血清Klotho水平对慢性肾脏病患者肾功能进展的预测价值

目的观察血清Klotho水平与慢性肾脏病(CKD)患者肾功能进展的关系,探讨血清Klotho水平预测CKD患者肾功能进展的可行性。方法收集昆山市第一人民医院非透析的CKD 3~5期患者81例,健康志愿者30例,随访12个月。用ELISA法检测血清Klotho、成纤维细胞生长因子23(FGF23)水平,并检测其他相关指标;随访前后用MDRD和GC公式分别计算CKD患者的GFR值;随访结束时根据GFR下降幅度分为肾功能稳定组及恶化组,分析血清Klotho水平与肾功能不全、肾功能进展的关系。结果随访时间(9.5±2.9)个月。CKD患者GFR由随访前(24.8±12.4)m L/min,降至随访后(18.7±12.1)m L/min,差异有统计学意义(P0.01)。血清Klotho水平由2.53(1.41,3.67)ng/m L降至1.63(1.07,3.19)ng/m L,差异有统计学意义(P0.01);其中,肾功能恶化组较肾功能稳定组降低明显(P0.01)。血清Klotho水平较高的患者中15例发生肾功能恶化,而血清Klotho较低的患者中26例发生肾功能恶化,差异有统计学意义(63.4%vs 36.5%,P=0.02)。Kaplan-Meier分析显示,低Klotho水平患者发生不良肾脏预后的风险高于高Klotho水平患者(P=0.013)。结论 CKD患者血清Klotho水平随肾功能进展下降;血清Klotho水平降低的CKD患者发生肾功能恶化的风险增加,低Klotho水平有望成为CKD患者肾功能进展的预测指标。     

慢性肾脏病管理模式对慢性肾脏病伴高尿酸血症患者的影响

目的探讨慢性肾脏病(CKD)管理模式用于CKD伴高尿酸血症患者的临床效果。方法选取2013年11月至2014年4月该院住院诊断为CKD伴高尿酸血症患者117例,随机分为CKD管理组58例,对照组59例,两组均采用常规药物治疗,CKD管理组在此基础上实施CKD管理模式。观察患者尿酸控制水平、生活方式改变情况,进行6个月随访。结果 CKD管理组尿酸控制水平、生活方式的改变优于对照组,差异有统计学意义(P0.05)。结论 CKD管理模式用于CKD伴高尿酸血症效果显著,值得推广。     

肾脏总体积对常染色体显性多囊肾病病情进展和预后评估价值的Meta分析

目的 采用Meta分析的方法,探讨肾脏总体积(TKV)对常染色体显性遗传性多囊肾病(ADPKD)病情进展及预后判断的价值.方法 运用计算机检索Cochrane Library、PubMed、Embase、中国知网(CNKI)等数据库,检索ADPKD患者TKV 和病情进展及预后判断相关的文献,检索期限为各数据库建库至20...     

Molecular diagnosis of autosomal dominant polycystic kidney disease

Introduction: Autosomal dominant polycystic kidney disease (ADPKD) is the most common inherited kidney disease that accounts for 5–10% of end-stage renal disease in developed countries. Mutations in PKD1 and PKD2 account for a majority of cases. Mutation screening of PKD1 is technically challenging largely due to the complexity resulting from duplication of its first 33 exons in six highly homologous pseudogenes (i.e. PKD1P1-P6). Protocol using locus-specific long-range and nested PCR has enabled comprehensive PKD1 mutation screening but is labor-intensive and costly. Here, the authors review how recent advances in Next Generation Sequencing are poised to transform and extend molecular diagnosis of ADPKD.

Areas covered: Key original research articles and reviews of the topic published in English identified through PubMed from 1957–2017.

Expert commentary: The authors review current and evolving approaches using targeted resequencing or whole genome sequencing for screening typical as well as challenging cases (e.g. cases with no detectable PKD1 and PKD2 mutations which may be due to somatic mosaicism or other cystic disease; and complex genetics such as bilineal disease).     

