血液透析和腹膜透析方式与肾移植术后并发症发生的关系：204例回顾性分析

目的:由于移植肾源不足,大多数晚期尿毒症患者术前需要透析治疗。探讨血液透析和腹膜透析方式与肾移植受者术后并发症发生的关系。方法:选择2000-01/2005-12南昌大学第一附属医院泌尿外科收治的肾移植受者204例,术前透析时间大于3个月,均知情同意。按照移植术前透析方式分为两组:①血液透析组(n=122)术前采用血液透析治疗,透析10￣12h/周,手术前1日透析1次。②腹膜透析组(n=82)术前采用标准连续非卧床腹膜透析治疗,直至手术当日,在术前4￣6h排空腹透液。术后3个月拔管。两组都采用同种异体尸肾移植,术后1年内随访记录两组患者术后超急性排斥反应、急性排斥反应、细菌感染、移植肾功能延迟恢复的发生情况以及人/肾1年存活率,并进行对比分析。结果:204例肾移植受者全部进入结果分析。①两组患者肾移植术后1年内超急性排斥反应的发生率及人/肾1年存活率差异无显著性意义(P>0.05)。②血液透析组患者肾移植术后1年内急性排斥反应、细菌感染的发生率低于腹膜透析组(14.8%,25.6%;13.9%,23.2%,P均<0.05),移植肾功能延迟恢复发生率高于腹膜透析组(40.2%,20.7%,P<0.05)。结论:肾移植前腹膜透析、血液透析各有优缺点。血液透析患者的感染率低,移植肾急性排斥反应发生率低;而腹膜透析患者术后肾功能恢复较快,肾功能延迟恢复的发病率低。     

肾移植术后肾功能延迟恢复的护理

目的探讨肾移植术后肾功能延迟恢复的护理措施。方法回顾分析28例尸肾肾移植术后肾功能延迟恢复（DGF）患者的临床资料、治疗和护理措施。结果本组28例D（净患者，26例肾功能恢复正常，痊愈出院；1例行移植肾摘除；1例合并严重感染和心功能衰竭死亡。结论科学、全面的护理措施是肾移植术后肾功能延迟恢复患者康复的重要保障。     

肾移植术后超延迟肾功能恢复15例治疗体会

背景：肾脏移植患者急性排斥反应已不再成为术后的主要并发症,延迟肾功能恢复和慢性移植肾肾病仍然是移植患者术后需要面对的问题。目的：总结分析15例术后发生超延迟肾功能恢复的肾移植患者资料,探讨临床经验及治疗对策。方法：对肾移植后发生超延迟肾功能恢复患者15例进行回顾性分析。15例患者移植后均采用常规剂量的半量（环孢素A3.0～4.0mg/kg,他克莫司0.5～1mg/kg）,并定期监测血药浓度,随时调整免疫用药剂量,采用血液透析/连续性肾脏替代治疗。分析超延迟肾功能恢复诱因,患者观察患者肾功能恢复情况。结果与结论：术中低血压、供肾热缺血时间过长、早期急性排斥反应、环孢素中毒、外科并发症、动脉粥样硬化致移植肾血液灌流不足可能为患者超延迟肾功能恢复的诱因。患者术后由少尿期开始进入多尿期时间最长者为108d,平均32～108d。肾功能正常8例（血清肌酐78～135μmol/L）,肾功能轻度异常5例（血清肌酐135～300μmol/L）,血清肌酐〉300μmol/L者2例。随访时间最长1例11年,至今移植肾功能正常。结果提示,肾移植后尽早行移植肾穿刺活检及移植肾彩超,根据结果采取综合治疗并制订个体化治疗方案可以使大多数的患者移植肾功能恢复正常。     

肾移植术后移植肾功能延迟恢复患者的护理

【目的】探讨肾移植术后移植肾功能延迟恢复患者的护理方法。【方法】总结28例肾移植术后移植肾功能延迟恢复患者的护理经验。【结果】27例患者移植肾功能恢复正常．包括2例并友肺部感染的患者,1例患者切除移植肾。【结论】重视术后心理护理、早期的血液透析及各种并发症的防治可提高手术的成功率。     

