尿NGAL、NAG及KIM-1联合检测在高龄老年急性肾损伤早期诊断中的价值

目的探讨尿中性粒细胞明胶酶相关脂质运载蛋白(uNGAL)、尿N-乙酰β-D氨基葡萄糖苷酶(uNAG)及尿肾损伤分子-1(uKIM-1)的联合检测老年急性肾损伤中的诊断价值。方法选择2016年6月至2018年6月在泰山疗养院住院的老年患者184例,根据急性肾损伤网络(AKIN)标准为诊断标准,诊断AKI组116例(1期55例、2期39例、3期24例),非AKI组68例,检测并比较各组尿NGAL、NAG、KIM-1水平,用受试者工作特征曲线(ROC)及曲线下面积(AUC)分析3项生物学标志物对AIK的诊断价值。结果①AKI组尿NGAL、NAG、KIM-1明显高于对照组(P<0.05),3期尿NGAL、NAG、KIM-1明显高于2期和1期,2期明显高于1期(P<0.05);②尿NGAL、NAG、KIM-1单独诊断AKI的AUC分别为0.734、0.804、0.705;③3项标志物联合诊断AKI的灵敏度、特异度分别为84.9%、90.7%,高于各单项诊断。结论尿NGAL、NAG、KIM-1是诊断AKI的较好指标,联合诊断对高龄老年急性肾损伤的早期诊断有着更重要的价值。     

KIM-1、CC16在急性肾/肺损伤临床诊断中的意义

目的观察肾损伤分子-1（kidney injury molecule 1, KIM-1）与Clara细胞分泌蛋白（Clara cell secretion protein, CCSP/CC16）在急性肾损伤（Acute Kidney Injury, AKI）合并急性肺损伤（Acute Lung Injury, ALI）患者体内的变化,探讨其在急性肾/肺损伤临床诊断中的意义。方法入选本院确诊为AKI的患者纳入AKI组（25例）,确诊为ALI的患者纳入ALI组（15例）,确诊为AKI合并ALI的患者纳入AKI+ALI组（25例）,与之年龄、性别、民族相匹配的非吸烟健康志愿者作为正常对照组（23例）,采用酶联免疫吸附法(enzyme-linked immunosorbent assay, ELISA)检测尿液KIM-1、尿液CC16和血浆KIM-1、血浆CC16的水平,用比色法检测尿N-乙酰-β-D-氨基葡萄糖苷酶(N-acetyl-beta-D-glucosaminidase, NAG),整理四组所有研究资料利用统计学方法进行综合分析。 结果与正常非吸烟对照组相比,AKI组的尿NAG酶、尿KIM-1、血浆KIM-1和血浆CC16水平均显著升高,差异有统计学意义（P＜0.05）;ALI组的尿CC16和血浆CC16水平均显著升高,差异有统计学意义（P＜0.05）;AKI+ALI组的尿NAG酶、尿KIM-1、血浆KIM-1、尿CC16和血浆CC16水平均显著升高,差异有统计学意义（P＜0.05）。 直线相关分析显示：AKI患者的尿KIM-1水平与尿NAG呈显著正相关关系（r=0.493, P＜0.01）,血浆KIM-1水平与尿NAG无直线相关关系（r=0.276, P＞0.05）。ALI患者的尿CC16、血浆CC16与氧合指数均呈显著负相关关系(r=0.460, P＜0.01; r=0.468, P＜0.01)。AKI合并ALI患者的尿KIM-1、血浆KIM-1与尿CC16、血浆CC16均呈显著正相关关系（P＜0.05）。3. ROC曲线分析提示：在AKI诊断中,尿KIM-1曲线下面积为0.781（95% CI：0.688～0.875,P＜0.01）;血浆KIM-1曲线下面积为0.988（95% CI：0.000～1.000,P＜0.01）;尿NAG酶曲线下面积为0.798（95% CI：0.708～0.888,P＜0.01）。在ALI诊断中,尿CC16曲线下面积为1.000(95% CI：1.000～1.000,P＜0.01);血浆CC16曲线面积为0.849（95% CI：0.764～0.935,P＜0.01）。 结论 AKI时尿NAG、尿KIM-1、血浆KIM-1均明显升高,进一步证实这些指标可作为诊断AKI早期生物学标志物。2. ALI时尿CC16、血浆CC16水平显著升高,同时具有高敏感性,是诊断ALI的良好实验室指标。急性肾/肺损伤患者体内尿、血浆KIM-1与CC16水平明显升高,二者具有良好的相关性,对诊断急性肾/肺损伤并判断预后具有重要的价值与临床意义。     

