原发性肾病综合征患儿尿TGF-β1检测的临床意义

【目的】检测原发性肾病综合征患儿尿液转化生长因子β1(TGFβ1)水平并评价其临床意义。【方法】对38例接受治疗的原发性肾病综合征患儿治疗前及缓解后检测尿液TGFβ1水平,并与30例健康对照组相比较。【结果】22例激素敏感型患儿治疗后尿TGFβ1水平明显下降[(363.8±187.6)vs(234.5±113.2)ng/mgCr,(P<0.01)]。16例激素抵抗型患儿治疗后尿TGFβ1水平无明显变化[(374.5±193.5)vs(353.9±173.3)ng/mgCr,(P>0.05)],但加用环磷酰胺冲击治疗后10例病情缓解,尿TGFβ1水平明显下调[(376.6±180.3)vs(208.5±102.7)ng/mgCr,(P<0.05)]。TGFβ1水平与尿白蛋白(r=0.480,P<0.01)、24h尿蛋白(r=0.419,P<0.01)呈正相关。【结论】尿TGFβ1水平可作为反映肾病综合征患儿病情、评价治疗效应的指标。     

尿钾排泄量减少与高血压正常高值期患者发生高血压的关系研究

目的探究尿钾排泄量与高血压前期患者发生高血压的关系。方法本研究选取于2011年1至7月在社区体检时检出的高血压前期患者200例为观察组,同时选取血压正常的志愿者200例进行对照。从早6点开始,于次日6点结束收集入组人员24 h尿液,进行尿钾排泄量测定,同时测量人员血压,数据统计后进行分析,比较两组人员尿钾排泄量的差异及尿钾排泄量与血压的相关关系,随访3年,记录发生高血压的例数,同时测量尿钾排泄量,比较患高血压与未患高血压人群尿钾排泄量的差异。结果观察组患者24 h尿钾排泄量为(29.01±7.30)mmol/L,对照组为(36.40±10.04)mmol/L,两组比较,差异具有统计学意义(P<0.05);对24 h尿钾排泄量与血压的相关关系进行分析,结果提示24 h尿钾排泄量与血压存在负相关(r=-0.79,P<0.05);3年内,高血压前期人群中有74例发展为高血压,24 h尿钾水平为(25.37±5.23)mmol/L,未发展为高血压的126例,24 h尿钾水平为(30.05±7.44)mmol/L,两组比较,差异具有统计学意义(P<0.05)。结论尿钾排泄量与高血压前期患者血压存在负相关,即患者血压越高,尿钾排泄量越低,临床上可以通过尿钾排泄量的测定来及早预防高血压的发生。     

餐后血糖水平对微量白蛋白尿发生发展的影响

目的探讨2型糖尿病患者空腹血糖水平及餐后血糖水平对尿微量白蛋白的影响。方法 2型糖尿病患者73例,年龄均在60岁以上,糖尿病病史>10年,其中平均空腹血糖水平≥7.0mmol/L及平均餐后血糖水平<11.1mmol/L者35例,为第1组;平均空腹血糖水平<7.0mmol/L及平均餐后血糖水平≥11.1mmol/L者38例,为第2组;检测2组24h尿微量白蛋白水平。结果第2组的尿微量白蛋白水平明显高于第1组[(287.80±35.60)vs(162.50±20.30)mg/24h,P<0.01]。结论 2型糖尿病患者餐后血糖水平对尿微量白蛋白水平的影响大于空腹血糖,积极控制餐后血糖,可能对延缓糖尿病肾病发生发展有重要意义。     

厄贝沙坦对老年高血压晨峰患者微量白蛋白尿的影响及降压疗效

目的 探讨厄贝沙坦对老年高血压晨峰患者尿微量白蛋白的影响及降压疗效.方法 选择经24 h动态血压监测血压未达标的老年高血压晨峰患者92例,观察睡前加用厄贝沙坦治疗后血压及血压晨峰的变化和对尿微量白蛋白的影响.结果 治疗前92例老年高血压患者24 h平均收缩压(140.1±12.7)mm Hg,晨峰收缩压(45.6±10.8)mm Hg,尿微量白蛋白[(58.6±3.7)mg/L]明显升高,与治疗前比较,睡前加服厄贝沙坦治疗后患者24 h平均收缩压[(129.5±11.8)mm Hg]下降(t=3.18,P＜0.05),晨峰收缩压[(14.2±4.1)mm Hg]下降(t=5.74,P＜0.01),尿微量白蛋白[(31.7±3.1)mg/L]显著降低(t=5.24,P＜0.01).结论 厄贝沙坦可以有效降低老年高血压患者的血压及血压晨峰,提高血压达标率,降低尿微量白蛋白.     

