34例老年肾病综合征的临床分析

肾病综合征是一组以大量蛋白尿(成人>3.5克/天)底蛋白血症两个必备条件及高脂血症、高度浮肿为临床表现的综合征.病因分为原发性和继发性两大类.在60岁以上老年人应首先排除继发性NS.特别注意新生物、糖尿病、多发性骨髓瘤、淀粉样变性等.期排除继发性     

34例老年肾病综合征的临床分析

肾病综合征是一组以大量蛋白尿(成人>3.5克/天)底蛋白血症两个必备条件及高脂血症、高度浮肿为临床表现的综合征.病因分为原发性和继发性两大类.在60岁以上老年人应首先排除继发性NS.特别注意新生物、糖尿病、多发性骨髓瘤、淀粉样变性等.期排除继发性     

34例老年肾病综合征的临床分析

肾病综合征是一组以大量蛋白尿(成人>3.5克/天)底蛋白血症两个必备条件及高脂血症、高度浮肿为临床表现的综合征.病因分为原发性和继发性两大类.在60岁以上老年人应首先排除继发性NS.特别注意新生物、糖尿病、多发性骨髓瘤、淀粉样变性等.期排除继发性     

激素抵抗型肾病综合征机制及治疗进展

激素抵抗型肾病综合征在通常容易导致慢性肾脏疾病,而目前对于该疾病的治疗方案尚未达成一致的看法.近些年来,随着该病发病机制研究的不断深入以及新型药物的运用和传统药物循证医学证据的增加,对该病的治疗有了进一步的认识.本文对以上进行综述.     

难治性肾病综合征的发病机制新进展

随着难治性肾病综合征的日益增多，人们通过新的途径对其发病机制进行不断探索，寻求新的治疗方案。本文就国内外新的研究从分子遗传学，免疫异常，炎症介质及非免疫方面对可能的发病机制作一综述。     

难治性肾病综合征的发病机制新进展

随着难治性肾病综合征的日益增多 ,人们通过新的途径对其发病机制进行不断探索 ,寻求新的治疗方案。本文就国内外新的研究从分子遗传学 ,免疫异常 ,炎症介质及非免疫方面对可能的发病机制作一综述。     

Castleman病肾损害的临床病理分析

目的 探讨Castleman病肾损害的临床病理特点。 方法 对10例Castleman病合并肾损害患者的临床病理资料进行分析。全部病例均接受了淋巴结和肾组织的病理检查,肾活检组织分别进行了光镜、免疫荧光和电镜检查。 结果 10例均为男性,平均年龄（49±14）岁。多数患者有水肿;全部患者均有蛋白尿,尿蛋白量（24 h）为（2.79±3.56）g,其中1例为肾病综合征（NS）;8例有血尿;6例并发急性肾功能不全;4例有高血压。多数有发热、乏力、纳差、体质量下降等。其他异常有贫血、血小板减少、浆膜腔积液、红细胞沉降率增块、高γ球蛋白血症、补体降低、C反应蛋白（CRP）升高、肝脾肿大、甲状腺功能低下等。2例符合POEMS综合征,1例有干燥综合征。10例均表现全身多处淋巴结肿大,以颈部、腋窝及腹股沟淋巴结肿大最常见。淋巴结活检病理类型分别为浆细胞型4例,透明血管型3例,混合型3例。肾活检病理诊断分别为血栓性微血管病5例、新月体性肾小球肾炎2例、肾淀粉样变1例、肾小球微小病变1例、慢性肾小管间质肾病1例。所有病例经过免疫抑制剂或COP方案治疗,病情均明显缓解,淋巴结缩小,蛋白尿减少或转阴,大部分病例肾功能恢复正常。 结论 Castleman病肾损害的临床和病理表现具有多样性,急性肾功能不全发生率较高,常并发全身多系统损害,肾脏病理以血栓性微血管病较多见。对于伴有全身多系统异常的肾脏病患者,有必要进行淋巴结影像学检查和淋巴结活检。     

硫酸乙酰肝素-呼吸道病毒激发MCNS的钥匙

微小病变型肾病是小儿常见病，其病因和发病机制尚未完全阐明，而呼吸道病毒感染与本病的触发密切相关。硫酸乙酰肝素是呼吸道合胞病毒等呼吸道病毒入侵靶细胞的受体，肾脏固有细胞硫酸乙酰肝素的减少可产生蛋白尿。呼吸道病毒通过硫酸乙酰肝素与肾脏固有细胞结合，侵入细胞，破坏细胞表面硫酸乙酰肝素，导致大量蛋白尿形成，另一方面病毒基因反式激活基因转录调控因子，导致细胞因子的改变从而触发该病。     

激素抵抗型肾病综合征机制及治疗进展

激素抵抗型肾病综合征在通常容易导致慢性肾脏疾病,而目前对于该疾病的治疗方案尚未达成一致的看法.近些年来,随着该病发病机制研究的不断深入以及新型药物的运用和传统药物循证医学证据的增加,对该病的治疗有了进一步的认识.本文对以上进行综述.     

