慢性肾衰竭、充血性心力衰竭与贫血三者之间的关系

目的:探讨充血性心力衰竭(CHF)、慢性肾衰竭(CKI)和贫血三者之间的关系。方法:74例CKI患者被分为心衰组(33例)和非心衰组(41例);按血红蛋白(Hb)水平分为≥90g/L组(21例)和<90g/L组(53例);按内生肌肌酐清除率(Ccr)分为>10ml/min组(15例)和≤10ml/min组(59例)。检测Hb和血红细胞压积(HCT),计算Ccr,测量血压(BP)、心脏彩超检查:左心房内径(LAD)、心室间隔(IVST),左心室后壁厚度(LVPWT)和左室射血分数(LVEF)。结果:CKI组和非心衰组比较,Hb、HCT、Ccr、LAD、IVST、LVP-WT和LVEF有明显差异(P<0.01)。心衰治疗前后比较,Hb、HCT、和BP有明显差异(P<0.01)。Ccr>10ml/min组与Ccr≤10ml/min组比较Hb、HCT、IVST、LVPWT、LAD、LVEF和BP有明显差异(P<0.01)。Hb≥90g/L组与Hb<90g/L组比较,CCr、BP、LAD、IVST、LVPWT和LVEF有明显差异(P<0.01)。结论:CKI、CHF和贫血三者常并存,彼此关联。治疗应三者兼顾,方能取得较好疗效。     

以急性肾衰竭起病的急性白血病1例

以急性肾衰竭(ARF)起病的急性白血病在临床上较少见〔1～3〕,其中以急性淋巴细胞白血病(ALL)占的比例较大,且多见于儿童。其起病隐匿,病情凶险,诊断困难,易造成误诊。我院收治以急性肾衰竭起病的急性白血病1例,病情复杂,现报告如下。     

充血性心力衰竭、慢性肾衰竭与贫血三者之间的关系

目的探讨充血性心力衰竭(CHF)、慢性肾衰竭(CKI)和贫血三者之间的关系.方法将74例CKI患者分为心衰组(33例)和非心衰组(41例);按血红蛋白(Hb)水平分为≥90 g/L组(21例)和(<90)g /L组(53例);按内生肌酐清除率(Ccr)分为>10 ml/min组(15例)和≤10 ml/min组(59例).检测Hb和红细胞压积(HCT),计算Ccr,测量血压(BP),心脏彩超探测左心房内径(LAD)、左心室间隔(IVST)、左心室后壁厚度(LVPWT)和射血分数(EF).结果 CKI心衰组和非心衰组比较,Hb、HCT、Ccr、LAD、IVST、LVPWT和EF有明显差异(P<0.01).心衰治疗前、后比较,Hb、HCT和BP有明显差异(P<0.01).Hb≥90 g/L组与Hb<90 G/L组比较,Ccr、BP、LAD、IVST、LVPWT和EF有明显差异(P<0.01).Ccr>10 ml/min组与Ccr≤10 ml/min组比较,Hb、HCT、IVST、LVPWT、LAD、EF和BP有明显差异(P<0.01).结论 CHF、CKI和贫血三者常并存,彼此关联.治疗应三者兼顾,方能取得较好疗效.     

散利痛引起急性肾衰竭4例

散利痛是一个常用的解热镇痛药，很少有引起肾衰竭的报道，我院2000年1月～2006年12月收治疗了4例由散利痛引起的急性肾衰竭患者，现报告如下。[第一段]     

甘露醇治疗急性脑血管病致急性肾衰竭72例分析

目的：探讨急性脑血管病（CVD）使用甘露醇（MT）致急性肾衰竭（ARF）的发生率、发生因素、临床表现、死亡率、死亡原因及防治措施。方法对临汾市人民医院收治的72例急性 CVD 使用 MT 致 ARF 患者的临床资料进行回顾性分析。结果急性CVD使用 MT致 ARF的发生率为22.0%,发生的主要因素为高龄、合并有易致肾功能损害因素、脑出血、大剂量甘露醇长时间使用,约90%出现少尿,50%出现无尿,急性CVD使用MT致ARF的病死率为58%,死亡原因为多器官功能衰竭（35.71%）、脑疝（21.43%）、消化道出血（14.29%）,注意控制甘露醇用量、滴速、用药时间、辅助使用其他脱水药物、保证适量的出入量防治 ARF。结论急性CVD使用 MT易发生 ARF,发生 ARF后患者总死亡率高,死亡主要原因是多器官功能衰竭和脑疝,对危重患者应密切观察肾功能,避免使用大剂量 MT,以减少 ARF的发生。     

