肾病综合征患者血清CA125升高的相关因素分析

目的 探讨影响肾病综合征患者血清癌抗原-CA125水平升高的相关因素.方法 分别统计入选的83例肾病综合征患者的性别、年龄、体重、血白蛋白、血肌酐、24h尿蛋白定量、浆膜腔积液,采用多元线性逐步回归法、Pearson相关分析及t检验,分析肾病综合征患者血清CA125升高的可能相关因素.结果 血清CA125水平与浆膜腔积液(计分)呈正相关(r=0 588,P<0 05).结论 肾病综合征患者的血清CA125水平升高,可能与浆膜腔积液及低白蛋白血症相关.     

肾病综合征患者血清甲状腺激素水平临床观察

目的：观察肾病综合征（NS）患者继发性甲状腺激素水平下降的发生率，并探讨其发病机制。方法：分别用全自动免疫分析仪和全自动生化分析仪检测52例中、重度水肿的NS患者治疗前后及22例原发性甲状腺功能减退症患者、18例健康者的血清FT3，FT4、促甲状腺激素（TSH）、总蛋白、白蛋白及尿总蛋白、白蛋白水平，并分析其血清甲状腺激素与血、尿蛋白间的相关性。结果：52例NS患者中41例甲状腺激素水平较正常值有不同程度下降，其中FT3为（1．72±0．59）pg／mL，FT4为（8．63±1．92）pg／mL，TSH（7．32±3．05）μIU／mL。NS组患者治疗前血清FT3与血清白蛋白水平呈正相关（r=0．387，t=2．523，P〈0．05），FT4与血清白蛋白水平呈正相关（r=0．359，t=2．369，P〈0．05），与尿蛋白（尿总蛋白及尿白蛋白）间无相关性：TSH与血清白蛋白及尿蛋白间无相关性。结论：中、重度水肿的NS患者易出现继发性甲状腺激素水平下降，甲状腺激素改变水平与血清白蛋白水平相关。     

小儿原发性肾病综合征并发感染临床分析

目的探讨小儿原发性肾病综合征并发感染的发生率及相关因素。方法回顾分析我院儿科住院的150例原发性肾病综合征患儿中发生感染的临床资料。结果150例中发生院内感染48例，发生院外感染25例，感染率为48．7％，其中呼吸道感染占多数；住院时间超过20d，患儿院内感染的发生率达79．4％，感染与血浆免疫球蛋白（IgG）、白蛋白下降有关。结论肾病综合征患儿易合并院内外感染，感染与住院时间长短、血浆免疫球蛋白以及白蛋白水平有关，缩短住院时间、提高免疫球蛋白、白蛋白水平可减少感染的发生。     

血清铁与血脂在肾病综合征蛋白倒置患者中的关系

目的探讨肾病综合征（NS）蛋白倒置（白蛋白／球蛋白〈1）患者巾血清铁与血脂之间的关系。方法分别用比色法检测健康对照组和肾病综合征患者组血清铁（SI）以及血清总胆固醇（Tc）、甘油三酯（TG）、高密度胆固醇（HDLc）、低密度胆固醇（LDL-C）水平,用免疫比浊法检测ApoAI和ApoB。结果NS组：血清铁与ApoAI（r=0．693,P〈0．01）、与ApoB（r=0．539,P〈0．05）具有相关性,差异显著,具有统计学意义,而与Tc、TG、HDL-C、LDL—C则无相关性,差异无统计学意义（P〉0．05）;以SI为因变量y、血脂各项指标为自变量,采用Stepwise进行分析,其回归方程为：y=-3．36＋10．202&#215;ApoAI。健康对照组：血清铁与血脂诸项指标间均未有相关关系,差异无统计学意义（P〉0．05）。结论NS患者中APoAI的浓度与血清铁的水平有密切关系,其生物学意义尚待进一步研究。     