尿生物标志物在儿童急性肾损伤早期诊断中的作用研究

目的：评价尿NGAL,KIM-1和β2-MG在儿童不同基础疾病导致的AKI早期诊断中的价值。方法：我们做的是前瞻性临床研究,检测在我院儿科门急诊不同疾病患儿尿中性粒细胞明胶酶相关的脂质运载蛋白（NGAL）,肾脏损伤因子-1（KIM-1）和-β2微球蛋白（β2-MG）的水平,以AKIpRIFLE为分期标准将入选患儿分组,比较尿NGAL,KIM-1和β2-MG在儿童急性肾损伤诊断中的敏感性,特异性,阳性似然比,阴性似然比,分析比较这3个指标在急性肾损伤早期诊断中的作用。结果：入选262例患儿中,23例患儿可诊断为AKI,15例患儿为AKI-R期,8例患儿为AKI-I期,入选患儿中没有AKI-F期,23例患儿中只有5例临床有AKI的诊断。尿NGAL,KIM-1和β2-MG的水平在血肌酐没有明显升高之前已经升高,随着肾损伤的加重升高的更明显,不同组间差异有统计学意义。尿NGAL和β2-MG在预测儿童AKI的早期诊断方面好于尿KIM-1（AUC〉0.8）。结论：尿NGAL,KIM-1和β2-MG均可以在Scr没有升高之前预测儿童AKI的发生,是儿童AKI的早期生物标志物。尿NGAL在早期预测不同基础疾病可能发生AKI方面好于其他两项指标。     

尿NGAL、KIM-1联合APACHEⅡ评分预测脓毒症并发急性肾损伤患者预后的价值

目的探讨尿中性粒细胞明胶酶相关脂质运载蛋白(NGAL)、肾损伤分子-1(KIM-1)联合急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分预测脓毒症急性肾损伤(AKI)患者预后的价值。方法选取海南西部中心医院收治的脓毒症并发AKI患者108例,根据其是否死亡分为存活组(n=72)和死亡组(n=36)。采用酶联免疫吸附法测定各组尿NGAL、KIM-1水平,并记录其APACHEⅡ评分。应用受试者工作特征(ROC)曲线评价尿NGAL、KIM-1及APACHEⅡ评分对脓毒症并发AKI患者预后的价值。结果死亡组尿NGAL(970.2±705.2 ng/mLvs 612.5±415.4 ng/mL)、KIM-1[(62.6±12.4) ng/L vs(28.8±7.2) ng/L]及APACHEⅡ评分[(26.8±8.3)分vs(17.90±6.20)分]均明显高于存活组(P0.05)。ROC曲线分析显示,尿NGAL、KIM-1及APACHEⅡ评分预测AKI患者死亡的最佳截取值分别为805.26 ng/mL、50.35 ng/L、23.90分,三者联合预测脓毒症并发AKI患者死亡的曲线下面积(0.937,95%CI 0.885～0.987)、敏感度(96.3%)和特异度(88.0%)较高。结论尿NGAL、KIM-1及APACHEⅡ评分三者联合检测在评估脓毒症并发AKI患者死亡时具有良好的预测价值,可提高脓毒症并发AKI患者预后评估的准确性。     