24h尿总蛋白和尿微量白蛋白联合检测对2型糖尿病早期肾损伤的诊断价值

目的探讨24h尿总蛋白和尿微量白蛋白联合检测对2型糖尿病早期肾损伤的诊断价值。方法选择90例2型糖尿病患者作为研究组[根据空腹血糖（FPG）水平将90例2型糖尿病患者分为轻度组(FPG<7 mmol·L-1,n=29)、中度组(7mmol·L-1≤FPG≤9mmol·L-1,n=31)和重度组(FPG>9mmol·L-1,n=30)],另选择30例健康体检者作为对照组,分别检测血清FPG及24h尿总蛋白、尿微量白蛋白的水平,并比较其水平的差异和检测的阳性率。结果轻度组、中度组、重度组血清FPG及24h尿总蛋白、尿微量白蛋白水平均明显高于对照组（均P<0.05）,且随着病情程度的加重,血清FPG及24h尿总蛋白、尿微量白蛋白水平均明显升高（均P<0.05）。研究组血清FPG、24h尿总蛋白及尿微量白蛋白检测阳性率均明显高于对照组（均P<0.05）。结论 24h尿总蛋白和尿微量白蛋白联合检测可作为2型糖尿病早期肾损伤诊断的参考依据,便于临床及早制定治疗措施。     

血糖漂移、同型半胱氨酸对2型糖尿病患者尿蛋白排泄量的影响

目的探讨血糖漂移、同型半胱氨酸对2型糖尿病患者尿蛋白排泄量的影响。方法对我院自2014年1月至2015年6月所收治的105例糖尿病患者根据尿白蛋白/肌酐(UACR)高低分为正常蛋白尿组、微量蛋白尿组和大量蛋白尿组;比较三组间年龄、糖尿病病程、收缩压(SBP)、舒张压(DBP)、体质量指数(BMI)、空腹血糖(FBG)、甘油三酯(TG)、综胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、同型半胱氨酸(HCY)、糖化血红蛋白(Hb A1c)的水平。同时对三组患者进行连续72 h的动态血糖监测,观察三组间平均血糖水平(MBG)及日内平均血糖漂移幅度(MAGE)的差异。多组间比较采用单因素方差分析,组间两两比较采用LSD法。用Spearman法进行相关分析,多因素分析采用多元逐步回归分析法。结果微量蛋白尿组、大量蛋白尿组病程[(12.85±6.3)年vs.(16.06±6.86)年vs.(8.42±4.17)年]、SBP[(143.21±22.51)mm Hg vs.(157.78±18.41)mm Hg vs.(131.73±20.95)mm Hg]、DBP[(80.12±11.66)mm Hg vs.(86.50±13.30)mm Hg vs.(72.73±12.76)mm Hg]、TG[(2.38±0.98)mmol/L vs.(3.11±2.06)mmol/L vs.(1.75±0.81)mmol/L]、HCY[(7.74±1.40)mmol/L vs.(9.55±1.46)mmol/L vs.(9.94±4.07)mmol/L]、MBG[(8.45±1.68)mmol/L vs.10.65±2.38)mmol/L vs.14.41±5.40)mmol/L]、MAGE[(9.30±1.47)mmol/L vs.(11.73±2.58)mmol/L vs.(25.15±18.45)mmol/L]均高于正常蛋白尿组(P<0.05);微量蛋白尿组病程[(12.85±6.3)年vs.(16.06±6.86)年]、SBP[(143.21±22.51)mm Hg vs.(157.78±18.41)mm Hg]、DBP[(80.12±11.66)mm Hg vs.(86.50±13.30)mm Hg]、TG[(2.38±0.98)mmol/L vs.(3.11±2.06)mmol/L]、HCY[(7.74±1.40)mmol/L vs.(9.55±1.46)mmol/L]、MBG[(8.45±1.68)mmol/L vs.(10.65±2.38)mmol/L]、MAGE[(9.30±1.47)mmol/L vs.(11.73±2.58)mmol/L]均低于大量蛋白尿组(P<0.05)。UACR与糖尿病病程、SBP、DBP、TG、HCY、MBG、MAGE呈明显正相关(P均<0.05)。逐步回归分析表明糖尿病病程(x1)、SBP(x2)、MBG(x3)及HCY(x4)是UACR的影响因素,回归方程为?y=-1.044+0.027x1+0.011x2+1.04x3+1.02x4。结论糖尿病肾病患者血糖漂移、HCY与尿蛋白排泄量之间存在相关性,糖尿病肾病患者血糖漂移偏大、HCY升高将会引起尿蛋白排泄量的增加。     

