Acute and chronic renal failure

Renal failure is defined as a deterioration of kidney function that results in the retention of nitrogenous waste products. It is increasingly prevalent in older populations, individuals with diabetes or hypertension, and postoperative patients. Therefore, podiatric physicians caring for these populations can expect to encounter this condition frequently. This article describes the epidemiology, causes, complications, and appropriate evaluation of renal failure relevant to a practicing podiatric physician. Also highlighted are treatment considerations, renal dosing of medications, and prevention of contrast nephropathy.     

肾衰方治疗慢性肾衰竭

目的：探究肾衰方治疗慢性肾衰竭的临床疗效。方法选取慢性肾衰竭患者80例,采用随机数字表随机分为2组,各40例,对照组给予西医常规药物治疗,实验组则在对照组的基础上应用肾衰方治疗,均30 d 为1个疗程,治疗2个疗程,检测临床总有效率,对比治疗前后血肌酐（Scr）、血尿素氮（BUN）和血红蛋白（Hb）的改善情况。结果实验组总有效率为85℅,高于对照组的70℅（P ﹤0.05）;2组 Scr、BUN 和 Hb 比较,实验组改善优于对照组,差异有统计学意义（P ﹤0.05）。结论肾衰方具有补益脾肾,益气养阴,活血利水,泄浊解毒之功,能有效改善肾功能,降低 Scr、BUN,明显提高 Hb 含量。     

Treatment of complications due to peritoneal dialysis for chronic renal failure with traditional Chinese medicine.

In this paper, the experience in the treatment of complications due to continuous ambulatory peritoneal dialysis for chronic renal failure with traditional Chinese medicine (TCM) is reported. Modified Renshen Yangrong Tang (Ginseng Nutrition Decoction) was used for anorexia and hypoproteinemia; modified Xiangsha Liujunzi Tang (Decoction of Cyperus and Amomum with Six Noble Ingredients) for abdominal pain and distension; modified Da Chaihu Tang (Major Bupleurum Decoction) for peritonitis; modified Shenling Baizhu San (Powder of Ginseng, Poria and Atractylodes) for diarrhea due to insufficiency of the spleen with abundance of dampness; Lizhong Tang (Decoction for Regulating the Function of Middle-jiao) and modified Sishen Wan (Pills of Four Miraculous Drugs) for insufficiency of both the spleen and the kidney; Siwu Tang (Decoction of Four Ingredients) added with other drugs for cutaneous pruritus, and Guishao Sijunzi Tang (Decoction of Four Noble Drugs added with Chinese Angelica Root and white Peony Root) for renal anemia. The therapeutic principles of invigorating the liver and kidney, strengthening the bones and muscles, and promoting blood circulation to eliminate blood stasis were adopted in the treatment of renal osteopathy, and the therapeutic principles of invigorating the liver and kidney, expelling phlegm and resolving dampness, and promoting blood circulation to eliminate blood stasis in the treatment of hyperlipemia. Shen Tekang capsules (capsules for improving the renal function) was administered to patients for strengthening the viability and improving the nutrition state, and the recipe for treating renal function failure (both formulated by the authors) for improving the renal function so as to decrease the frequency and duration of dialysis.     

Tuberculous orchitis in chronic renal failure

Tuberculosis confined to the testes with no epididymal involvement is uncommon. Chronic renal failure patients requiring hemodialysis have increased risk for developing tuberculosis. We report a 47-year old chronic renal failure man presenting with right testicular tuberculous orchitis. A high index of suspicion is required to recognize the unusual presentation of tuberculosis in this group of patients, and routine screening for tuberculosis may be recommended in patients undergoing hemodialysis.     

Applications of mesenchymal stem cells: an updated review

Mesenchymal stem cells (MSCs) can be readily isolated from a number of adult and fetal tissues, and have the capacity of expansion in vitro on a clinical scale. Bone marrow MSCs are able to differentiate into multiple cell lineages that resemble osteoblasts, chondrocytes, myoblasts, adipocytes, endothelial cells, neuron-like cells, cardiomyocytes and hepatocytes. Preclinical findings from animal experiments are promising and have shown that human multipotent MSCs may have considerable therapeutic potential in a wide variety of human diseases. Research into the role that MSCs play in the induction of tolerance in bone marrow and organ transplantation holds great for future therapeutic strategies. Clinical trials are underway to assess the safety, feasibility and efficacy of MSC transplantation in a variety of human diseases. Clinicians need to know the recent progress and rationale for performing these clinical studies. As such, this review focuses on the background of MSCs and medical research in this area, bridging bench and bedside applications. Conflicting preclinical results and published data from our laboratory are discussed.     

慢性肾功能衰竭动物模型制作的研究

目的制备慢性肾功能衰竭(CRF)动物模型,模拟CRF的自然发病,为研究其发病机制,早期治疗研究提供实验依据。方法15只健康兔通过耳缘静脉注射自制阳离子化牛血清白蛋白(C-BSA),持续8周,分别于注射C-BSA前,注射后2、4、6、8周检测血生化指标,并于各时间点随机处死1只动物,观察肾脏病理。结果模型动物在注射后2周肾脏体积增大,血生化指标在注射后6周明显升高,8周时肾脏光镜和电镜均表现为典型的CRF病理变化。结论成功建立了稳定的,可重复性强的CRF动物模型。     

慢性肾功能衰竭的健康教育

对25例慢性肾功能衰竭患实施健康教面后收到较好的效果，患在出院时能更新观念，改善生活方式，具有初步自我维持健康的功能，提高了生活质量和生存率。     

中国五省市自治区慢性肾脏病患者心血管疾病的患病率调查

目的了解中国慢性肾脏病(CKD)患者心血管疾病(CVD)的发病规律和发病因素。方法对我国5个省市、自治区7家三级甲等医院2002年至2003年收治的1239例慢性肾脏病患者进行流行病学调查。结果(1)慢性肾脏病患者冠状动脉疾病(CAD)的患病率为16．5％,左心室肥厚(LVH)为58．5％,充血性心力衰竭(CHF)27．7％,脑卒中(CVA)5．6％,大血管动脉粥样硬化性病变31．5％。(2)第2—3期轻度慢性肾脏病患者的CAD(5．9％)和CVA(1．0％)患病率已明显高于同地区一般人群;高达41．2％的轻度肾功能减退患者合并LVH,13．8％有充血性心衰的临床证据;CAD、LVH和CHF的患病率随肾功能恶化而增高。(3)本组透析患者CAD的患病率(20．0％)低于欧美国家,而脑卒中患病率(5．4％)显著高于国外报告;不同年龄组、不同地区和糖尿病与非糖尿病慢性肾脏病之问CAD的患病率存在差异;但男、女两性之间无明显差异,女性LVH的患病率甚至高于男性。结论慢性肾脏病患者是心血管疾病的高发人群,轻度慢性肾脏病患者心血管疾病的危险性已明显增加。本组透析病人CAD的患病率低于欧美国家,发病规律也与一般人群有别,故有必要深入研究慢性肾脏病患病人群心血管疾病的发病机制和危险因素。