儿童原发性肾病综合征并发急性肾损伤患儿尿NGAL和KIM-1的改变及临床相关因素分析

目的：探讨儿童原发性肾病综合征（NS）并发急性肾损伤（AKI）的可能相关临床因素,明确中性粒细胞明胶酶相关脂质运载蛋白（NGAL）和肾损伤因子-1（KIM-1）在肾病综合征初发患儿和并发AKI患儿中的改变.方法：2012年1月~2012年12月在我院儿肾科住院的患儿,记录新发儿童原发性NS人数和并发AKI人数,患儿的水肿情况,水肿时间,24 h尿量,尿蛋白定量,血白蛋白,胆固醇,纤维蛋白原,肌酐水平,是否有胃肠道症状,发热情况,输注白蛋白情况.采用ELLSA方法检测尿NGAL、KIM-1;免疫组化法检测NGAL、KIM-1在患儿肾小管中的表达.结果：2012年1月-2012年12月共收治原发性肾病综合征初发儿童87例,其中12例并发急性肾损伤.NS并发AKI患儿组在水肿时间,24 h尿量与新发NS组患儿比较,差异有统计学意义（P〈0.05）.NS并发AKI患儿发热患儿比例,胃肠道症状患儿比例,输注白蛋白患儿比例较单纯NS组患儿比较,差异有统计学意义（P〈0.01）.NS并发AKI患儿住院时间与单纯NS患儿组比较,差异有统计学意义（P〈0.01）.NS并发AKI患儿Scr,尿NGAL,KIM-1以及肾组织NGAL和KIM-1的表达明显高于单纯新发NS组,差异有统计学意义（P〈0.01）.结论：水肿持续时间越长,24 h尿量越少,儿童原发性NS越易并发AKI;原发性NS患儿出现胃肠道或其他感染症状,易导致AKI的发生.尿NGAL和KIM-1对早期判断NS患儿并发急性肾损伤有重要的临床意义.     

肝移植后早期并发急性肾损伤时尿液中肾损伤分子-1的变化及意义

目的 探讨肝移植后早期并发急性肾损伤(AKI)时尿液中肾损伤分子-1(KIM-1)的变化及意义.方法 回顾性分析原位肝移植50例的资料,按照急性肾损伤协作组(AKIN)标准依据受者术后是否发生AKI将受者分为AKI组(27例)和非AKI组(23例),测定两组各设定时间点血清肌酐(SCr)、尿肌酐(UCr)和尿KIM-1的水平,分析尿KIM-1与AKI之间的关系,运用受试者工作特征曲线(ROC)及曲线下面积(AUC)评价依据尿KIM-1诊断AKI的准确性.结果 两组术后24 h时SCr达峰值,AKI组的SCr明显高于非AKI组(P＜0.05),随后均逐渐降至术前水平.门静脉开放后即刻两组的尿KIM-1水平均明显升高,AKI组于门静脉开放2h时尿KIM-1水平达峰值,明显高于非AKI组(P＜0.01),这种差异一直持续至门静脉开放后12 h.若以门静脉开放后2h的尿KIM-1水平14.19 ng/g UCr作为诊断AKI的临界点,其灵敏度为82.6％,特异性为88.9％.结论 尿KIM-1可作为诊断肝移植后AK1的有效指标;对于术前肾功能正常者,术中尿KIM-1的变化可能对早期预测AKI有帮助.     

急性肾损伤患者尿液IL-18、NGAL的变化

目的:探讨急性肾损伤(AKI)患者尿液中白细胞介素-18(IL-18)、中性粒细胞明胶酶相关脂蛋白(NGAL)的改变及临床意义。方法:AKI患者30例,原发性慢性肾脏病(CKD)患者30例,健康对照者30例,应用酶联免疫吸附检测法(ELISA)测定三组患者尿液IL-18、NGAL水平的变化;测定三组血清肌酐值。结果:血清肌酐AKI组较CKD组及健康对照组增高(P<0.001),而CKD组与健康对照组比较差异无统计学意义(P>0.05)。AKI组尿IL-18水平高于CKD组(P<0.05),显著高于健康对照组(P<0.001)。CKD组尿IL-18水平高于健康对照组,但差异无统计学意义(P>0.05)。AKI组尿NGAL水平高于CKD组(P<0.05),显著高于健康对照组(P<0.001);CKD组尿NGAL水平高于健康对照组,但差异无统计学意义(P>0.05)。尿IL-18与尿NGAL之间存在正相关关系(r=0.994)。结论:尿IL-18、NGAL在急性肾损伤患者中均增高,是反映AKI较敏感的生物学标志物。     

