ACEI、ARB单用与联用治疗老年早期糖尿病肾病的疗效对比

糖尿病肾病(DN)是微血管病变引发的严重并发症之一.是导致中老年糖尿病患者致病、致残、致死的重要因素.随着DN患者逐年增多,临床高血压透析负荷过重给患者造成巨大痛苦,并为之耗费大量人力及财力.因此,临床治疗该病需早期预防、准确施药、干预恰当可延缓DN病变发生.本研究选择血管紧张素转换酶抑制剂( ACEI)和血管紧张素受体拮抗剂( ARB)单用及联用干预DN病变发展,对比分析其疗效.     

硫氧还蛋白和硫氧还蛋白相互作用蛋白与糖尿病肾病关系的研究进展

糖尿病肾病(DN)是糖尿病最常见的微血管并发症之一,临床上一旦发生,肾脏损害常呈不可逆进展,透析病人中DN患者占20%~40%[1],故DN的早期诊断及治疗对于改善患者生活质量及预后具有重要的临床意义.     

炎症与糖尿病肾病

<正>糖尿病肾病(diabetic kidney disease,DKD)包括结节性肾小球硬化即经典的糖尿病肾病(diabetic nephropathy,DN)、血管性肾硬化、肾乳头坏死、乃至继发的慢性肾盂肾炎等。DN是糖尿病肾病的主要类型之一。在全球范围内,DN是引起终末期肾脏病(end stage renal disease,ESRD)的首要因素[1]。目前临床上主要用于延缓DN进展的方法包括控制     

糖尿病肾病易感基因的研究现状

随着糖尿病发病率的逐年上升及糖尿病病人寿命的延长 ,糖尿病肾病 (DN)已成为糖尿病患者致死和致残的主要原因之一。在许多发达国家已为终末期肾病的主要原因 ,占透析和肾移植病人的 1/ 3[1 ] 。因此 ,如何确定 DN的易感因素 ,对易感者及早采取针对性的防治措施是当前 DN研究的重要课题。许多证据提示 ,遗传因素在 DN的发生中起着重要作用。临床流行病学研究发现 1型糖尿病 DN的发生率在糖尿病发病 15～ 2 0年内逐年升高 ,在 2 5～ 30年后达到高峰 ,发病率约为 30 % ;而糖尿病视网膜病变 (DR)却随着病程的延长而逐年升高 ,达 6 0 %～ 7…     

终末期糖尿病肾病透析治疗体会

糖尿病肾病 (DN)发展到终末期的过程是可以延缓但是不可逆的。2 0 0 3年Wrenger等报道 ,透析患者DN占 36 %,主要为 2型糖尿病。终末期糖尿病肾病 (ESDN)的治疗方法是肾脏替代。1　肾脏替代治疗的指征　　开始替代治疗的指标肾小球滤过率 (GFR) <15ml/min。但患者有明显的水钠潴留、电解质代谢紊乱、难以控制的心力衰竭和高血压、严重的视网膜病变时应提早透析 ,特别是腹透 (不影响残余肾功能 ,根据病情掌握剂量 ,甚至病情缓解可以停透 ) ,我们的经验表明 ,这是挽救生命及时和有效的措施。有作者主张ESDN的一体化治疗应首先选择腹膜透…     

糖尿病肾损害及其临床处理

据统计,1型糖尿病和2型糖尿病(T2DM)发展为DN者分别为25%～40%和5%～40%[1],微量白蛋白尿(MA)发生率约39%[2],马来群岛人T2DM合并高血压患者中大量蛋白尿患病率为15.7%,MA为39.7%[3].在ESRD透析患者中,DN约占1/3.     