前列地尔在肾移植术后肾功能延迟恢复治疗中的辅助作用

目的 探讨静脉应用前列地尔在肾移植术后肾功能延迟恢复治疗中的辅助作用。方法 肾移植术后发生肾功能延迟恢复（DGF）的29例患者，在常规免疫抑制治疗的基础上，其中16例（A组）辅以每天应用前列地尔100μg，13例（B组）未应用前列地尔。比较两组在出现DGF后的透析治疗时间、肾功能恢复情况、彩超的移植肾血流阻力指数（RI）及3个月内急性排斥反应（AR）的发生率。结果 与对照组（B组）比较，前列地尔组（A组）透析治疗时间明显缩短（P〈0．05），移植肾的血肌酐下降速度快（P〈0．05），移植肾血流阻力指数低（P〈0．05），但3个月内AR发生率无明显差异（P〉0．05）。结论 早期静脉应用前列地尔作为一种辅助治疗，对肾移植术后DGF患者移植肾功能的恢复具有显著的促进作用。     

不同亲属供肾肾移植临床疗效观察

目的：评估不同亲属活体供肾肾移植的临床疗效。方法：回顾总结我院实施的40例亲属活体供肾肾移植的效果，其中夫妻间供肾3例，丈夫给妻子1例，妻子给丈夫2例；父母给子女21例；兄弟姐妹间供肾16例。结果：所有供者术后7d内出院．随访2～48个月。供者肾功能均正常；所有受者肾功能均恢复后出院，其中夫妻间供肾肾移植手术患者中，1例患者术后3d发生加速排斥反应；父母给子女的21例接受移植手术的患者中2例肾移植术后7d左右发生急性排斥反应．经大剂量激素冲击治疗后恢复；兄弟姐妹间供肾的16例肾移植手术患者中．1例患者术后移植肾功能延迟至第4周恢复正常。结论：亲属活体供肾肾移植效果明显优于同期尸体供肾移植．其中父母给子女供肾或兄弟间供肾肾移植效果较好，夫妻间供肾效果相对稍差。     

肾移植术后超延迟肾功能恢复15例治疗体会

背景:肾脏移植患者急性排斥反应已不再成为术后的主要并发症,延迟肾功能恢复和慢性移植肾肾病仍然是移植患者术后需要面对的问题.目的:总结分析15例术后发生超延迟肾功能恢复的肾移植患者资料,探讨临床经验及治疗对策.方法:对肾移植后发生超延迟肾功能恢复患者15例进行回顾性分析.15例患者移植后均采用常规剂量的半量(环孢素A 3.0～4.0 mg/kg,他克莫司0.5～1 mg/kg),并定期监测血药浓度,随时调整免疫用药剂量,采用血液透析/连续性肾脏替代治疗.分析超延迟肾功能恢复诱因,患者观察患者肾功能恢复情况.结果与结论:术中低血压、供肾热缺血时间过长、早期急性排斥反应、环孢素中毒、外科并发症、动脉粥样硬化致移植肾血液灌流不足可能为患者超延迟肾功能恢复的诱因.患者术后由少尿期开始进入多尿期时间最长者为108 d,平均32～108 d.肾功能正常8例(血清肌酐78～135 μmol/L),肾功能轻度异常5例(血清肌酐135～300 μmol/L),血清肌酐> 300 μmol/L者2例.随访时间最长1例11年,至今移植肾功能正常.结果提示,肾移植后尽早行移植肾穿刺活检及移植肾彩超,根据结果采取综合治疗并制订个体化治疗方案可以使大多数的患者移植肾功能恢复正常.     

肾移植术后肾功能延迟恢复行血液净化治疗的观察和护理

肾功能延迟恢复（DGF）是肾移植术后常见并发症,其定义为术后1周内需要透析治疗移植肾功能延迟恢复^[1]。DGF是肾移植术后急性肾衰竭的一种形式,以移植。肾少尿、无尿为特征。在移植肾功能恢复之前进行血液净化治疗是非常重要的。     

红花黄色素改善移植肾早期肾功能疗效观察

目的探讨红花黄色素对肾移植受者移植肾功能恢复的影响。方法肾移植受者382例随机分为观察组231例和对照组151例,对照组给予常规治疗,观察组在常规治疗基础上给予红花黄色素氯化钠注射液100mL／次,2次／d,静脉滴注,连续7d。比较2组术后第1～7天24h尿量、血肌酐水平,术后第5、10天移植肾段动脉、叶间动脉血流阻力指数及肾功能延迟恢复与术后3个月内急性排斥反应发生率。结果观察组术后肾功能延迟恢复发生率（5．63％）低于对照组（11．26％）（P〈0．05）,急性排斥反应发生率（6．49％）与对照组（8．61％）比较差异无统计学意义（P〉0．05）;观察组术后第1～6天24h尿量较对照组明显增多（P〈0．05）,术后第1～5天血肌酐水平较对照组低（P〈0．05）;观察组术后第5、10天移植肾段动脉、叶间动脉血流阻力指数均低于对照组（P〈0．05）。结论肾移植术后应用红花黄色素可降低肾功能延迟恢复发生率,促进移植肾功能的早期恢复。     

