阿魏酸钠对慢性肾功能衰竭患者尿蛋白的影响

将 40例慢性肾功能衰竭 (CRF)患者随机分为对照组 (n =2 0 )和治疗组 (n =2 0 )进行 4周治疗观察。结果对照组和治疗组2 4小时尿蛋白 ( 2 4hUPE)、Scr、BUN均有所下降 ,Ccr有所升高 ,但只有治疗组 2 4hUPE、BUN下降明显 (P <0 .0 5 ) ,对照组和治疗组其余各项变化均不明显 (P >0 .0 5 )。阿魏酸钠对CRF氮质血症期的尿蛋白有治疗作用。     

Pseudoclubbing in Chronic Renal Failure

Seven patients with chronic renal failure developed a peculiarabnormality of the fingers referred to as pseudoclubbing. Allhad radiological evidence of severe secondary hyperparathy roidismand elevated parathormone levels measured by C-terminal assay.Treatment with vitamin D and calcium, parathyroidectomy or renaltransplantation resulted in radiological healing but the deformityof the finger tips did not improve. Although these patientsrepresent a group with severe secondary hyperparathyroidism,autonomous secretion of parathormone is not a necessary accompanimentof this disorder.     

Myopathy in Chronic Renal Failure

A group of eleven patients in end-stage renal failure who developedproximal weakness is described. The muscle weakness in all caseswas shown to be myopathic in nature by quantitative electromyography.Four of the patients presented with muscle dysfunction and werefound to have severe osteomalacia secondary to renal disease.In these patients vitamin D in high doses produced some improvementin muscle weakness. In the other patients who were on maintenancedialysis, muscle weakness improved dramatically after renaltransplantation or dialysis with deionized water. There wereno quantitative differences between the two groups as far asmuscle weakness was concerned. However it is suggested thatmetabolic bone disease may be one pathogenic factor in the firstgroup and that some aspect of renal failure per se (or its treatmentby dialysis) may predominate in the second and contribute tothe first. ¹Present address: Medical School, Northwestern University, 303East Chicago Avenue, Chicago 60611, Illinois, U.S.A. ²Present address: Department of Neurology, Wayne State UniversityMedical School, Detroit, Michigan 48092, U.S.A.     

Urea Metabolism in Chronic Renal Failure

Urea degradation was measured during 16 experiments in 13 chronic uremic patients being treated with essential amino acids or their analogues. [(14)C]Urea was injected i.v. and the clearance of labeled urea from its volume of distribution was compared with the simultaneous renal clearance of ordinary urea, which averaged 2.0 liters/day. The difference, extrarenal clearance of urea, averaged 3.1 liters/day as compared with a previously reported mean of 18 liters/day in normal subjects. Thus urea-splitting activity in the gut of uremic subjects expressed in these terms is far less than in normal individuals. Nevertheless, the amount of ammonia N formed from urea in these patients, 3.5 g/day, is not significantly different from normal, owing to their elevated plasma urea. In the same subjects, urea appearance rate was measured as the sum of urea excretion and the daily change in the urea pool. No negative correlation was noted between urea appearance and urea degradation, as might be expected if portal ammonia were being utilized for protein synthesis. However, urea production was positively correlated (r = 0.76) with urea degradation, suggesting that most of the resulting portal ammonia is converted back to urea. The results fail to support the view that degradation of urea in the gut promotes N conservation in uremic subjects maintained on low protein diets.     

