Comparison between the erythrocyte and urinary Sda antigen distribution in a large number of individuals from Emilia-Romagna,a region of northern Italy*

Summary. In this study we found that the frequencies of Sd^a antigen on erythrocytes and urine of a large number of individuals from Emilia-Romagna (a region of northern Italy) are 0·89 and 0·93, respectively. The hypothesis that the infection by pyelonephritogenic Escherichia coli strains with specific adhesions for the α2,3sialyl-galactosyl structure might operate as selective agents for the high frequency of Sd^a antigen in distal renal cells is discussed.     

恩格列净改善高糖诱导HK-2细胞凋亡的机制探讨

目的 探讨恩格列净改善人肾皮质近曲小管上皮细胞（HK-2细胞）凋亡的机制。方法 将HK-2细胞置于正常葡萄糖、高葡萄糖、高葡萄糖+不同浓度的恩格列净共干预环境下培养48 h。采用蛋白免疫印迹法检测肾脏沉默信息调节因子2相关酶1（SIRT1）、硫氧还蛋白互作蛋白（TXNIP）以及裂解的半胱天冬酶-3（cleaved Caspase-3）的表达水平。采用TUNEL染色评估HK-2细胞凋亡情况。结果 蛋白免疫印迹结果显示,高葡萄糖培养48 h后HK-2细胞的TXNIP和cleaved Caspase-3表达水平均高于正常葡萄糖组,而SIRT1表达水平低于正常葡萄糖组（P均< 0.05）。1000 nmol/L恩格列净和30 mmol/L葡萄糖共干预48 h后,HK-2细胞的TXNIP和cleaved Caspase-3的蛋白表达水平降低,SIRT1表达水平升高（P均< 0.001）。TUNEL染色结果显示恩格列净和30 mmol/L葡萄糖共干预组较30 mmol/L葡萄糖组TUNEL阳性细胞数少,且1000 nmol/L恩格列净和30 mmol/L葡萄糖共干预组凋亡改善更明显。结论 恩格列净可能通过上调SIRT1的表达、抑制TXNIP表达,改善高糖诱导HK-2细胞凋亡。     

辅助肾小管装置免疫调节机理研究

目的研究辅助肾小管装置参与全身免疫调节的机理.方法分别用感染患者持续血液滤过(continuous venovenous hemofiltration,CVVH)超滤液和脂多糖(LPS)干预培养人肾小管上皮细胞系HKC细胞,用RT-PCR、ELISA检测IL-10转录水平和蛋白水平表达变化,用"transwell"方法检测IL-10在HKC细胞内的转位特点.结果RT-PCR、ELISA结果显示,HKC细胞暴露于感染患者CVVH超滤液或含LPS培养液后,IL-10转录水平升高,上清中IL-10蛋白水平升高."transwell"方法检测发现IL-10向两侧分泌.结论辅助肾小管装置中的HKC可以通过表达IL-10,参与全身免疫调节.     

同型半胱氨酸测定在慢性肾病诊断中的应用

目的探讨血清同型半胱氨酸(homocysteine,HCY)测定在慢性肾脏疾病诊断中的应用。方法健康对照组40例,实验组共120例,其中肾功能代偿组32例、氮质血症组27例、肾衰竭组35例、尿毒症组26例。采用酶转换法测定血清HCY的浓度,同时测定血清尿素氮(BUN)、血清肌酐(Scr)。结果对照组和实验组血清HCY比较,差异有统计学意义(P0.01);对照组与肾功能代偿组比较,差异有统计学意义(P0.05);氮质血症组、肾衰竭组、尿毒症组,血清HCY逐渐升高,与肾功能代偿组比较,差异有统计学意义(P0.01)。结论血清HCY在慢性肾衰竭患者的肾功能代偿期即可增高,比传统的血清BUN、Scr能更敏感地反映肾功能损伤。     

慢性肾脏病情感障碍及危险因素研究

目的：了解慢性。肾脏病患者焦虑和抑郁的发生情况及其危险因素。方法：采用横断面调查,对住院病人进行SAS和SDS量表测评。结果：慢性。肾脏病患者焦虑和抑郁的发生率分别为53、4％、60．9％,其中。肾功能不全组又明显高于。肾功能正常组,焦虑的发生率分别为72．9％、23．9％;抑郁的发生率分别为74．3％、39．5％。尿毒症患者不同的替代治疗方式对焦虑的发生和抑郁严重程度的分布有影响,。肾移植病人焦虑的发生率最低。多因素分析表明Cer降低(OR=0．911,0．831-0．999)、自费(OR=3．528,95％CI：1．242-10．018)和家庭低收入(OR=3．493,95％CI：1．252-9．747)是抑郁的危险因素;Ccr降低(OR=0．973,0．959-0．981)和家庭低收入是焦虑的危险因素(OR=2．571,95％CI：1．108-5．969)。结论：慢性。肾脏病患者,特别是。肾功能不全患者,焦虑和抑郁的发生率高于普通人群;Ccr降低是焦虑和抑郁的危险因素。医药费来源于属于自费和低家庭收入是抑郁发生的危险因素;低家庭收入是焦虑发生的危险因素。     

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。     

Sleep-Disordered Breathing in 2 Pediatric Patients on Peritoneal Dialysis

Sleep-disordered breathing (SDB) is prevalent in children with chronic kidney disease (CKD), and has the potential to worsen vascular and neuro-cognitive health and quality of life. We present 2 children with CKD who experience central sleep apnea and nocturnal hypoventilation and discuss the possible underlying mechanisms in relation to CKD and dialysis.     