老年急性肾衰竭的诊治进展

急性肾衰竭(ARF)是由多种病因引起的,临床表现为肾功能在数天或数周内迅速恶化、体内代谢产物潴留、肾小球滤过率下降以及由此引起的水、电解质及酸碱平衡紊乱的临床综合征.随着年龄的增加,由于肾脏结构和生理功能的改变,老年人肾脏重量减轻、肾血管硬化、肾血流量下降、自身血管调节能力明显减低、血管活性物质分泌减少、尿浓缩稀释功能降低、肾脏储备功能下降等,或常合并有肾脏基础病变(如高血压肾损害、糖尿病肾病等),因此,老年是罹患ARF的高危人群,尤其是医院获得性ARF (HA-ARF),占住院患者的2％～7％,占重症患者的25％[1,2],同时研究表明老年人对各种肾损伤因素的敏感性增高,极易发生ARF,而且年龄越大,发生ARF的概率越高[3].     

药物引起的急性肾衰竭

肾脏血流丰富，是体内药物代谢和排泌的重要器官，当血液中存在肾毒性物质时，肾脏极易受损。近年来，不仅抗菌药物引起急性肾衰竭（ARF）、慢性肾衰竭日益增多，由血管紧张素转换酶抑制剂（ACEI）类及肿瘤化疗药物所致的肾衰竭也呈上升趋势。药物因素已成为肾实质性ARF的首要病因。药物引起的肾衰竭主要为肾实质性ARF，包括急性肾小管坏死（ATN）、小管间质炎症及肾血管、小球损伤。以下主要针对药物所致的肾实质性ARF展开阐述。     

急性肾衰竭发展进程中血液流变性变化

<正>急性肾衰竭(ARF)是患病机体发展为多器官衰竭(MOF)的重要原因之一〔1〕。为了深入研究ARF的发生机制、探讨治疗措施,学者们根据ARF的病因学复制了多种动物模型,有以氯化汞为代表的重金属中毒、以甘油为代表的挤压综合征、以庆大霉素为代表的药物中毒、以脂多糖(LPS)为代表的生物毒素中毒等肾毒性ARF模型;还有以失血性休克、肾动脉夹闭引起的肾缺血再灌注为代表的肾缺血性ARF模型及以脓毒症引     

创伤后急性肾衰竭62例临床多因素分析

急性肾衰竭是指由各种原因引起的急性肾功能损害,它可以使体内产生代谢产物积聚及水电解质、酸碱失衡,是临床常见的疾病之一,最突出的表现为尿量减少,然而尿量并不是判断有无急性肾衰竭的唯一指标,尤其在创伤后患者常常出现非少尿型急性肾衰竭,为了更好地诊断、治疗创伤后的肾衰竭,本文总结分析住院治疗创伤患者临床特征。     

肾病综合征并急性肾衰竭6例临床分析

急性肾衰竭(acute renal failure,ARF)是由各种原因引起的肾功能在短时间(几小时至几天)内突然下降而出现的临床综合征,是肾病综合征(nephrotic syndrome,NS)的严重并发症之一,临床上也常见,诊断治疗及时正确与否直接关系到肾病综合征的转归及患者的预后。为提高对本病的诊断治     

Acute renal failure following low osmolality radiocontrast dye

It is hoped that recently released low osmolality radiocontrast agents (RCAs) will have a lower nephrotoxic potential, since dye nephropathy may be related to hyperosmolality. We report here 2 cases of typical oliguric dye nephropathy in patients without risk factors for dye nephropathy. These cases show that these new agents do have nephrotoxic potential.     