Combined furosemide and human albumin treatment for diuretic-resistant edema

OBJECTIVE: To evaluate the clinical usefulness of combined furosemide and human albumin for the treatment of diuretic-resistant edema in patients with nephrotic syndrome and cirrhosis. DATA SOURCES: Clinical literature was accessed through MEDLINE (1966-May 2002). Key search terms included furosemide, albumin, human albumin solution, nephrotic syndrome, and cirrhosis. DATA SYNTHESIS: Hypoalbuminemia, edema, and ascites are often manifestations of nephrotic syndrome and cirrhosis of the liver. Many patients with these conditions are resistant to the effects of diuretics. The combination of furosemide and human albumin solution is occasionally used in these patients. An evaluation of published studies focusing on combined furosemide and albumin in the management of nephrotic syndrome and cirrhosis was conducted. CONCLUSIONS: Published studies report conflicting results regarding the efficacy of combined furosemide and albumin. Although it is difficult to generate firm conclusions, it appears the combination may provide clinical benefits for select patients. Given these findings, we believe that the addition of albumin to enhance diuretic efficacy should be reserved for patients with recalcitrant edema or ascites in whom diuretic doses have been maximized and those with severe hypoalbuminemia.     

Rapid assessment of albumin concentration by immunoturbidimetry

The dye-binding methods involving bromcresol green and bromcresol purple may seriously overestimate albumin in serum that has a below-normal albumin/globulin ratio, particularly in nephrotic syndrome hypoalbuminemia. To overcome this problem, we developed a new immunoturbidimetric method for albumin with use of a centrifugal analyzer. Results by this method (y) and by radial immunodiffusion (x) agreed well and yielded the regression equation: y = 0.91x + 1.33 (n = 40, r = 0.96). Compared with laser immunonephelometry, our method is easier and faster (15 min for the overall determination). Thus, the proposed immunoturbidimetric method is particularly suitable for the rapid indirect assessment of oncotic pressure and indirectly for monitoring intravascular body fluids.     

低分子肝素治疗肾病综合征疗效分析

目的 探讨低分子肝素（LMWH）治疗肾病综合征的临床疗效。方法 将42例肾病综合征患者分为两组，分别给予LMWH和双嘧达莫治疗，并检测其用药前后血清白蛋白、血脂水平、血小板、出凝血时间及24小时尿蛋白定量。结果 LMWH组较双嘧达莫组治疗后24小时尿蛋白定量、血清胆固醇明显降低，血清白蛋白较双嘧达莫组恢复明显，两组均无出血并发症。结论 低分子肝素（LMWH）治疗NS，抗凝作用强，出血危险性小，并可减少蛋白尿。     

防己黄芪汤对原发性肾病综合征水肿期患者的疗效及对24h尿蛋白、血清白蛋白、血脂的影响

目的探讨防己黄芪汤对原发性肾病综合征(PNS)水肿期的疗效及对24 h尿蛋白、血清白蛋白、血脂的影响。方法选取80例原发性肾病综合征水肿期患者,随机分为观察组和对照组。对照组患者给予常规西医治疗,在此基础上观察组患者给予防己黄芪汤治疗。观察2组患者治疗效果,分析两种治疗方法对患者24 h尿蛋白、血清白蛋白、血脂的影响。结果观察组患者治疗有效率为90.00%,显著高于对照组的80.00%(P0.05);治疗后,观察组患者PT、Alb显著高于对照组,24 h尿蛋白定量、TG、Chol水平显著降低(P0.05)。结论在原发性肾病综合征水肿期患者治疗过程中,防己黄芪汤有利于缓解临床症状,提高血浆白蛋白水平,降低尿蛋白。     

Effect of hypoalbuminemia on the increased serum cholesteryl ester transfer protein concentration in children with idiopathic nephrotic syndrome

OBJECTIVES: To examine the alteration of cholesteryl ester transfer protein (CETP) mass with the regression of albumin level in childhood nephrotic syndrome (NS) in order to clarify the effect of albumin on CETP in NS. DESIGN AND METHODS: Serum concentrations of CETP, kidney parameters and lipid traits were determined in 110 children with idiopathic NS and 150 control subjects. Of the NS patients, 69 children with an active phase formed group 1, and 41 in remission formed group 2. RESULTS: Group 1 presented severe hypoalbuminemia and hyperlipidemia, while group 2 exhibited marked recovery in both serum albumin level and lipid/lipoprotein profile. CETP concentration was significantly higher in group 1 (7.36+/-2.43 mg/L, compared with controls 3.38+/-1.83 mg/L, P<0.0001), and declined to within normal range in group 2 (2.91+/-1.77 mg/L). CETP concentration had a strong inverse correlation with serum albumin level (r=-0.688, P<0.0001) in NS patients. Furthermore, when multiple linear regression analysis was performed, in which albumin, proteinuria, lipid traits, and prednisone dose were treated as independent variables, albumin was the only variable showing a significant correlation with CETP in the NS patients (R(2)=0.587, beta=-0.475, P<0.0001). CONCLUSIONS: The results demonstrate that the decreased serum albumin level might be a main determinant of the increased CETP concentration in pediatric NS.     