尿肾损伤分子-1对肺移植术后早期并发急性肾损伤患者的早期诊断

目的 探讨尿肾损伤分子-1(KIM-1)在肺移植术后急性肾损伤(AKI)中的早期诊断价值.方法 前瞻性收集本院52例肺移植手术患者在手术前后不同时相的血、尿标本,分别测定血肌酐(Scr)和尿KIM-1.根据AKI的诊断标准,将患者分为AKI组和非AKI组,观察两组Scr和尿KIM-1的动态变化.用受试者工作特征曲线(ROC)评价尿KIM-1对AKI的诊断作用.结果 52例患者中,术后发生AKI的有19例,发生率为36.5％.AKI组Scr在术后的第24h上升至基础值的1.80倍,达到AKI的诊断标准.AKI组术后4h尿KIM-1较基线值明显上升[(1.7±0.6) ng/mL比(0.5±0.3)ng/mL,P＜0.05].术后4h,尿KIM-1的ROC曲线下面积为0.837,95％的可信区间为0.729～0.946,以1.6ng/mL作为AKI的诊断界限时,敏感性和特异性分别为73.7％和75.8％.结论 尿KIM-1可较Scr更早诊断肺移植术后AKI的发生.尿KIM-1可能为肺移植术后并发AKI患者的早期诊断的标记物.     

乌司他丁对脓毒症急性肾损伤患者尿KIM-1、ANP、 NGAL、 Cys-C和IL-18的影响

目的 探讨乌司他丁对脓毒症急性肾损伤(AKI)患者尿肾损伤分子-1(KIM-1)、心钠肽(ANP)、中性粒细胞胶原酶相关脂质运载蛋白(NGAL)、半胱氨酸蛋白酶抑制剂C(Cys-C)、白介素-18(IL-18)水平的影响.方法 收集2018年1月至2019年12月期间本院收治的脓毒症并发AKI患者120例,随机分为观察...     

动态监测尿微量蛋白对危重患者预后的价值

目的 探讨尿微量蛋白作为危重患者预后指标的可行性。 方法 前瞻性动态监测ICU危重患者尿微量白蛋白(MA)、α1-微球蛋白(α1-MG)、N-乙酰-β-D-氨基葡萄糖苷酶(NAG)、视黄醇结合蛋白(RBP)，并与目前临床常用的预后评估系统APACHEⅡ、SOFA进行比较。结果 相关分析结果显示尿MA、α1-MG、NAG、住ICU时间、机械通气时间、APACHEⅡ评分、SOFA与死亡呈正相关。尿MA、α1-MG、住ICU时间、机械通气时间、APACHEⅡ评分、SOFA升高与多器官功能不全综合征(MODS)发生呈正相关。尿MA(r=0.397)、α1-MG(r=0.448)和RBP(r=0.465)与APACHEⅡ评分显著相关。APACHEⅡ评分、SOFA评分、MA、α1-MG、RBP、NAG预测死亡的ROC曲线下面积分别是0.875﹙P < 0.05﹚、0.825﹙P < 0.05﹚、0.820﹙P < 0.05﹚、0.730、0.530、0.620。结论 动态监测尿MA、α1-MG、RBP可作为危重患者预后的临床指标。     

Viral associations with kidney disease diagnosis and altered kidney metatranscriptome by kidney function

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Correlation of kidney size with kidney function and anthropometric parameters in healthy subjects and patients with chronic kidney diseases