Plasma quinine concentrations in falciparum malaria with acute renal failure

Plasma quinine (Qn) monitoring was performed in 32 patients with severe falciparum malaria (10 with acute renal failure (ARF) and 22 with other severe manifestations) who were treated with the standard regimen of 10 mg/kg body weight Qn dihydrochloride, with a loading dose of 20 mg/kg body weight. Median plasma Qn concentrations prior to the first dose on each day were approximately 10–30% higher in ARF patients than in non-ARF patients during acute infection. Seven patients underwent haemodialysis; 2 died after 2 cycles. There were no significant changes in plasma Qn concentrations in patients with ARF during haemodialysis. No Qn was detectable in haemodialysate fluids. This suggests that dosage adjustment of Qn during haemodialysis is unnecessary. Cardiotoxity of Qn must be of concern in malaria patients with ARF after 3 days of Qn therapy, and ECG monitoring during Qn infusion is recommended in all severe malaria patients with persistent ARF. If there is any arrhythmia, the infusion should be discontinued. However, in some hospitals where ECG facilities are not available, reduction in Qn dosage in persistent ARF patients should be considered after the third day of therapy. The appropriate dosage reduction should be further studied. Monitoring of total plasma Qn concentrations (which has been used routinely) is of no value for predicting the cardiotoxicity in ARF patients; monitoring of free Qn would be more appropriate. However, ECG seems to be the practical procedure to monitor cardiotoxicity of Qn. It may be possible to use the QTc interval to estimate the Qn concentration in severe malaria patients without ARF, but not in patients with persistent ARF.     

Acute renal failure complicating high-dose intravenous immunoglobulin therapy for acquired haemophilia

Acquired haemophilia is a rare disorder requiring therapy to control bleeding and to suppress the inhibitory antibody. High-dose intravenous immunoglobulin is commonly used as part of immunosuppressive regimens for this condition. We describe the case of an elderly patient who developed acute oliguric renal failure as a result of intravenous immunoglobulin therapy. All patients receiving such treatment should have renal function carefully monitored both during and after the infusion.     

Seasonal profiles of malaria infection,anaemia, and bednet use among age groups and communities in northern Ghana

We conducted all-age point prevalence surveys to profile the severity and seasonality of malaria and anaemia in Kassena-Nankana District of northern Ghana. Random cross-sectional surveys were timed to coincide with the end of low (May 2001) and high (November 2001) malaria transmission seasons and to yield information as to the potential value of haemoglobin (Hb) levels and parasitaemia as markers of malaria morbidity and/or malaria vaccine effect. Parasitaemia was found in 22% (515 of 2286) screened in May (dry-low transmission), and in 61% of the general population (1026 of 1676) screened in November (wet-high transmission). Malaria prevalence in May ranged from 4% (infants <6 months and adults 50-60 years) to 54% (children 5-10 years). Age-specific malaria prevalence in November ranged from 38% (adults 50-60 years) to 82% (children 5-10 years). Differences between low- and high-transmission periods in the prevalence of severe anaemia (SA) among young children (6-24 months) were unexpectedly comparable (low, 3.9%vs. high, 5.4%; P = 0.52) and greatly reduced from levels measured in this same community and age group in November 2000 (12.5%) and November 1996 (22.0%). Despite the lower frequency of anaemia/SA in young children surveyed in 2001, it was still clear that this condition was strongly associated with parasitaemia and that children under 5 years of age experienced a significant drop in their mean Hb levels by the end of the high transmission season. Prevalence of parasitaemia was significantly lower (P < 0.01) among infants and young children (<2 years) whose parents reported the use of bednets. There was a significantly lower risk of parasitaemia among infants [odds ratio (OR) 6-8] and young children (OR 3-4) living in the central, more urbanized sector of the study area.     

腹泻伴溶血尿毒综合征、急性肾衰─—附3例报告

溶血尿毒综合征（ＨＵＳ）是小儿时期引起肾衰的原因之一，是儿科的重要问题。ＨＵＳ可分为伴腹泻（Ｄ＋ＨＵＳ）与不伴腹泻（Ｄ－ＨＵＳ），以Ｄ＋ＨＵＳ更为常见。本文报道３例小儿Ｄ＋ＨＵＳ有急性肾衰并对诊断治疗包括腹膜透析作了讨论，进行了近年文献复习。腹泻是小儿很普通的症状，但要引起注意，腹泻可以隐藏有严重的疾病——溶血尿毒综合征、急性肾衰。     

Pharmacokinetics of intravenous recombinant human erythropoietin in patients with chronic renal failure