Reduction of urinary thiols in nephrotic syndrome--a possible effect of free iron

BACKGROUND: Albumin is a potent antioxidant as it chelates transitional metals and contains antioxidants like thiol and bilirubin. In neprotic syndrome, the defining parameter is proteinuria with hypoalbuminemia. Therefore albuminuria in nephrotic syndrome may increase toxic transitional metal ions and also can cause loss of albumin associated antioxidants causing oxidative stress to the individual. METHODS: We investigated this possibility and estimated some markers of oxidative stress in 20 nephrotic syndrome patients and healthy controls along with urinary thiols, urinary bilirubin and plasma free iron in both cases and in the controls. RESULT: We found oxidative stress in 20 nephrotic syndrome patients and the markers of oxidative stress correlated significantly with proteinuria, but the urine of nephrotic syndrome patients (28.33+/-4.2 micromol/g creatinine)contained significantly less thiols compared to the healthy controls (88.45+/-10.6 micromol/g creatinine) and no biliribin. The patients plasma also showed free iron (0.7+/-0.05 micromol/l), a parameter undetectable in the healthy controls. CONCLUSION: We suggest that oxidative stress and presence of free iron in the patients were responsible for less thioluria and no bilirubinuria. A detailed study of oxidative biology in a large cohort of nephrotic syndrome patients is necessary to confirm the presence of free iron as appropriate chelation of free iron may benefit the long-term prognosis of the disease.     

Use of 125I- and 51Cr-Labeled Albumin for the Measurement of Gastrointestinal and Total Albumin Catabolism

A method for the simultaneous measurement of gastrointestinal protein loss and total albumin turnover entailing the use of a combination of (125)iodine- and (51)chromium-labeled albumin is described. Albumin turnover was calculated by the measurement of albumin-(125)I plasma decay and cumulative urinary excretion, and the results obtained agreed closely with previous studies utilizing albumin-(131)I. Gastrointestinal catabolism was calculated from the rate of fecal excretion of (51)Cr and the specific activity of plasma albumin-(51)Cr, and these data were related to the calculated albumin turnover results. During the period of 6-14 days after administration, the ratio of specific activties of albumin-(125)I and -(51)Cr in plasma and in extravascular spaces or gastric and biliary secretions remained almost identical. Fecal excretion of (51)Cr was also quite stable at this time. In six normal subjects gastrointestinal catabolism accounted for less than 10% of total albumin catabolism. Excessive gastrointestinal protein losses did not contribute to the low serum albumin in three patients with cirrhosis or in two adults with the nephrotic syndrome. Multiple mechanisms leading to hypoalbuminemia were demonstrated in other subjects with a variety of gastrointestinal disorders.     

Elevated levels of immunoglobulin E may indicate steroid resistance or relapse in adult primary nephrotic syndrome, especially in minimal change nephrotic syndrome

Immunoglobulin E (IgE) antibodies may play a role in the development of kidney diseases that are related to hypersensitivity reactions. Patients with idiopathic nephrotic syndrome often exhibit increased serum IgE levels and this may be related to sensitivity to steroid treatment. In the present study, the serum IgE levels in 120 patients with different types of primary nephrotic syndrome (PNS) were analysed and found to be significantly elevated in cases of minimal change nephrotic syndrome (MCNS) compared with membranous nephropathy or membrano-proliferative glomerulonephritis. No difference in serum IgE level was observed between cases of steroid-sensitive nephrotic syndrome (SSNS) or steroid-resistant nephrotic syndrome, although the serum IgE level was significantly elevated in SSNS patients in relapse compared with SSNS patients in remission. In MCNS patients, 73.6% exhibited SSNS regardless of their serum IgE level at diagnosis. It is concluded that elevated levels of IgE may be a feature of steroid resistance or relapse, indicating prognostic significance in adult PNS, particularly in MCNS.     