Urine liver fatty acid binding protein and chronic kidney disease progression

Excretion of the tubular protein liver fatty acid binding protein (L-FABP) is a potential novel biomarker of renal dysfunction. We examined whether urine L-FABP excretion adds prognostic information to the well-established risk markers, blood pressure (BP), albumin excretion and baseline GFR, regarding progression of chronic kidney disease (CKD). In a prospective study design a cohort of 74 stage 3-4 CKD patients (age 61?±?13 years) were included. Glomerular filtration ratio (GFR, ⁵¹Cr-EDTA-clearance), 24-hour ambulatory BP, 24-hour urinary albumin/creatinine ratio (UAC) and urinary L-FABP/creatinine ratio (U-L-FABP/C) were determined at baseline and after 18 months of follow-up. For comparison 25 age-matched healthy controls were included. The U-L-FABP/C was elevated in CKD patients when compared to controls (mean U-L-FABP/C 2.3 [95% CI 1.7–2.9] μg/mmol vs 0.6 [0.5–0.7] μg/mmol, p?<?.001). In CKD patients, log U-L-FABP/C at baseline and at follow-up were positively associated (Pearson correlation coefficient r?=?0.74, p?<?.001). Baseline log U-L-FABP/C was negatively correlated with baseline GFR (r?=??0.32, p?<?.001) and directly correlated with UAC (r?=?0.67, p?<?.001). The relative change in GFR from baseline to follow-up correlated with baseline UAC (p?<?.001), 24-hour systolic BP (p?=?0.05) and log U-L-FABP/C (p?<?.001). Using multiple regression analysis adjusting for baseline GFR, UAC, BP, age and gender, baseline log U-L-FABP/C was associated with a decline in GFR only in patients with UAC <3?mg/mmol (n?=?29, p?=?0.001) and not in patients with UAC ≥3?mg/mmol (n?=?44, p?=?0.21). In conclusion urine L-FABP/C is permanently elevated in CKD patients, but only associated with GFR decline in those without albuminuria.     

Protein biomarkers associated with acute renal failure and chronic kidney disease

Acute renal failure (ARF) as well as chronic kidney disease (CKD) are currently categorized according to serum creatinine concentrations. Serum creatinine, however, has shortcomings because of its low predictive values. The need for novel markers for the early diagnosis and prognosis of renal diseases is imminent, particularly for markers reflecting intrinsic organ injury in stages when glomerular filtration is not impaired. This review summarizes protein markers discussed in the context of ARF as well as CKD, and provides an overview on currently available discovery results following 'omics' techniques. The identified set of candidate marker proteins is discussed in their cellular and functional context. The systematic review of proteomics and genomics studies revealed 56 genes to be associated with acute or chronic kidney disease. Context analysis, i.e. correlation of biological processes and molecular functions of reported kidney markers, revealed that 15 genes on the candidate list were assigned to the most significant ontology groups: immunity and defence. Other significantly enriched groups were cell communication (14 genes), signal transduction (22 genes) and apoptosis (seven genes). Among 24 candidate protein markers, nine proteins were also identified by gene expression studies. Next generation candidate marker proteins with improved diagnostic and prognostic values for kidney diseases will be derived from whole genome scans and protemics approaches. Prospective validation still remains elusive for all proposed candidates.     

Wnt信号通路与常染色体显性多囊肾病发病关系的研究进展

Wnt信号通路是一条保守的信号途径,其生物学效应非常广泛,对细胞的黏附、迁移、增殖和凋亡具有调控作用,与多种疾病的发生发展均有关系。近年研究发现,在常染色体显性多囊肾病的发病过程中,Wnt信号通路扮演着非常重要的角色。本文就Wnt信号通路与常染色体显性多囊肾病发病的研究进展做一综述。     

Helicobacter cinaedi kidney cyst infection and bacteremia in a patient with autosomal dominant polycystic kidney disease