In order to improve our understanding of the dose-concentration and concentration-effect relationships, the pharmacokinetics of recombinant erythropoietin were studied after the initial dose (n = 6) and after repeated doses (n = 9) administered intravenously in patients with chronic renal failure. Several venous blood samples were collected before (to obtain the baseline concentration) and after an intravenous dose of erythropoietin. A radioimmunoassay was used to determine the erythropoietin concentration in the samples. The apparent volume of distribution at steady state was 4.2 +/- 0.91 (initial dose) and 3.7 +/- 0.61 (repeated dosing), which is close to the assumed plasma volume in these patients. The half-life was 5.3 +/- 1.3 h and 5.8 +/- 1.2 h in the two groups, respectively, and is therefore too short for any accumulation to be expected when dosing three times per week. Consequently, no difference in baseline values could be detected between the groups. The clearance of erythropoietin in the groups was estimated to be 11.4 +/- 7.0 ml min-1 and 7.8 +/- 3.8 ml min-1, respectively. Erythropoietin kinetics did not differ after repeated dosing compared to the single initial dose. Intravenous administration of erythropoietin will result in high peak concentrations followed by a rapid decline to basal values.     

Fatigue and anaemia in patients with chronic heart failure

BACKGROUND: Fatigue is common in patients with chronic heart failure (CHF) and has great impact on functional ability and daily activity. Although anaemia is associated with fatigue, the relationship between fatigue and anaemia is unclear in CHF. The aim of this study was to describe the fatigue experience and its relationship to haemoglobin (Hb) concentration and to evaluate its effect on health-related quality of life in an unselected hospitalised CHF population. METHODS: Ninety three consecutive patients hospitalised with a diagnosis of CHF, enrolled in the EuroHeart Failure Survey, completed the Multidimensional Fatigue Inventory Scale (MFI-20). New York Heart Association (NYHA) functional class, quality of life and haemoglobin were also assessed. RESULTS: Anaemia (Hb < or = 125 g/L) was found in 31 (33%) patients. The perception of fatigue differed significantly between patients with CHF and healthy individuals. Anaemic patients reported significantly more fatigue compared to non-anaemic patients. Decreased haemoglobin and higher NYHA class explained 30% of the variance in General Fatigue. Perceived fatigue was also inversely related to global health and quality of life. CONCLUSION: Our findings suggest that the subjective experience of fatigue in patients with CHF is associated with low haemoglobin concentration and reduced functional status after controlling for age and sex.     

Acute renal failure associated with haematological malignancies: a review of 10 years experience

Patients with ARF and haematological malignancy (excluding myeloma), presenting to a single unit over 10 years were analyzed to see if patients likely to benefit from intensive renal supportive therapy could be identified. 31 episodes of ARF were identified in 29 patients (mean age 51 +/- 2.9 yr): 19 were associated with acute leukaemia (13 AML, 6 ALL); 10 with lymphoma. Acute tubular necrosis (ATN) was identified as the cause of ARF in 26 cases, with sepsis (96%) and exposure to nephrotoxic drugs (88%), especially aminoglycosides, being the commonest precipitating factors. Toxic levels of the latter were commonly documented. Patient survival was 45%. Requirement for mechanical ventilation resulted in a universally fatal outcome; age greater than 55 yr and the presence of CNS symptoms or signs were also significantly associated with a poor outcome. Non-ATN causes (urate nephropathy or obstruction) carried a better prognosis. However, only 4 patients (14%) lived for more than 6 months following ARF. Thus, although a subgroup of patients more likely to benefit from treatment can be identified, the overall prognosis is poor and limited by that of the underlying disease. The potential benefit of avoiding nephrotoxic drugs, especially aminoglycosides, in these patients is highlighted by this study.     

Subacute fulminant hepatic failure with intermittent fever

BACKGROUND:Viral hepatitis B accounts for over 80% of acute hepatic failures in China and the patients die mainly of its complications.A patient with hepatic failure and fever is not uncommon,whereas repeated fever is rare.METHODS:A 32-year-old female was diagnosed with subacute hepatic failure and hepatitis B viral infection because of hyperbilirubinemia,coagulopathy,hepatic encephalopathy,serum anti-HBs-positive without hepatitis B vaccination,and typical intrahepatic pathological features of chronic hepa...