点尿法及24 h尿收集法估算高血压病患者24 h尿钠钾排泄量的应用比较

目的探讨利用点尿法及24 h尿收集法估算高血压病患者24 h尿钠钾排泄量的应用价值。 方法研究对象为2017年2月至2018年1月就诊于新疆医科大学第一附属医院高血压科的高血压病患者,共264例。收集患者24 h尿及相应的清晨空腹点尿,分别测定所有尿样的钠、钾、肌酐水平。采用Tanaka、Kawasaki和INTERSALT公式分别估算点尿法24 h尿钠钾排泄量,采用配对秩和检验比较公式估算值与实际测量值的差异;利用Spearman相关分析评价各公式估算的24 h尿钠钾排泄量与实测24 h尿钠钾排泄量的相关关系。 结果Tanaka法公式估算的24 h尿钠值(167.99 mmol/d)高于实际24 h尿钠值(157.73 mmol/d),差异无统计学意义(Z＝－0.23,P>0.05);Kawasaki法公式估算的24 h尿钠值(217.66 mmol/d)亦高于实际24 h尿钠值,差异有统计学意义(Z＝－8.81,P<0.01);INTERSALT法公式估算的24 h尿钠值(154.71 mmol/d)低于实际24 h尿钠值,差异有统计学意义(Z＝－3.53,P<0.01)。Tanaka、Kawasaki和INTERSALT公式估算的24 h尿钠值与实际24 h尿钠值的相关系数分别为0.68,0.55,0.58(均P<0.01);Tanaka公式估算的24 h尿钾值(39.51 mmol/d)低于实际测量值(42.90 mmol/d),差异有统计学意义(Z＝－3.47,P<0.05),相关系数为0.50(P<0.01)。 结论在高血压病患者中,公式法估算的24 h尿钠钾排泄量与实际测量值,存在不同程度的低估与高估,且相关性差。利用点尿法公式估算高血压病患者24 h尿钠钾排泄量存在一定程度的不准确性和局限性。     

随机尿样微量白蛋白/肌酐比值与24 h尿白蛋白定量结果的对比研究

目的:探讨随机尿样微量白蛋白/肌酐比值和24h尿白蛋白定量测定之间的关系。方法:分别采用放射免疫法、免疫比浊法和酶法检测124例2型糖尿病患者和58例健康体检者尿微量白蛋白/肌酐比值,24h尿白蛋白定量,空腹血糖和糖化血红蛋白A1c的浓度,并对数据进行相关统计学分析。结果:糖尿病组尿微量白蛋白/肌酐比值对数值为1.46±0.83,明显高于对照组0.42±0.14(P<0.01),且性别差异无统计学意义(P>0.05)。尿微量白蛋白/肌酐比值与24h尿白蛋白定量,空腹血糖,糖化血红蛋白A1c的相关系数分别为0.903,0.025,0.038。结论:随机尿样微量白蛋白/肌酐比值与24h尿白蛋白定量结果呈高度等级相关,可以快速诊断微量白蛋白尿。     