激素抵抗型肾病综合征机制及治疗进展

激素抵抗型肾病综合征在通常容易导致慢性肾脏疾病,而目前对于该疾病的治疗方案尚未达成一致的看法.近些年来,随着该病发病机制研究的不断深入以及新型药物的运用和传统药物循证医学证据的增加,对该病的治疗有了进一步的认识.本文对以上进行综述.     

肾病综合征患者肾活检组织的透射电镜病理学研究

目的:探讨电镜检查在肾病综合征(NS)肾活检病理诊断中的作用。方法:对403例NS患者的肾活检组织进行透射电镜检查,分析电镜结果对最终诊断的意义。结果:"电镜对诊断起决定性作用"144例(35.7%),"电镜对诊断具有重要价值"77例(19.1%),"电镜对诊断非必需"182例(45.2%)。NS组中"电镜有诊断价值"("决定性作用"+"重要价值")的比例高于非NS组(NS∶非NS=54.8%∶32.2%,P<0.01)。"电镜有诊断价值"的比例因NS的病因、年龄和性别的不同存在组间差异,P<0.01(原发性NS∶继发性NS=77.4%∶7.5%;年龄<20岁组∶20岁～40岁组∶≥60岁组=74.4%∶52.1%∶45.8%;男∶女=68.0%∶42.2%)。结论:电镜检查对NS的正确病理诊断具有重要的意义。NS肾活检确诊对电镜的依赖程度受患者性别、年龄及病因等因素的影响。     

肾结石并发肾盂上皮细胞癌7例

目的：探讨提高肾结石并发肾盂上皮细胞癌术后生存率的方法。方法：回顾性分析7例肾结石并发肾肿瘤患者的临床资料，其中肾盂鳞状细胞癌6例，肾盂移行上皮细胞癌1例。诊断采用静脉肾盂造影和逆行肾盂造影、B超、CT等方法。均行根治性肾切除术加局部淋巴结清扫。结果：随访平均5年，存活2例。结论：早期诊断并手术治疗，是提高肾结石并发肾盂上皮细胞癌患者的术后生存率的有效手段。     

X线下Ⅱ期经皮肾镜弹道联合超声清石系统治疗残余肾结石

目的探讨X线定位经皮肾镜取石术(percutaneous nephrolithotomy,PCNL)治疗残余肾结石的临床应用价值。方法2005年7月～2008年11月,采用X线下定位Ⅱ期PCNL治疗残余肾结石90例,其中单侧肾结石81例,双侧肾结石9例。结果76例结石直接完全清除,6例仍有直径1cm残余结石,余8例因建立盏间通道出血,Ⅲ期清除结石。术后无严重并发症,无术后出血及感染症状。90例中失访8例,82例随访3～6个月,平均4.5月,术后无严重并发症。结论X线下Ⅱ期经皮肾镜碎石术是治疗残余肾结石的一种安全、有效方法,具有较高的结石清除率,并发症少。     

Hepatic Vascular Disease After Kidney Transplantation: Report of Two Cases and Review of the Literature

Severe hepatic vascular disease developed in two patients 4and 8 years after kidney transplantation, while receiving combinedimmunosuppressive therapy with prednisone and azathioprine.Portal hypertension and marked liver failure were observed inboth cases. The diagnosis was established by histological examinationof liver biopsies showing typical veno-occiusive disease ofthe liver associated with peliosis in both cases. Azathioprine was discontinued. Two years later one patient wasasymptomatic and liver function tests were normal. The secondpatient died 3 years later from liver failure. Early recognitionof hepatic vascular disease arising in kidney transplant recipientswould be of utmost importance, as substitution of another immunosuppressiveagent for azathioprine could halt the process leading to portalhypertension.     

Renal Cell Carcinoma of Extraordinarily Large Size: A Case Report

One of our patients was a 66-year-old woman with a T2 renal cell carcinoma weighing 3900 g. Two years after radical nephrectomy the woman was alive and well. A survey of Japanese medical literature revealed that patients with renal cell carcinomas weighing more than 2000 g have an unexpectedly favorable prognosis with a 5-year survival rate of 76.9%.     