Body Composition in Chronic Renal Failure

In severe chronic renal failure loss of weight is common dueto a reduction in body fat and fat-free solids. The lean bodymass forms an increased proportion of body weight. Body wateris relatively increased largely due to an excess extracellularfluid. Intracellular fluid is reduced relative to standard weightin the majority of patients. The exchangeable sodium is increased. The changes are not confined to patients with terminal uraemiabut are most marked in those who have received prolonged treatmentwith low-protein diets. After the start of regular haemodialysis body weight falls becauseof losses of body water from both extracellular and intracellularspaces. Thereafter body weight increases, due to gains in bodyfat and fat-free solids. Changes in exchangeable sodium arevariable. Intercurrent illness, poor dialysis, or fluid indiscretionsrapidly induce a return of the original abnormalities and recoveryis slow. Similar changes in body composition are observed after renaltransplantation though these may be modified by large dosesof prednisone. In general, transplantation is more effectivein restoring body composition to normal than haemodialysis. These changes closely resemble those found in malnutrition andit is suggested that the abnormalities of body composition foundin chronic renal failure are attributable to protein-caloriedeficiency. ¹This work forms part of a thesis approved by the Universityof London for the degree of Doctor of Medicine.     

瘦素与慢性肾功能衰竭

瘦素是一种由肥胖基因（Obgene）编码的分子量为16.7kDa的多肽类激素,具有降低食欲、增加能量消耗等重要生理作用。瘦素与肾脏的关系密切,肾脏是瘦素的主要清除器官,同时瘦素又可对肾脏功能产生直接作用,影响慢性肾功能衰竭患者的疾病进程。因此,研究者希望通过调节血清中瘦素水平,达到缓解慢性肾功能衰竭进程的目的。     

The Artificial Kidney in Chronic Renal Failure

Hemodialysis has proved valuable in improving and stabilizing patients in terminal chronic uremia.

In this analysis of 71 patients in whom hemodialysis was used, the diagnosis and therapeutic response were definitely correlated. The highest percentage of favorable responses was obtained in cases of polycystic renal disease; none of the patients with subacute glomerulonephritis responded favorably.

The prognosis was worse in chronic glomerulonephritis when hypertension or extensive glomerular destruction was present. Factors such as age, congestive heart failure and active infection were not significant in predicting a response.     

Plasma 25-Hydroxycholecalciferol in Chronic Renal Failure

Abstract. 47 patients with chronic renal failure were investigated for plasma 25-hydroxycholecalciferol (25-OH D₃) concentration, serum calcium, phosphorus, alkaline phosphatase. 22 patients had chronic haemodialysis twice weekly. There is a highly significant positive coefficient of correlation between calcaemia and 25-OH D₃ plasma concentration. Levels of serum calcium had previously been shown to correlate well with the presence and type of osteodystrophies in chronic renal failure. Since these patients may be unable to synthesize 1,25 dihydroxy D₃, the metabolite of vitamin D₃ considered to be active on intestine and bone, a direct role of 25-OH D₃ in the regulation of calcium metabolism may have to be considered.     

The Urinary Excretion of Parenterally Administered Radiovitamin B12 in Renal Failure

Purified fibrinogen and fibrin, and the clottable proteins of normal plasma, have been examined by quantitative N-terminal amino acid analysis. When normal plasma was incubated with traces of thrombin, the clottable proteins always contained N-terminal glycine. This probably reflects soluble fibrin (precipitated by 8% ethanol) and possibly also high molecular weight derivatives of fibrinogen, devoided of fibrinopeptides (precipitated by 16% ethanol). The clottable proteins of normal, non-incubated plasma, did not contain N-terminal glycine, indicating absence of fibrin.     

慢性肾功衰竭患者的糖代谢紊乱

本文测定了27例慢性肾功衰竭(CRF)患者口服葡萄糖耐量试验(OGTT)时的血清胰岛素,并以性别年龄匹配的27例正常人作为对照。结果显示CRF患者耐糖曲线及胰岛素释放曲线均高于正常对照组;耐糖异常(IGT)及耐糖正常(NGT)的CRF患者胰岛素释放曲线有明显差异。     

