透析患者数量在逐年增加，呈年轻化和老年化趋势现象。慢性肾炎仍然是主要病因，糖尿病和高血压所占比例在逐年上升。血液透析患者长期存活率逐年提高。首要死亡原因为心血管事件。     

四川地区肾活检2330例临床病理分析

目的：探讨四川地区肾穿刺活检病理类型的分布特点以及疾病谱的变迁。方法回顾性分析2330例肾活检患者的临床病理资料,分析本地区肾脏疾病的临床病理特征。结果2330例肾活检患者中,男女比例为1∶1.15,发病高峰年龄为20~40岁。2330例患者中,原发性肾小球疾病1896例（占81.37%）,常见的病理类型依次为 IgA 肾病820例（占35.19%）、系膜增生性肾小球肾炎372例（占15.97%）、膜性肾病298例（占12.79%）、微小病变肾病200例（占8.58%）和局灶节段性肾小球硬化症78例（占3.35%）;继发性肾小球疾病367例（占15.75%）,以狼疮性肾炎最常见（134例,占5.88%）,其次为紫癜性肾炎127例（占5.45%）、糖尿病肾脏疾病35例（占1.5%）和淀粉样变性肾病20例（占0.86%）;肾小管间质疾病50例（占2.15%）;遗传性肾病17例（占0.73%）。2330例肾脏疾病患者的临床表现依次为肾病综合征1015例（占43.56%）、慢性肾炎综合征681例（占29.22%）、急性肾炎综合征392例（占16.82%）、隐匿性肾小球肾炎121例（占5.29%）、慢性肾衰竭72例（占3.09%）、急性肾衰竭47例（占2.02%）。近年来,膜性肾病构成比呈逐渐增加趋势。结论本地区肾脏疾病多见于青壮年,以原发性肾小球疾病最常见,其中 IgA 肾病和系膜增生性肾小球肾炎是最多见的病理类型,膜性肾病的检出率有增高趋势。继发性肾小球疾病以狼疮肾炎和紫癜性肾炎最常见。