Abstract

Background/Aim: Echosonography is a simple, noninvasive method of kidney visualization. The objective of this study was to compare the kidney echosonograpic characteristics with the kidney function and anthropometric characteristics in healthy subjects and patients with the chronic kidney disease (CKD). Methods: The study involved 49 patients (21 men; 46.02?±?14.27 years) with CKD and the control group of 46 healthy persons (20 males; 45.45?±?18.48 years). Physical examination, kidney echosonography and laboratory analyses including creatinine clearance (Ccr; 24?h and calculated by Cockroft--Gault (C--G) formula) were done in all persons. Results: There was no significant difference in age and sex between two groups but serum creatinine concentration was significantly higher (218.8 vs. 84.5?μmol/L) and Ccr significantly lower (66.44 vs. 94.20?mL/min, C--G) in patient group. The left kidney was larger in both groups, but the only significant difference was in kidney depth (p?<?0.01). There was significant correlation between all measured kidney dimensions, volume, parenchymal thickness and serum creatinine concentration and Ccr (C--G) in patient group. In the controls, there was no significant correlation between the kidney size and function, but there was a significant correlation between the kidney width, depth, volume and patients’ age and anthropometric parameters. On the contrary, all analyzed parameters of kidney size, except volume, did not correlate significantly with the anthropometric parameters of patients. Conclusion: Kidney size of patients with CKD correlated significantly with kidney function, while correlation with anthropometric parameters, which is otherwise present in healthy subjects, was lost in patients with CKD.     

Pregnancy and contraceptive counseling of women with chronic kidney disease and kidney transplants

Women with kidney disease of childbearing age should expect proactive counseling regarding pregnancy and contraception. Discussions should include the impact of pregnancy on their kidney disease and the impact of kidney disease on maternal and fetal outcomes. However, nephrologists rarely discuss sexual dysfunction, infertility, menstrual irregularities, and contraception with their premenopausal women patients. This review will consider pregnancy-related issues to discuss when counseling women with all stages of chronic kidney disease. Issues related to contraception in women on dialysis, women with functioning kidney transplants, and those with chronic kidney disease will also be reviewed.     

供体存在副肾动脉时大鼠肾移植模型的建立

目的 解决大鼠原位肾移植过程中供体出现副肾动脉时供肾循环难以建立的问题.方法 9例供肾存在副肾动脉,其中2例结扎副肾动脉后行肾动脉端端吻合;7例利用受体正常肾动脉在接近肾门处2到3支分支,修剪出2个吻合端,端端吻合供肾的2条肾动脉.结果 结扎副肾动脉吻合肾动脉后出现肾脏血液灌注不良以及缺血坏死,应用新设计的方法可建立良好的供肾血液循环.结论 利用新方法,解决了供肾存在副肾动脉的情况下建立的大鼠原位肾移植问题,节约了试验动物.     

肝肾联合移植治疗巨大多囊肾合并多囊肝并发肝肾功能衰竭

目的 总结巨大多囊肾合并多囊肝并发肝肾功能衰竭行肝肾联合移植的临床经验.方法 对8例巨大多囊肾合并多囊肝并发肝肾功能衰竭的患者进行肝肾联合移植,男性5例,女性3例;年龄41～67岁,平均52.8岁.先肝后肾采用经典非转流原位肝移植6例,先肾后肝并采用背驮式肝移植2例.术后对急性排斥反应、并发症、肝肾功能、人/肝/肾存活率等临床疗效进行长期随访.结果 随访28～65个月,8例患者均存活,肝肾功能正常.存活5年以上2例,4年以上2例,2年以上4例.围手术期并发胸腔积液2例,肺部金黄色葡萄球菌感染1例,均对症治疗后痊愈.截至随访终点,未发现移植物急性排斥反应.结论 巨大多囊肾合并多囊肝并发肝肾功能衰竭的患者,肝肾联合移植术是安全有效的治疗方法.     

Double kidney with ureterocele

Twenty-six children with ureteroceles--twenty-three with unilateral double collecting system and three with bilateral double kidney--are analyzed. The clinical and radiological features of these ureteroceles are presented. The different possibilities of surgical management and their results are discussed. In 14 of these children we performed resection of the ureterocele with en bloc reimplantation of both ureters. Eleven cases were treated by resection of the ureterocele and upper pole nephroureterectomy and four cases by nephroureterectomy. Vesicoureteral reflux in both renal pelvic moieties was found in five cases after ureteral reimplantation en bloc. Because of frequent bilateral disease (10%) and the common association of other urological malformation it is preferable to try to perform ureteric reimplantation rather than primary nephroureterectomy even when the possibility of postoperative reflux is considered.     