伴微量白蛋白尿2型糖尿病患者并发冠状动脉粥样硬化性心脏病的危险性

目的:观察伴微量白蛋白尿2型糖尿病患者冠状动脉粥样硬化性心脏病(简称冠心病)发病情况,以及与不伴微量蛋白尿2型糖尿病患者病程、血压、血脂、血糖的差异性。方法:①选择2004-07/2006-05上海交通大学医学院附属新华医院住院的102例2型糖尿病患者,男55例,女47例,年龄56～82岁,病程1个月～15年。均符合1999年世界卫生组织2型糖尿病诊断标准;并对检测项目知情同意。根据蛋白尿情况将患者分为2组:不伴微量白蛋白尿组(78例,24h尿白蛋白排泄率<20μg/min)和伴微量白蛋白尿组(24例,24h尿白蛋白排泄率≥20μg/min,<200μg/min)。②测量患者血压,以酶法测定血清三酰甘油、总胆固醇和高密度脂蛋白胆固醇水平,以Friedewald公式计算血清低密度脂蛋白胆固醇,以葡萄糖氧化酶法测定空腹血糖,以肌酐酶法测定血肌酐,以离子交换层析法测定糖化血红蛋白,采用散射浊度法检测尿微量白蛋白。择期采用Judkin法,行冠状动脉造影诊断是否患有冠心病。③组间各临床指标比较采用t检验,计数资料各检验指标采用χ2检验,并进行Logistic多元回归分析进行数据分析。结果:2型糖尿病患者102例均进入结果分析。①临床资料:伴微量白蛋白尿组患者的病程和平均收缩压明显长于或高于不伴微量白蛋白尿组(P<0.05),平均舒张压与不伴微量白蛋白尿组相近(P>0.05)。②血糖、血脂、血肌酐及合并冠心病发病率的比较:伴微量白蛋白尿组冠心病的发病率、空腹血糖、血肌酐、糖化血红蛋白水平分别为79%(19/24),(9.31±1.74),(89.12±25.03)mmol/L,(8.92±1.63)%,高于不伴微量白蛋白尿组[36%(28/78),(8.20±2.32),(82.00±19.80)mmol/L,(8.07±1.15)%,P<0.05￣0.01],血脂水平差异不明显(P>0.05)。③Logistic多元回归分析结果:24h尿白蛋白排泄率与收缩压、空腹血糖、糖化血红蛋白、血肌酐、冠心病呈明显正相关(OR=1.08￣4.41,P<0.01)。结论:①2型糖尿病患者出现微量白蛋白尿者的冠心病发病率较未出现微量白蛋白尿者高。②糖尿病病程较长,血糖、收缩压和血肌酐水平较高的2型糖尿病患者合并肾功能损害的可能性也较高。③24h尿白蛋白排泄率的增加与收缩压、空腹血糖、糖化血红蛋白、血肌酐水平和冠心病的发生有关。     

微量白蛋白尿在系统性红斑狼疮患者早期肾损害诊断中的意义

目的探讨微量白蛋白尿在诊断系统性红斑狼疮(SLE)早期肾损害中的意义及其与疾病活动性的相关性。方法检测104例系统性红斑狼疮患者的24小时尿白蛋白定量,分析其与临床病程、疾病活动性及免疫学指标之间的关系。结果104例患者中72例(69.2%)24小时尿白蛋白升高。在尿常规检测尿蛋白阴性患者中,47.5%(29/61)的患者24小时尿白蛋白升高(微量白蛋白尿),其中在初治和复治患者中分别有48.7%(19/39)和45.5%(10/22)的患者24小时尿白蛋白升高;初治患者尿白蛋白升高组的SLEDAI评分[(10.2±3.6)分]和血沉[(62.9±37.1)mm/1 h]较尿白蛋白正常组[分别为(6.6±2.9)分和(40.2±29.5)mm/1 h]显著升高(P均<0.05),且伴有血白蛋白降低(10/19)和免疫球蛋白升高(5/19)的比例较正常组(分别为3/20和0/20)显著增加(P均<0.05);复治患者尿白蛋白升高组的SLEDAI评分[(6.5±3.5)分]也较正常组[(3.3±2.7)分]显著升高,且伴有贫血(4/10)和血清补体降低(7/10)的比例较正常组(分别为0/12和2/12)显著增加(P均<0.05)。结论检测微量白蛋白尿有助于早期发现系统性红斑狼疮患者的肾损害,并与疾病的活动度及严重性显著相关。     

