汞中毒性肾病6例临床分析

报道6例汞中毒肾病,其中有5例诊断为肾病综合征,分析汞中毒性肾病患者临床特点、实验室检查、治疗方法,提出汞中毒性肾病综合征的肾脏损害经病因治疗(驱汞),配以糖皮质激素、利尿、降脂、抗凝等综合治疗,病情改善迅速,整个病程较短,预后良好。     

链脲佐菌素诱导糖尿病大鼠肾病模型的建立

目的评价链脲佐菌素(STZ)糖尿病大鼠肾病动物模型。方法用STZ 65 mg/kg一次性腹腔内注射方式制作糖尿病大鼠模型,60只SD大鼠随机分为正常对照组(M),糖尿病1个月组(M1)、3个月组(M2),每组20只。期间观察大鼠血糖、尿糖及一般情况变化,实验结束时,测定血肌酐、尿素氮、尿蛋白、尿白蛋白排泄率,取肾作病理及超微病理检查。结果M未见异常改变,从M1开始出现异常改变,以M2最明显。M2模型组大鼠的血肌酐、尿素氮、尿蛋白、尿白蛋白明显升高,出现肾脏肥大,病理显示明显的肾小球、肾小管病变。结论STZ诱导的糖尿病大鼠肾脏病变表现为肾小球及小管间质损害,可用作糖尿病肾病研究的动物模型。     

Light-chain nephropathy

The authors deal with the clinicopathology of the renal, alterations in light-chain disease in connection with 6 cases. The disease was recognized by the monotype (in 5 cases kappa, in 1 case lambda) immunoreactivity of the light-chain paraprotein deposited in the basal membranes of the renal tissue. Electron microscopic examinations proved the fine-granulated, electrodense character of the paraprotein. Multiple myeloma was found in 3 cases and plasma cell dyscrasia of non-tumorous characteristic in 3 cases in the background of the deposition. The renal involvement appeared clinically in the picture of proteinuria without nephrosis syndrome and in progressing azotemia. Chronic renal insufficiency developed during some months in 5 patients. Morphologically renal impairment manifested in interstitial fibrosis, tubular atrophy and ateriolar hyalinosis was seen. These were associated with different glomerular alterations, for instance in 3 cases with nodular glomerulosclerosis. In 1 patient with plasma cell dyscrasia of non-tumorous characteristic nodular glomerulosclerosis and semilunar formation was observed in 56% of the glomeruli. In an other patient with myeloma the simultaneous existence of cylinder nephropathy and light-chain nephropathy was demonstrated. Both observations are unusual phenomena in plasma cell dyscrasia.     

急救危重患者发生对比剂肾病及生存状况的相关因素

目的 探究急救危重患者发生对比剂肾病及生存状况的相关因素.方法 回顾性分析重症加强治疗病房内除进行肾脏替代治疗且使用过对比剂的660例患者的临床资料,采用单因素和Logistic多因素分析急救危重患者发生对比剂肾病的相关因素及患者生存状况的相关因素.结果 660例患者中85例发生对比剂肾病,100例住院期间病死;单因素分析结果显示APACHEⅡ评分、脓毒症、休克、肾毒性药物、检查前SCr、是否使用对比剂均与对比剂肾病的发生有一定的相关性(P＜0.05),多因素Logistic分析结果显示,APACHEⅡ评分、脓毒症、休克、使用肾毒性药物为急救危重患者发生对比剂肾病的独立危险因素(P＜0.05).132例使用对比剂的急救危重患者中20例患者住院病死,单因素分析结果显示性别、年龄、APACHEⅡ评分、脓毒症、是否发生对比剂肾病均与使用对比剂的急救危重患者住院病死有一定的相关性(P＜0.05);多因素Logistic分析结果显示,男性、年龄≥65岁、APACHEⅡ评分、脓毒症为使用对比剂的急救危重患者住院病死的独立危险因素(P＜0.05).结论 APACHEⅡ评分、脓毒症、休克、使用肾毒性药物为急救危重患者发生对比剂肾病的独立危险因素,对比剂肾病不会显著增高急救危重患者的住院病死率.     

Membranous nephropathy in a patient with nail-patella syndrome nephropathy

Membranous nephropathy is described in a patient with nail-patella syndrome who also had the characteristic changes of nail-patella syndrome nephropathy on electron microscopy. This combination has not previously been reported. Nail-patella syndrome nephropathy is reviewed in relation to other glomerular lesions which have been reported.