A 48-year-old man with autosomal dominant polycystic kidney disease (ADPKD) was admitted to our hospital with a 5-day history of lower right back pain, high-grade fever, and arthralgia. He was diagnosed with right kidney cyst infection and bacteremia due to Helicobacter cinaedi (H. cinaedi) based on these symptoms, highly elevated CRP (32.25 mg/dL), abdominal magnetic resonance imaging findings, and the identification of H. cinaedi from blood cultures using PCR and sequence analysis of the 16S ribosomal DNA gene. Intravenous cefotaxime 0.5 g twice daily followed by meropenem 0.5 g twice daily and ciprofloxacin 200 mg twice daily were partially effective; oral doxycycline added at 200 mg/day finally eradicated the infection. Total duration of antimicrobial therapy was 9 weeks. H. cinaedi infections typically present as bacteremia with or without cellulitis in immunocompromised patients such as those with AIDS or malignant disease. To our knowledge, this is the first report describing an ADPKD patient with H. cinaedi cyst infection. Although H. cinaedi infections are increasingly recognized, even in immunocompetent subjects, numerous cases may still be overlooked given that this bacterium is slow-growing, and is difficult to culture, be Gram-stained, and identify on phenotypic tests. Consideration of this bacterium as a possible pathogen and sufficient duration of incubation with molecular testing are necessary in treating ADPKD patients with cyst infection.     

实时剪切波弹性成像评价慢性肾脏病早期肾脏损害的价值

目的 探讨实时剪切波弹性成像（RT-SWE）技术在慢性肾脏疾病早期肾损害中的潜在应用价值。 方法 应用RT-SWE技术检测早期慢性肾病1~3期患者肾脏皮质杨氏模量均值（E_mean）,与患者24 h尿蛋白定量、血肌酐值及肾穿刺活检病理间质纤维化程度作对比;引入年龄因素校正E_mean值（pyE_mean）,比较早期慢性肾病各期患者pyE_mean值的差异。 结果 E_mean值在慢性肾病1~3期患者不同组的差异无统计学意义（P > 0.05）;根据患者年龄校正得出的pyE_mean值在慢性肾病1期与2期患者之间差异无统计学意义（P > 0.05）,但1、2期与3期的差异有统计学意义（P < 0.05）。 结论 pyE_mean值排除了年龄对肾脏硬度值的影响,对评估早期慢性肾病患者肾脏纤维化程度可能具有重要的潜在应用价值,RT-SWE技术可以应用于慢性肾病早期肾损害评估。     

A structured literature review of pain assessment and management of patients with chronic kidney disease

Aims and objectives. This paper reviews the literature concerning nurses’ assessment and management of pain in adult patients with chronic kidney disease, and proposes implications for clinical practice to support the control of pain in these patients. Background. Chronic kidney disease is a worldwide public health concern with increasing incidence and prevalence, poor patient outcomes and high cost. Patients with kidney disease often experience pain. Optimal pain assessment and management are key clinical activities; however, inadequate pain control by health professionals persists. Renal failure compounds this problem because of the small margin between pain relief and toxicity, and the patient's concomitant health problems. Conclusions. The literature review uses 93 articles that were published in medical‐ and other health‐related journals, including 12 medical and pharmaceutical studies specifically relating to pain control in adults with kidney disease. Very little research has been conducted on pain in patients with kidney disease prior to requiring dialysis or kidney transplantation for survival. However, past research showed pain is common and analgesics are underprescribed in patients on dialysis in end‐stage kidney disease. The review indicates that an interest in nephrotoxicity and analgesic‐induced morbidity dominates over an interest in pain relief in patients with kidney disease. Most analgesics are excreted renally or by the liver, and the use of simple analgesics such as paracetamol is cautioned. Relevance to clinical practice. Findings from the literature review highlight specific difficulties relating to effective pain control in patients with chronic kidney disease. Research is required to identify and overcome barriers to effective pain management, including the development of specific tools to facilitate interventions that optimize analgesic outcomes in patients with chronic kidney disease.     