Hemodialysis-related emergencies—part 1

Hemodialysis patients are seen in the emergency department much more frequently than their relatively small number would suggest. Many pitfalls attend the management of these patients, in whom there is a high potential for serious morbidity and mortality. This article outlines the principles of emergency department management of hemodialysis patients and describes the approach to the diagnosis and treatment of their most common presenting problems. Many of these are related to the hemodialysis procedure itself or to underlying chronic renal failure. Special attention is given to the problems of the vascular access, the hemodialysis patient's lifeline. The indications for emergent dialysis are discussed, as well as the temporizing measures available to the emergency physician while awaiting institution of dialysis.     

慢性肾脏病透析并高磷血症病人的饮食治疗现状

综述了慢性肾脏疾病（CKD）透析病人高磷血症限磷饮食教育的方法及内容,介绍了影响饮食依从性的因素以及依从性的测量。     

左卡尼汀和红细胞生成素治疗肾性贫血的临床观察

目的：观察左卡尼汀和红细胞生成素治疗维持性血液透析患者肾性贫血的疗效，以及对红细胞生成素用量的影响。方法：将维持性血液透析肾性贫血患者40例随机分成两组，治疗组在应用红细胞生成素的同时口服补充左卡尼汀，对照组单用红细胞生成索。治疗8周，两组红细胞生成寨初始用量均为每周150U／Kg，当血红蛋白≥100g／L，红细胞压积≥30％时，EPO逐渐减量至维持量。结果：两组患者的血红蛋白、红细胞压积较治疗前均有所提高（P〈0．05），治疗组提高比对照组更显著（P〈0．05），且治疗组红细胞生成素的维持用量更少（P〈0．01）。结论：左卡尼汀能显著提高红细胞生成素治疗肾性贫血的疗效，减少红细胞生成素的用量。     

慢性肾脏病透析并高磷血症病人的饮食治疗现状

综述了慢性肾脏疾病(CKD)透析病人高磷血症限磷饮食教育的方法及内容,介绍了影响饮食依从性的因素以及依从性的测量。     

Bad Blood: Medical Answers to Legal Confusions

The great majority of outpatients who present with a history of “low blood sugar” have a normal glucose level, even when samples are taken at home after meals or during symptomatic periods. Chronic fatigue and depression are not symptoms of hypoglycemia but often are manifestations of an emotional problem that may respond to psychotherapy. The authors define hypoglycemia, describe how to establish or disprove its presence, and discuss common and less common causes.     

Cardiac troponins in renal failure – time for an optimistic consensus?

Elevated cardiac troponin concentrations are now accepted as the gold standard biochemical markers for the diagnosis of myocardial damage in patients with unstable coronary syndromes, having also a demonstrated value in early risk stratification and in adopting different therapeutic strategies. The specificity and sensitivity of cardiac troponins for diagnosis of acute coronary diseases in renal failure have been a point of confusion over the past decade, mainly because of moderate elevations of these cardiac biomarkers, commonly observed in patients with chronic renal dysfunction and without any significant myocardial damage. This review discusses the cardiac troponins, their biochemistry, their currently accepted cut-off values and their real significance in chronic renal failure (CRF), concluding that troponins maintain their diagnostic and prognostic values in patients with CRF, being predictive not only of cardiovascular mortality but also of general mortality in this patient group.     

品管圈活动提高慢性肾脏病患者治疗依从性的成效

目的探讨品管圈（quality control circle,QCC）活动在提高慢性肾脏病患者治疗依从性中的作用。方法开展QCC活动对100例慢性肾脏病患者实施护理,包括确立活动主题、进行要因分析、设定目标、制订对策并实施,比较QCC活动前后患者治疗依从性的差异。结果 QCC活动后患者治疗依从性（98.0%）较活动前（61.0%）高,活动前后比较,差异具有统计学意义（P＜0.01）。结论 QCC活动可提高患者治疗依从性,而且此活动深受护士们的欢迎,值得在临床护理管理中推广应用。     

Chronic renal failure: assessing the Fatigue Severity Scale for use among caregivers

Background. Quality of life for caregivers of end‐stage renal disease patients has not been well addressed yet the physical and psychological status of this overlooked group can be important in the recovery or adaptation of patients with chronic renal failure, not to mention the caregivers themselves. One particular feature of the overall quality of life of such caregivers is that of fatigue. Aims and objectives. The purpose of the study was to test the Fatigue Severity Scale for potential usefulness in assessing fatigue among a non‐medical population, caregivers of end‐stage renal disease patients. Methods. Subjects completed a short battery of measures at either a dialysis centre or at home. Results. The Short Form‐12 of the Short Form‐36 and the Center for Epidemiologic Studies Depression Scale accounted for 56% of the variance on the Fatigue Severity Scale. The results suggest that physical fatigue may be more prominent than mental fatigue as a feature of caregiver quality of life. Conclusions. The Fatigue Severity Scale which has been used for multiple sclerosis patients may prove to be useful as a short assessment of fatigue among the non‐medical population of end‐stage renal disease caregivers. This may result in improved interventions for the population of caregivers. Relevance to clinical practice. Physicians, nurses and allied health professionals will be called on more frequently to assess and intervene with fatigued and overburdened caregivers in addition to patients themselves. A more thorough understanding of the nature of caregiver fatigue may drive changes or innovations with caregivers who are too often overlooked in the current era of scarce resources. Accordingly results of the study suggest that the direction in intervention may focus more on rest and respite as opposed to a need for psychosocial support or counselling. While there are various modes for assessing end‐stage renal disease caregivers’ fatigue, a simple measure like the Fatigue Severity Scale is brief enough to be administered without undue demand on practitioners or caregivers.