Monitoring urinary orosomucoid in acute inflammation: observations on urinary excretion of orosomucoid, albumin, alpha1-microglobulin, and IgG

BACKGROUND: Inflammation-associated proteinuria in acute, nonrenal disease is a common but poorly understood phenomenon. We performed an observational study of the urinary excretion of orosomucoid (alpha(1)-acid glycoprotein), albumin, alpha(1)-microglobulin (protein HC), and IgG to obtain quantitative and temporal data on these 4 proteins. METHODS: Urine samples were collected at daily intervals for up to 23 days from 6 patients with surgery-induced inflammation and at hourly intervals for a 24-h period from 7 sepsis patients. Urinary protein concentrations were assessed by immunoturbidimetry. RESULTS: During surgery-induced inflammation, the increase and decrease in orosomucoid excretion mirrored changes in plasma C-reactive protein. Values for all 4 urinary proteins were increased in sepsis patients. The observed maximum increases in urinary protein excretion relative to the upper reference values were 280-fold for orosomucoid, 98-fold for alpha(1)-microglobulin, 33-fold for albumin, and 26-fold for IgG. CONCLUSIONS: Orosomucoid, usually present in plasma and urine in much lower concentrations than albumin, is increased in urine to concentrations equal to or higher than albumin in proteinuria associated with acute inflammation. The pathophysiologic mechanisms responsible for this markedly increased excretion are unknown. Monitoring of urinary excretion of orosomucoid and other specific proteins, expressed as protein/creatinine ratios, may provide a window for clinically relevant real-time observation of changes in acute inflammatory processes. Orosomucoid in urine may be a more informative marker than albumin for inflammation.     

Serum ionized calcium, nephrogenous and total urinary cyclic AMP and urinary phosphate in normal subjects

Total urinary cyclic AMP (UcAMP) and nephrogenous cyclic AMP (NcAMP) were measured in 4, 20 and 24 h urine in forty-eight healthy volunteers. There were no significant differences between 4, 20 and 24 h excretion rate of UcAMP and NcAMP whether it was corrected for the glomerular filtration rate [( UcAMP]GF, [NcAMP]GF), creatinine corrected (UcAMP/Crea)U, or expressed as actual excretion rate (NcAMP,n), nor any sex differences. Mean values +/- one standard deviation (SD) for these parameters: [UcAMP]GF: 30.4 +/- 9.4 nmol/l; 27.7 +/- 7.0 nmol/min; 28.1 +/- 6.9 nmol/l in 4, 20 and 24 h urine, respectively. [NcAMP]GF: 13.4 +/- 8.5 nmol/l; 10.6 +/- 7.7 nmol/l; and 11.1 +/- 7.2 nmol/l in 4, 20 and 24 h urine, respectively. (NcAMP,n): 1.45 +/- 0.90 nmol/min; 1.14 +/- 0.80 nmol/min; 1.17 +/- 0.73 nmol/min in 4, 20 and 24 h urine, respectively, NcAMP accounts for about 40% of UcAMP. A positive correlation was found between plasma cyclic AMP and [UcAMP]GF (r = 0.41, P less than 0.001), whereas this relationship could not be demonstrated between plasma cyclic AMP and [NcAMP]GF (r = -0.008, P greater than 0.1). The calculation of [NcAMP]GF therefore corrects for unsuspected high or low plasma cyclic AMP values, and is therefore the preferred parameter of the PTH effect on the kidney tubular cells. No correlation could be demonstrated between [NcAMP]GF and concentration of ionized calcium in plasma.(ABSTRACT TRUNCATED AT 250 WORDS)     