Sonographic diagnosis of seminal vesicle cysts in autosomal dominant polycystic kidney disease

Multiple, bilateral seminal vesicle cysts were found in a young man by transabdominal sonography. Examination of the kidneys disclosed previously unknown autosomal dominant polycystic kidney disease. This case report draws attention to the rare association between these 2 conditions. © 1998 John Wiley & Sons, Inc. J Clin Ultrasound 26:221–222, 1998.     

Darbepoetin alfa: a new therapy for the management of anaemia associated with chronic kidney disease

Darbepoetin alfa (Aranesp^®, Amgen, Inc., Thousand Oaks, California) is a new erythropoietic protein that corrects anaemia associated with chronic kidney disease (CKD) in the majority of patients. Darbepoetin alfa contains five N-linked carbohydrate chains compared with three in recombinant human erythropoietin (rHuEPO). The two additional sialic acid-containing carbohydrate chains prolong the serum half-life of darbepoetin alfa, resulting in greater biological activity and a reduced dosing frequency compared with rHuEPO. Clinical studies in patients with CKD have demonstrated that darbepoetin alfa is effective in correcting anaemia in rHuEPO-naive patients and in patients who have been converted from rHuEPO therapy. Darbepoetin alfa provides long-term maintenance of haemoglobin levels when administered once weekly or once every other week, with the possibility of once-monthly dosing in some patients. Darbepoetin alfa is well tolerated and has a safety profile similar to that of rHuEPO. Owing to its half-life being three times longer than rHuEPO, darbepoetin alfa can be administered at an extended dosing interval, without compromising efficacy. Lessfrequent dosing has potential benefits for both patients with CKD and healthcare providers. These benefits include reduced visits to the clinic, fewer injections and a reduced demand on staff and treatment facilities.     

肾功能指标对慢性肾病的预测价值研究

目的：探讨肾功能指标对慢性肾病（CKD）的预测价值。方法按照肾小球滤过率估算（eGFR）值,将212例CKD患者分为3组：A组（eGFR＞60mL·min－1·1．73m－2）,B组（eGFR30～60mL·min－1·1．73m－2）,C组（eGFR＜30mL·min－1·1．73m－2）。选取175例具有CKD患病风险的患者和60例健康体检者,分别设为高危组和健康对照组。分别测定各组尿中微量清蛋白/肌酐比值（UmAlb/Cr）和血清尿素（Urea）、肌酐（Cr）、尿酸（UA）、胱抑素C（CysC）、β2‐微球蛋白（BMG）、同型半胱氨酸（Hcy）水平。结果CysC和BMG水平不仅在3组CKD患者之间差异统计学意义（P＜0．05）,而且在高危组与健康对照组之间差异也有统计学意义（P＜0．05）。结论CysC和BMG可以作为预测CKD的有效指标。     

慢性肾脏病流行病合作工作组方程和肌酐全年龄段方程用于成人慢性肾脏病

目的 比较慢性肾脏病流行病合作组方程(CKD-EPI)和肌酐全年龄段方程(FAS)评估慢性肾脏病(CKD)患者肾小球滤过率(GFR)的价值.方法 回顾性分析393例CKD,以99Tcm-DTPA肾动态显像法所测GFR(Tc-GFR)为金标准,采用3个CKD-EPI方程及3个FAS方程,分别为流行病学-血肌酐(EPI-S...     

中西医结合治疗慢性肾脏病急性肾损伤的临床效果

目的探讨中西医结合治疗慢性肾脏病急性肾损伤(CKD-AKI)的临床效果。方法选取2017年12月至2018年12月我院收治的CKD-AKI患者98例,随机分为对照组(49例)和研究组(49例)。对照组给予前列腺素E1治疗,研究组在此基础上给予黄芪注射液治疗。比较两组治疗前、后的肾功能指标水平及临床疗效。结果治疗后,两组β2-MG、Scr、BUN、Cys C、NGAL、KIM-1水平均低于治疗前,且研究组显著低于对照组(P<0.05)。研究组治疗总有效率显著高于对照组(P<0.05)。结论中西医结合治疗CKA-AKI的效果显著,能够有效改善患者肾功能,值得临床推广应用。