Excretion of Noradrenaline in Urine in Hypertension

Abstract

Background. Previously, data on both the within-subject (SD_I) and the between-subject (SD_G) variation of cystatin C in children has not been reported. Thus, this study aimed to determine this biological variation including analytical variation (SD_A) of both cystatin C and creatinine to characterize the two analytes as renal function markers in children. Methods. On two consecutive days blood samples for duplicate analysis of cystatin C (nephelometric, Dade Behring) and creatinine (enzymatic, Roche) were obtained from 30 children (11 females and 19 males, mean age 8.3 range 2–13 years) referred for GFR measurements by ⁵¹Cr-EDTA clearance. For determination of the between-subject variation only children with normal GFR (n=21) were included. Data were adjusted for the well known age-related increase in creatinine. Results. The results are given as coefficients of variation. The within-subject variations were identical for both analytes (6.4%). The between-subject variation was 11.1% for cystatin C and 28.4% for creatinine, though decreasing to 20.1% after adjusting for age. The analytical variation was 1.7% and 2.5% for cystatin C and creatinine, respectively. The index of individuality (IOI = SD_I/SD_G) was 0.65 for cystatin C and 0.25 for creatinine, though increasing to 0.36 after age-adjustment. Conclusion. The within-subject variation was identical and low for cystatin C and creatinine suggesting that the two are equally suitable for serial monitoring of renal function in children. Based on the low IOI neither analyte, however, seems suitable as a screening marker of renal function in a healthy population of children using population-based reference intervals.     

彩色多普勒对慢性肾功衰竭肾动脉血流参数范围探讨

本文利用彩色多普勒成像技术对慢性肾功衰竭失代偿期患者４５例的肾动脉血流分布、频谱特征及血流参数进行检测。旨在对临床医师提供参考及疾病鉴别。结果：（１）、慢性肾衰双侧主肾动脉及分支血流信号分布有逐渐减弱甚至消失的趋势，主肾动脉显示率为１００％（４５／４５），段动脉显示率为９３％（４２／４５），叶间动脉显示率为５８％（２６／４５），弓形动脉显示率为０（０／４５）；（２）、各级动脉频谱波峰变钝，舒张充盈曲线低平、中断，曲线欠光滑，空心层流消失，弓形动脉频谱极难测得；（３）、肾动脉血流参数表明从主肾动脉至分支血流速度逐级明显降低，阻力指数较大，搏动指数增大。结论：本组结果表明，慢性肾衰失代偿期患者肾动脉及分支血流分布、频谱特征及血流参数与正常相差较大，从而以血流信号的分布、频谱形态的变化及血流参数的异常初步判断肾血流及肾功能状态，以迅速了解病情、监测治疗、估评预后，为慢性肾衰的快速判定和全面诊断提供更加完善的依据     

慢性肾功能衰竭病人血流变学指标的变化

对 5 0例慢性肾功能衰竭患者组和 5 0例正常对照组进行血流变 12项指标检测并观察其变化现象 ,结果显示 :除男性全血低切粘度、全血高切粘度和女性血浆粘度、血小板粘附率与对照比较无显著性差异外 ,其它指标均有显著性差异或极显著性差异 (Ｐ<0 0 5～ 0 0 1) ,说明慢性肾功能衰竭患者组的血液流变性有非常明显的异常变化。同时慢性肾功能衰竭男女患者之间的流变性型别存在着差异 ,提示临床注意分别进行判断治疗。1　材料与方法1 1　对象　患者组为我院血液透析科病人 (透析前 ) 5 0人 ,年龄 14～ 72岁 ,男 2 6人、女 2 4人。对照组为我市…     

大黄治疗慢性肾功能衰竭的系统评价

目的评价大黄治疗慢性肾功能衰竭、延缓慢性肾功衰进展的疗效及安全性. 方法计算机检索Medline数据库、Cochrane 图书馆临床对照试验资料库、中国生物医学文献光盘数据库,检索年限从建库～2000年12月.人工检索<中华肾脏病杂志>等15种肾脏病和中医中药的核心杂志,检索年限从1980年1月至2000年12月.查找符合纳入标准的随机/半随机对照试验,进行质量评价,而后提取相关数据进行Meta分析,统计软件用RevMan 4.1. 结果共纳入18篇随机/半随机对照试验,有1 322例病人符合纳入标准,但其方法学质量均较低.与非中药治疗处理相比,大黄治疗慢性肾功能衰竭在降低血肌酐、尿素氮、减轻症状、纠正贫血与营养不良方面有一定疗效.在减少死亡人数 [OR 0.15,95%CI (0.06,0.36), P =0.000]、减少终末期肾病发生 [OR 0.38, 95%CI (0.09,1.64), P =0.19 ] 方面,由于样本例数太少,疗效仍不肯定.结论大黄治疗慢性肾功能衰竭可能有效,但延缓慢性肾功衰进展的作用尚不肯定.还需要设计良好的大规模、多中心随机对照试验做进一步证实.     