科素亚联合益肾胶囊治疗老年糖尿病肾病78例疗效观察

糖尿病肾病 (DN)是糖尿病 (DM )的严重并发症之一 ,我国目前DM的发生率为 3 .2 1% ,DM约有 40 %发展为DN ,在我国DN致终末期肾病病人约占透析病人的 5 % ,且呈增加趋势 ,因此DN的早期透析治疗显得尤为重要 ,现应用科素亚加益肾胶囊治疗糖尿病肾病取得良好效果 ,现报道如下。1　资料与方法1.1　一般资料　 78例DN病人符合DN诊断标准[1] ,选取病例均为DNⅣ期～Ⅴ期 ,随机分为两组 ,治疗组 42例 ,年龄 68岁± 5 .2岁 ,最小 60岁 ,最大 82岁 ;病程 6年～ 2 1年 ,平均 11.8年 ;对照组 3 6例 ,年龄 67岁± 6.1岁 ,最小 60岁 ,最大 70岁 ;…     

糖尿病肾病的透析治疗

糖尿病肾病 (DN)是导致慢性肾功能衰竭的重要原因。近年来 ,我国糖尿病的发生率也有明显上升。本文简要谈谈DN透析时机选择及各种透析疗法的一些注意事项。1　DN透析时机选择　　关于DN透析时机 ,目前尚无严格的标准。一般提倡早期透析 ,而DN患者一般也比非糖尿病肾病患者提前出现尿毒症症状。DN时血肌酐 (SCr)水平往往不能反映疾病的严重程度 ,与非糖尿病终末期肾衰相比 ,其水钠潴留 ,贫血及全身中毒症状更为显著 ,而当SCr >35 2 μmo1/L后 ,其进展异常迅速 ,为此糖尿病肾衰者较非糖尿病肾衰者应更早地接受替代治疗。糖尿病肾衰的透…     

延缓糖尿病肾病进展的非降糖性药物治疗

糖尿病肾病 (DN)是糖尿病常见而严重的微血管并发症 ,也是糖尿病患者的主要死亡原因之一。在美国 ,1997年新发生的终末期肾病 (ESRD)患者中就有 4 0 %为DN ,为此要耗费 15 6亿美元的医疗费。上世纪 90年代我国该比例为 5 % ,但目前患糖尿病和并发DN的比例都有明显上升趋势。因此如何更有效的延缓DN进展 ,减少进入ES RD的比例 ,目前正为广大医生所关注。成功延缓DN进展的关键在于早期诊断、早期治疗。微量白蛋白尿被认为是DN早期损害的临床标志 ,即尿白蛋白 2 0～ 2 0 0 μg/min或 30～ 30 0mg/ 2 4h。对于 1型糖尿病患者发病 5年后…     

糖尿病肾病患者的血糖管理

糖尿病肾病(DN),是糖尿病微血管并发症之一,是欧美国家患者引发终末期肾功能衰竭(ESRD)的首要原因,也是糖尿病患者死亡的主要原因之一.DN发病隐匿,早期不易被发现,而临床一旦出现蛋白尿,肾功能减退进展迅速.高血糖是导致肾脏损害的根本原因,无论是1型或2型糖尿病,强化治疗高血糖可预防DN的发生,或延缓肾脏疾病的进展.尤其在DN的早期,降血糖对延缓DN发生发展的意义要大于降血压,因此DN患者的血糖管理至关重要.     

Vascular access guidelines for hemodialysis

Quality of vascular access (VA) has a remarkable influence in hemodialysis patients outcomes. Dysfunction of VA represents a capital cause of morbi-mortality of these patients as well an increase in economical. Spanish Society of Neprhology, aware of the problem, has decided to carry out a revision of the issue with the aim of providing help in comprehensión and treatment related with VA problems, and achieving an homogenization of practices in three mayor aspects: to increase arteriovenous fistula utilization as first vascular access, to increment vascular access monitoring practice and rationalise central catheters use. We present a consensus document elaborated by a multidisciplinar group composed by nephrologists, vascular surgeons, interventional radiologysts, infectious diseases specialists and nephrological nurses. Along six chapters that cover patient education, creation of VA, care, monitoring, complications and central catheters, we present the state of the art and propose guidelines for the best practice, according different evidence based degrees, with the intention to provide help at the professionals in order to make aproppiate decissions. Several quality standars are also included.     