输尿管软镜下钬激光碎石术治疗肾结石(附106例报告)

目的探讨输尿管软镜下钬激光碎石术治疗肾结石的疗效。方法采用输尿管软镜下钬激光碎石术治疗肾结石106例,结石大小0.8～1.6cm,平均1.2cm。经输尿管硬镜扩张后留置输尿管扩张鞘,寻及结石以200μm光纤、0.8～1.2J/5～10Hz功率钬激光碎石。结果106例共有结石122枚,结石寻及率96.7%(118/122),单次碎石成功率91.8%(112/122)。手术时间30～60min,平均45min。术后住院1～4d,平均3d。无脓肾、输尿管穿孔等并发症。91例随访3～12个月,平均6个月,无结石复发。结论输尿管软镜下钬激光碎石术治疗肾结石安全、有效,尤其适用于结石体积较小、肾盏无明显积水,以及因解剖特点预期体外震波碎石效果不佳的患者,疗效确切,并发症少。     

Breast Cancer with Nephrotic Syndrome: Report of Two Cases

We report two cases of women found to have breast cancers within a few months of being diagnosed with nephrotic syndrome. Case 1 was a 53-year-old Japanese woman in whom breast cancer was diagnosed 14 months after the onset of nephrotic syndrome. The histological diagnosis was invasive ductal carcinoma with no lymph node metastasis. We performed a modified radical mastectomy, after which the proteinuria and hypoproteinemia resolved almost completely, and the patient has been disease-free for 5 years since. Case 2 was a 61-year-old Japanese woman in whom breast cancer was diagnosed 2 months after the onset of membranous nephropathy. We performed a modified radical mastectomy and the histological diagnosis was invasive ductal carcinoma with marked lymphatic vessel permeation and involvement of five axillary lymph nodes. Proteinuria and hypoproteinemia did not resolve postoperatively and there is a high possibility of remnant or recurrent cancer. To our knowledge, there are only four other reported cases of paraneoplastic membranous nephropathy complicating breast cancer. However, we speculate that the postoperative resolution of nephrotic syndrome might be a measure of cancer control.     

Renal epithelioid angiomyolipoma: 2 Cases report

Introduction

The 2004 World Health Organization Classification of Renal Neoplasms defined epithelioid angiomyolipoma as a potentially malignant mesenchymal neoplasm, characterized by a proliferation of predominantly epithelioid cells with approximately one third of patients experiencing metastases and one half of them having a history of tuberous sclerosis complex.

Coronavirus Disease 2019 Pneumonia in Immunosuppressed Renal Transplant Recipients: A Summary of 10 Confirmed Cases in Wuhan,China

BackgroundPrevious studies on coronavirus disease 2019 (COVID-19) have focused on populations with normal immunity, but lack data on immunocompromised populations.ObjectiveTo evaluate the clinical features and outcomes of COVID-19 pneumonia in kidney transplant recipients.Design, setting, and participantsA total of 10 renal transplant recipients with laboratory-confirmed COVID-19 pneumonia were enrolled in this retrospective study. In addition, 10 of their family members diagnosed with COVID-19 pneumonia were included in the control group.InterventionImmunosuppressant reduction and low-dose methylprednisolone therapy.Outcome measurements and statistical analysisThe clinical outcomes (the severity of pneumonia, recovery rate, time of virus shedding, and length of illness) were compared with the control group by statistical analysis.Results and limitationsThe clinical symptomatic, laboratory, and radiological characteristics of COVID-19 pneumonia in the renal transplant recipients were similar to those of severe COVID-19 pneumonia in the general population. The severity of COVID-19 pneumonia was greater in the transplant recipients than in the control group (five severe/three critical cases vs one severe case). Five patients developed transient renal allograft damage. After a longer time of virus shedding (28.4 ± 9.3 vs 12.2 ± 4.6 d in the control group) and a longer course of illness (35.3 ± 8.3 vs 18.8 ± 10.5 d in the control group), nine of the 10 transplant patients recovered successfully after treatment. One patient developed acute renal graft failure and died of progressive respiratory failure.ConclusionsKidney transplant recipients had more severe COVID-19 pneumonia than the general population, but most of them recovered after a prolonged clinical course and virus shedding. Findings from this small group of cases may have important implications for the treatment of COVID-19 pneumonia in immunosuppressed populations.Patient summaryImmunosuppressed transplant recipients with coronavirus disease 2019 infection had more severe pneumonia, but most of them still achieved a good prognosis after appropriate treatment.     

后腹腔镜下保留肾单位9例报告

目的探讨后腹腔镜下保留肾单位手术控制肾蒂及处理肾脏创面的方法。方法我院2003年12月~2007年1月行后腹腔镜下保留肾单位手术9例,术中采取牵拉硅胶管不全阻断肾动脉,在距肿瘤0.5~1.0 cm超声刀切除肿瘤,生物蛋白胶、止血纱布及可吸收线缝合肾脏创面。结果9例手术均获成功,无中转开放手术。手术时间2~3.5 h,平均2.6h;术中出血量50~400 ml,平均150 ml。围手术期无出血、尿漏等并发症。术后病理:8例透明细胞癌,1例血管平滑肌脂肪瘤,标本切缘均为阴性。9例随访4~36个月,平均13个月,肾功能正常,B超或CT显示无局部复发,B超、胸片、骨扫描显示无其他脏器转移。结论掌握一定的控制肾蒂及处理肾脏创面的方法,后腹腔镜下保留肾单位手术安全、有效,可以在临床上推广使用。