慢性肾功能衰竭患者性功能障碍

血液透析或腹膜透析能解除患者生命之虞，慢性肾功能衰竭（CRF）患者常常合并性功能障碍，已成为影响其生活质量的一个重要问题，却很少得到关注。本文就有关慢性肾功能衰竭患者性功能障碍的病因、诊断、治疗方法等进行综述如下。     

慢性肾功能衰竭患者血粘度指标的观察

目的：探讨慢性肾功能衰竭患者血流变指标的变化。方法：对80例慢性肾功能衰竭患者及50名正常对照者进行血流变指标的检测。结果：慢性肾功能衰竭患者组的全血粘度,血沉,红细胞压积,全血还原粘度,血浆粘度及纤维蛋白原含量等与正常结果组比较均有显著性差异（P＜0．05或P＜0．01）,结论：慢性肾功能衰竭病人的高粘滞状态是引起高凝状态的原因之一。     

Gastric Helicobacter and Upper Gastrointestinal Symptoms in Chronic Renal Failure

We studied histologically antral biopsies from 89 consecutive patients with chronic renal failure for Helicobacter pylori (previously Campylobacter pylori). A dose-response gastric secretion test was also performed. The frequency of Helicobacter-positive subjects was low (15/89, 17%), corresponding to figures reported in the literature for young symptomless volunteers. Helicobacter-positive patients had significantly more frequently upper gastrointestinal symptoms than Helicobacter-negative individuals (P < 0.05). Antral gastritis was more common in the Helicobacter-positive than in the Helicobacter-negatice renal patients (P < 0.01), but the incidence of body gastritis did not differ between them. The Helicobacter-positive patients had lower serum urea levels (P < 0.01) and higher acid outputs (P < 0.001) than Helicobacter-negative subjects. All patients had raised fasting serum gastrin levels, which possibly obscured the difference between Helicobacter-positive (283 pg/ml) and-negative (331 pg/ml) patients. We conclude that in chronic renal failure gastric colonization of Helicobacter pylori is not more frequent than usual. It correlates positively with antral gastritis, gastric acid output and upper gastrointestinal symptoms, but negatively with serum urea levels.     

The Pharmacokinetics and Pharmacodynamics of Methylprednisolone in Chronic Renal Failure

Methylprednisolone (MP) pharmacokinetics and its directly suppressive effects on cortisol secretion, circulating T-cells, and basophils in blood were compared in six chronic renal failure (CRF) subjects and six healthy controls after an IV administration of MP 0.6 mg kg(minus sign1) as the sodium succinate ester. The CRF subjects were studied between hemodialysis treatments. The total clearance of methylprednisolone sodium succinate (the prodrug) was reduced by 40% in CRF; however, the pharmacokinetics of methylprednisolone remained unchanged. Methylprednisolone clearance was approximately 280 ml h(minus sign1) kg(minus sign1) and volume of distribution was about 1.1 L kg(minus sign1). Physiological pharmacodynamic models were applied for the immediate effects of MP, based on the premise that receptor binding is followed by rapid suppression of the secretion of cortisol and recirculation of basophils, T-helper cells, and T-suppressor cells, which persist until inhibitory concentrations (IC(50)) of methylprednisolone disappear. The difference in IC(50) for each pharmacodynamic parameter was not statistically significant, suggesting no difference in the responsiveness of these factors to methylprednisolone in CRF. As the pharmacokinetics of other corticosteroids are altered in CRF, the lack of pharmacokinetic and pharmacodynamic changes of methylprednisolone may engender a therapeutic advantage for this corticosteroid in CRF.