预致敏受者尸体肾移植术后的急性排斥反应

目的：预致敏肾移植受者的增加已是目前肾移植成功的重大影响因素。观察人类白细胞抗原氨基酸残基配型及新型免疫抑制剂治疗方案对预致敏患者肾移植术后急性排斥反应的治疗效应，寻找提高移植物存活率的最佳方案。方法：选择2003—01／2005—08在首都医科大学附属北京友谊医院行肾移植手术的患者396例，患者均知情同意。分组：①预致敏组（n=32）：即术前致敏患者。采用诱导治疗（抗淋巴细胞球蛋白100mg／d，3～7d）＋三联免疫抑制剂维持治疗方案（他克莫司＋霉酚酸酯＋激素）。②对照组（n=364）：未致敏患者。采用三联免疫抑制剂维持用药方案。比较两组患者肾移植术后6个月内急性排斥反应发生率、移植肾功能延迟恢复发生率及移植肾，患者1年存活率，同时分析人类白细胞抗原氨基酸残基配型对移植肾急性排斥反应的影响。结果：396例患者全部进入结果分析。①两组患者肾移植术后急性排斥反应发生率差异无显著性意义（P〉0．05）。预致敏组患者移植肾功能延迟恢复发生率显著高于对照组（P〈0．01）。②两组患者1年存活率差异无显著性意义（P〉0．05）。预致敏组患者1年移植肾存活率低于对照组（P〈0．05），如果去除患者死亡因素的影响，两组患者1年移植肾存活率差异无显著性意义（P〉0．05）。③预致敏组患者人类白细胞抗原氨基酸残基相配率高于对照组（P〈0．05）。预致敏组中氨基酸残基配型3-4错配患者的急性排斥反应发生率显著高于0-2错配患者（P〈0．01），高度致敏患者（移植术前群体反应抗体〉50％）急性排斥反应发生率显著高于低度致敏患者（群体反应抗体10％-20％）（P〈0．01）。结论：供受者之间良好的人类白细胞抗原氨基酸残基分型及采用新型免疫抑制药物治疗方案，对预防及减轻致敏患者移植术后急性排斥反应疗效确切，并可以缩短致敏患者等待移植手术的时间。     

急性肾功能损伤与衰竭生物标志物

急性肾功能损伤（ARI）与急性肾功能衰竭（ARF）是加强医疗病房（ICU）的常见疾病．ICU中80％的ARF由急性肾小管损伤所致，而非肾小球或间质性病变引起。其死亡率较高，寻找敏感性和特异性较好的ARI或ARF生物标志物，对早期诊断、治疗和改善预后有着重要意义。本文介绍和评估了ARI或 ARF生物标志物的研究现状。并展望了其未来的前景。[第一段]     

Biomarkers of acute renal injury and renal failure

Acute renal failure (ARF) is a frequent problem in the intensive care unit and is associated with a high mortality. Early recognition could help clinical management, but current indices lack sufficient predictive value for ARF. Therefore, there might be a need for biomarkers in detecting renal tubular injury and/or dysfunction at an early stage before a decline in glomerular filtration rate is noted by an increased serum creatinine. A MEDLINE/PubMed search was performed, including all articles about biomarkers for ARF. All publication types, human and animal studies, or subsets were searched in English language. An extraction of relevant articles was made for the purpose of this narrative review. These biomarkers include tubular enzymes (alpha- and pi-glutathione S-transferase, N-acetyl-glucosaminidase, alkaline phosphatase, gamma-glutamyl transpeptidase, Ala-(Leu-Gly)-aminopeptidase, and fructose-1,6-biphosphatase), low-molecular weight urinary proteins (alpha1- and beta2-microglobulin, retinol-binding protein, adenosine deaminase-binding protein, and cystatin C), Na+/H+ exchanger, neutrophil gelatinase-associated lipocalin, cysteine-rich protein 61, kidney injury molecule 1, urinary interleukins/adhesion molecules, and markers of glomerular filtration such as proatrial natriuretic peptide (1-98) and cystatin C. These biomarkers, detected in urine or serum shortly after tubular injury, have been suggested to contribute to prediction of ARF and need for renal replacement therapy. However, excretion of these biomarkers may also increase after reversible and mild dysfunction and may not necessarily be associated with persistent or irreversible damage. Large prospective studies in human are needed to demonstrate an improved outcome of biomarker-driven management of the patient at risk for ARF.     