Sexual dysfunction in men and women with chronic kidney disease and end-stage kidney disease

Sexual dysfunction is a common finding in both men and women with chronic kidney failure. Common disturbances include erectile dysfunction in men, menstrual abnormalities in women, and decreased libido and fertility in both sexes. These abnormalities are primarily organic in nature and are related to uremia as well as the other comorbid conditions that frequently occur in the chronic kidney failure patient. Fatigue and psychosocial factors related to the presence of a chronic disease are also contributory factors. Disturbances in the hypothalamic-pituitary-gonadal axis can be detected before the need for dialysis but continue to worsen once dialytic therapy is initiated. Impaired gonadal function is prominent in uremic men, whereas the disturbances in the hypothalamic-pituitary axis are more subtle. By contrast, central disturbances are more prominent in uremic women. Therapy is initially directed toward optimizing the delivery of dialysis, correcting anemia with recombinant erythropoietin, and controlling the degree of secondary hyperparathyroidism with vitamin D. For many practicing nephrologists, sildenafil has become the first line therapy in the treatment of impotence. In the hypogonadal man whose only complaint is decreased libido, testosterone may be of benefit. Regular gynecologic follow-up is required in uremic women to guard against potential complications of unopposed estrogen effect. Uremic women should be advised against pregnancy while on dialysis. Successful transplantation is the most effective means of restoring normal sexual function in both men and women with chronic kidney failure.     

肝肾联合移植治疗巨大多囊肾合并多囊肝并发肝肾功能衰竭

目的 总结巨大多囊肾合并多囊肝并发肝肾功能衰竭行肝肾联合移植的临床经验.方法 对8例巨大多囊肾合并多囊肝并发肝肾功能衰竭的患者进行肝肾联合移植,男性5例,女性3例;年龄41～67岁,平均52.8岁.先肝后肾采用经典非转流原位肝移植6例,先肾后肝并采用背驮式肝移植2例.术后对急性排斥反应、并发症、肝肾功能、人/肝/肾存活率等临床疗效进行长期随访.结果 随访28～65个月,8例患者均存活,肝肾功能正常.存活5年以上2例,4年以上2例,2年以上4例.围手术期并发胸腔积液2例,肺部金黄色葡萄球菌感染1例,均对症治疗后痊愈.截至随访终点,未发现移植物急性排斥反应.结论 巨大多囊肾合并多囊肝并发肝肾功能衰竭的患者,肝肾联合移植术是安全有效的治疗方法.     

Semen quality in men with chronic kidney disease and its correlation with chronic kidney disease stages

The aim of this study was to assess whether chronic kidney disease (CKD) has any impact on semen quality parameters in men with CKD stage 1–5. Results were collected from 66 men with different CKD stages (age 18–50 years). Age and BMI (body mass index) were recorded for each male. Higher CKD stage had a significant negative linear trend on semen volume (P < 0.05), progressive motility (P < 0.01), nonprogressive motility (P < 0.001), sperm concentration (P < 0.01), total sperm number (P < 0.01), cytoplasmic droplets (P < 0.01), teratozoospermia index (P < 0.05) and accessory gland markers, α‐glucosidase activity (P < 0.05), zinc (P < 0.01) and fructose (P < 0.01). BMI per se had no significant effect on semen volume, sperm number, sperm concentration, morphology, α‐glucosidase activity, fructose concentration or zinc level. A significant negative correlation between BMI and sexual‐hormone‐binding globulin (SHBG) (P < 0.01) was observed but not with other sex hormones. Age per se was related to a significant decrease of sperm concentration (P < 0.05), normal forms (P < 0.01) and testosterone level (P < 0.05). Our results indicate that CKD stage per se is a factor determining the number of spermatozoa available in the epididymis for ejaculation, in part independent of age‐related decrease of testosterone level and BMI.     

胰十二指肠及肾一期联合移植三例体会

报告３例Ⅰ型糖尿病并发尿毒症患者接受全胰十二指肠及肾一期联合移植，术后术移植胰及肾功能恢复良好，停用胰岛素后，停用胰岛素后，血肌酐、尿素氮降至正常。本组其中２例胰肾有功能存活分别为３年和２年。例３因移植肾急性排斥，多器官衰竭于术后第２２天死亡。作者认为胰肾一期联合移植可同时纠正糖尿病和尿毒症。