Alterations in urinary elimination: concepts, research, and practice

This is a three-part article that demonstrates the process of development and confirmation of nursing diagnoses. Part I, “Taxonomy for Urine Control: Concepts Development,” looks at the development of the taxonomy of alterations in urinary elimination that was recently endorsed by the North American Nursing Diagnosis Association under the category of alterations in urinary elimination. Part II, “Urinary Incontinence in the Adult: Prevalence, Contributing Factors, and Potential Healthcare Services,” examines epidemiological findings of recent years and their application to nursing practice, to develop the taxonomy into a working model for the assessment and treatment of incontinent persons. Part III, “Taxonomy for Urine Control: Bridges to Practice,” builds on the foundation of the first two parts, exploring several ways in which systematic clinical application of the taxonomy and findings might occur.     

Radioimmunoassay of human urinary kallikrein: determination of human urinary kallikrein, II

A radioimmunoassay for the determination of human urinary kallikrein was developed. The sensitivity of the assay was 0.5 microgram/l. Dose-response curves of human submandibular and parotid saliva, sweat, pancreatic juice and bile paralleled the standard curve obtained with purified human urinary kallikrein. Substances with similar antigenic determinants were also found in human serum, ascites, seminal plasma, amniotic fluid, cervical mucus, tears, liquor and faeces, but not in human breast milk and gastric juice. Moreover, immunoreactive material was detected in the urine of guinea pigs, orangoutangs and chimpanzees, but not in the urine of rats, cats and rabbits. Porcine acrosin and kallikrein, as well as bovine trypsin and chymotrypsin, showed no cross reactivity.     

Current survey of urinary tuberculosis in Hokkaido, Japan

Urinary tuberculosis has been rare in recent years and its diagnosis is difficult because there are no disease-specific symptoms. We tried to clarify the occurrence of urinary tuberculosis in recent years in our area. During the past 5 years, there were 12 patients with urinary tuberculosis in the clinics that participated in this study. Their chief complaints were frequent voiding in 7 patients and gross hematuria in 3 patients. They were diagnosed by nucleic acid amplification tests and imaging modalities such as excretory urography, computed tomography, and/or cystoscopy. Most of the patients received multidrug treatment and had relatively favorable treatment outcomes. There has been a small but neglected number of patients with urinary tuberculosis in recent years. We should keep this rare and difficult-to-diagnose disease in mind and suspect it when patients complain of longstanding urinary symptoms with no obvious cause.     

Assessment of urinary N-telopeptide: point-of-care testing, sample types, and relationship to urinary helical peptide excretion

BACKGROUND: A point-of-care (POC) device would be useful in the space program for measuring N-telopeptide (NTX), a marker of bone resorption. This study was done to establish whether NTX measurements from a POC device compare favorably with standard (ELISA) techniques. We also compared results from fresh and frozen urine samples, samples collected on consecutive days, and second voids (of the day) and 24-h urine pools. Helical peptide (HP), another crosslink, was compared in second voids and 24-h urine pools. METHODS: Ten subjects collected urine for 96 h. NTX was measured with the POC device and by ELISA, and HP measured by ELISA. Seven subjects collected 24-h urine pools, and samples were analyzed fresh and after 27 days of freezing. RESULTS: Excretion of NTX was greater (P<0.05) when measured by the POC device than when measured by ELISA, but was not different between second voids and 24-h urine pools, or among days. HP was similar in second voids and 24-h pools. Less NTX (P<0.05) was found in fresh 24-h pools [mean (S.D.) values, 38.4 (11.6) and 33.6 (9.2) nmol/mmol creatinine for the POC device and ELISA] than in previously frozen 24-h pools [42.7 (17.4) and 41.5 (12.5) nmol/mmol creatinine for the POC device and ELISA]. CONCLUSIONS: Comparisons between NTX measurements from frozen and fresh samples and those analyzed by POC and ELISA techniques should be made with caution.     

Pediatric urologic conditions, including urinary infections

Genitourinary complaints are common in children, and the busy primary care provider must determine initial treatment and assess need for specialty referral. Many complaints are self-limited, but some represent disorders that can threaten organ function. In this article, an initial approach in the primary care office and a guide to specialty referral for pediatric urologic conditions of the urinary tract, male genitalia, and female genitalia are suggested.