Epidemiology of renal recovery after acute renal failure

PURPOSE OF REVIEW: Recovery of renal function after acute renal failure is an important clinical determinant of patient morbidity. Herein, the epidemiology of renal recovery after acute renal failure will be described, along with potential predictive factors and interventions. RECENT FINDINGS: Renal recovery has been variably defined, most often as recovery to independence from renal replacement therapy. A recent consensus definition for acute renal failure has been published and included provisions for defining renal recovery. Renal recovery to renal replacement therapy independence occurs in the majority by hospital discharge and peaks by 90 days. All of older age, female sex, co-morbid illnesses, especially chronic kidney disease, and late initiation of renal replacement therapy or conventional intermittent renal replacement therapy have been coupled with non-recovery. Analysis of the literature suggests several interventions may influence recovery. SUMMARY: The prognosis is generally good for recovery after acute renal failure. Most patients will be independent of renal replacement therapy by 90 days. Additional research is necessary, however, to understand recovery rates not only to independence from renal replacement therapy, but also to complete and partial recovery. Future studies need to consider the health economic implications for survival and non-recovery. Finally, questions on the role of various interventions require characterization in randomized controlled trials to determine how they may influence renal prognosis.     

Ultrasonographic determination of renal mass and renal volume.

Volumes and surface areas of 45 kidneys were determined ultrasonographically in vivo before autopsy and in a water bath phantom after autopsy by means of both the ellipsoid and the stepped section methods. Comparison of results revealed that renal volume may be determined by the simplest method, the ellipsoid method, with sufficient accuracy for clinical use. Results also revealed that renal mass expressed in grams may be directly obtained from renal volume expressed in milliliters, but mass in grams was found to correlate better with renal surface area than with renal volume. A formula relating renal mass to both volume and surface area was developed from regression analysis of the data and was found to provide a more precise estimate of renal mass than does mass computed from either volume or surface area alone.     

Preservation of renal function in chronic renal failure.

Mechanisms of progression of chronic renal failure (CRF) have been well documented in the rat but may not be relevant in man. Factors which may modify clinical CRF include underlying disease, diet, hypertension, intercurrent events, and adverse or beneficial effects of drug therapy. It has been argued that progression in many forms of renal disease is inexorable below a certain level of renal function. In other diseases, eg primary malignant hypertension, analgesic nephropathy, function frequently improves in both the short and long term with appropriate management. Thus knowledge of the nature of the underlying disease is essential in assessing progression. The value of diet in preserving renal function has been debated, particularly the relative roles of protein and phosphate control. In our own unit, a prospective randomized study showed a benefit of protein restriction. Development of accelerated hypertension is an important cause of progression of renal disease and clinical and experimental evidence supports the view that non-accelerated hypertension is also a factor in progression, amenable to treatment. Various intercurrent events may accelerate progression and function may be lost permanently following sepsis, urinary tract obstruction, renal arterial or venous obstruction, hypotension and in some cases pregnancy. Numerous drugs can have deleterious effects on the kidney. The possibility that converting enzyme inhibitors might preserve renal function is attracting attention but in view of their side effects their place in therapy should be determined by prospective controlled studies in which the above factors are carefully considered.     

Ruptured renal angiomyolipoma presenting as renal colic

The case of a patient with acute onset of flank pain and hematuria is presented. Initial therapy was directed toward relief of pain believed to be caused by renal colic. It was not until the patient developed atypical features that the true diagnosis, ruptured renal angiomyolipoma, was discovered. The case and discussion emphasize the need to carefully consider a complete differential diagnosis when evaluating patients with flank pain and hematuria who have atypical clinical features or an atypical course.     

肾血管平滑肌脂肪瘤和肾癌的螺旋CT诊断

目的 分析探讨肾血管平滑肌脂肪瘤和肾癌的螺旋CT征象.方法 回顾性分析205例临床肾肿瘤病例的螺旋CT征象.其中肾血管平滑肌脂肪瘤63例,肾癌142例(小肾癌21例),增强扫描146例.结果 肾血管平滑肌脂肪瘤特征性的病理表现为内含脂肪,强化较均匀;肾癌平扫大部分呈混杂密度,不均匀强化;小肾癌病例强化后大部分呈快进快出表现.结论 肾血管平滑肌脂肪瘤和肾癌螺旋CT表现具有一定特征性,增强扫描至关重要.