A model for evening home hemodialysis

In an effort to better rehabilitate patients on home dialysis by shortening the duration of effective dialysis and thereby permitting evening hemodialysis, the simultaneous use of two hollow fiber artificial kidneys (HFAK) was evaluated. The clearances of urea, creatinine, uric acid, phosphate, iothalamate and cyanocobalamin were substantially higher than those obtained with any available single dialyzer. These clearances also were significantly enhanced by use of the single pass dialysate delivery system as compared to the recirculating single pass system. The clearances were comparable whether the blood flow through the two HFAK was in parallel or in series. Reuse of the HFAK was feasible, thus minimizing any economic disadvantage of the system. In eight patients, who have used the system at home for 9 to 12 hours per week for up to 6 months, weight, blood pressure, serum chemistries and motor nerve conduction have remained stable. This shorter dialysis with the double HFAK system allows for evening dialysis, thus freeing daytime hours for productive activity and nighttime for sleep.     

用移植血管建立血液透析通路

本文报告了应用聚氟四乙烯人造血管和异体大隐静脉为4例不宜常规做永久性内瘘的患者建立了透析通路.术后瘘管无栓塞、出血、感染,仅移植部位出现水肿.移植术后3周即开始做血透,流量良好.我们认为用移植血管建立的永久性血透通路,是妥善解决无适宜自身血管做内瘘的尿毒症患者透析通路的良好方法.     

Removal of doripenem during hemodialysis and the optimum dosing regimen for patients undergoing hemodialysis

The removal of doripenem by hemodialysis was studied in six hemodialysis patients. Following an intravenous drip infusion of 0.5 g of doripenem, plasma concentrations of the drug were measured. The decrease in drug concentrations in plasma was observed during various periods of non-hemodialysis, and hemodialysis accelerated the elimination of doripenem. For example, the calculated mean half-life during hemodialysis was significantly shorter than that during non-hemodialysis periods (P = 0.002). The calculated pharmacokinetic parameters indicated that the mean rate of decrease in plasma concentration due to hemodialysis alone was 56.12 ± 8.11%. Upon obtaining these results and several pharmacokinetic parameters, we attempted to optimize the dosing regimen of doripenem for hemodialysis patients. We recommend the use of 0.25 g of doripenem once a day in patients infected with viable bacteria, and in patients who are infected with Pseudomonas aeruginosa, 0.5 g twice a day on the first day of administration, followed by 0.5 g once a day.     

Parathyroidectomy for advanced renal hyperparathyroidim in hemodialysis

Treatment of advanced secondary hyperparathyroidism should be shifted from to avoid progression of bone disease to protection of cardiovascular complications induced by ectopic calcification. Patients who suffer from advanced secondary hyperparathyroidism with uncontrollable hypercalcemia or/and hyperphosphatemia by medical treatment should be referred to surgical treatment at relatively early time. Total parathyroidectomy with forearm autograft is adequate operative procedure especially in patients who require long-term hemodialysis.     

Prostacyclin substitution for heparin in long-term hemodialysis

We studied prostacyclin as a substitute for heparin in 12 patients who underwent maintenance hemodialysis. All subjects underwent initial hemodialysis with prostacyclin as the sole anticoagulant; 10 of the 12 were restudied during heparin hemodialysis. Few adverse reactions occurred during prostacyclin hemodialysis in the 10 patients in whom dialysis was performed against a bicarbonate-containing dialysate; however, significant hypotension developed in two subjects when an acetate bath was used. Platelet aggregation progressively decreased during prostacyclin hemodialysis (p less than 0.02), but not during heparin hemodialysis, and returned toward control values after hemodialysis. Platelet thromboxane release decreased during both prostacyclin and heparin hemodialysis. Intradialytic percent decrements in serum urea nitrogen and creatinine were greater during prostacyclin than heparin administration (42 +/- 2.9 percent versus 36 +/- 2.6 percent [p less than 0.05] and 33 +/- 2.6 percent versus 29 +/- 2.1 percent [0.05 less than p less than 0.1], respectively). The plasma concentrations of 6-keto-prostaglandin-F1 alpha, a prostacyclin metabolite, reached peak levels by 120 minutes of hemodialysis and declined biexponentially toward predialysis concentrations during 120 minutes after hemodialysis, thereby providing an index of cumulative prostacyclin dosage. We conclude that prostacyclin is not only a safe alternative to heparin anticoagulation during hemodialysis, but that prostacyclin might also increase the efficiency of hemodialysis.