核糖核酸治疗慢性肝病低蛋白血症临床观察

目的 观察核糖核酸治疗慢性肝病低蛋白血症的疗效。方法 １２２例随机分为两组，治疗组６６例用核核酸静滴，对照组５６例用促肝细胞生长素静滴，现代化且基础治疗相同。分别测定两组治疗前及治疗一个月后血清白蛋白、球蛋白含量；对不同病型组治疗前后血清白蛋白和球蛋白含量进行比较；对侧定的结果进行统计学分析。结果 治疗后治疗组血清白蛋白含量明显高于对照组（Ｐ〈０．０５）；慢肝中度和慢重肝病例治疗后治疗组血清白蛋白     

Systemic edema in kidney diseases

Extracellular fluid expansion states are characterized by increase total body water. These disorders are usually associated with avid renal sodium and water retention. Some examples of such abnormal sodium retention in renal diseases are acute glomerulonephritis and nephrotic syndrome. Edema formation in case of acute glomerulonephritis is primarily responsible for salt retention. On the other hand, the pathogenesis of edema in nephrotic syndrome involves two different mechanisms those are underfill and overfill hypothesis. According to the underfill hypothesis, nephrotic syndrome results in increase of urinary loss of albumin, which subsequently leads to hypoalbuminemia and decreased plasma osmotic pressure. Overfill theory explains that renal salt and water retention is primary phenomenon that leads to plasma volume expansion and subsequent exudation of fluid to the interstitium.     

LDL-apheresis in patients with nephrotic syndrome: effects on serum albumin and urinary albumin excretion

BACKGROUND: Hyperlipidemia is a common feature of the nephrotic syndrome (NS). From retrospective studies, it has been suggested that aggressive lipid-lowering with low-density lipoprotein apheresis (LDL-A) may not only improve dyslipidemia but also decrease urinary albumin excretion and increase serum levels of albumin in patients with focal segmental sclerosis. METHODS: Seven patients (6 males) aged 44 +/-7 years (SEM) with NS (duration 29+/-11 months) of diverse etiologies were investigated in a prospective study. A fixed protocol of LDL-A was designed for treatment twice-a-week for 3 weeks and then once a week for 7 weeks. The effects of LDL-A on lipid parameters (cholesterol, triglycerides, HDL, Lp(a), apo A-I, apo B) and renal parameters (iohexol clearance, serum albumin and 24-h urinary albumin excretion) were evaluated. RESULTS: Following treatment by LDL-A a remission in the severity of the NS was observed in two patients whereas a clear improvement was observed in four of the patients. A small, but significant (P<0.05), increase in serum albumin levels from 20+/-2 to 24+/-2 g L(-1) was noted after LDL-A. As expected, serum lipid parameters improved during LDL-A, and significant decreases in serum cholesterol, apo B and plasma Lp(a) were observed at different time-points of LDL-A. Conversely, no significant changes in either triglyceride, HDL or apo A-I levels were observed during LDL-A. CONCLUSIONS: The present uncontrolled prospective study shows that LDL-A causes a rapid 30-40% decrease in serum cholesterol and plasma Lp(a) levels in patients with NS. The present prospective study also suggests that short-term LDL-A treatment may increase serum albumin levels in nephrotic patients.     

Influence of hypoalbuminemia or hyperalbuminemia on the serum anion gap

BACKGROUND: Conflicting data exist as to what extent hypoalbuminemia reduces the anion gap; estimates range from 1.5 to 2.5 mM per g/dL decrease in serum albumin. METHODS: We measured serum albumin, total protein, and electrolyte concentrations in 5328 consecutive patients aged 1 month to 102 years. Most patients (3750; 70%) had a normal albumin, but 1158 had hypoalbuminemia (< or =3.4 g/dL); 420 had hyperalbuminemia (> or =4.7 g/dL). Relationships between serum albumin or total protein and the anion gap were analyzed by linear regression. RESULTS: 309 (27%) hypoalbuminemic patients had a decreased anion gap, and 257 hyperalbuminemic patients (61%) had an increased anion gap. Among the entire group of 5328 patients, there were highly significant correlations between either serum albumin or total protein and the anion gap (P < 0.001). The slope of the regression for albumin versus anion gap was 2.3 mM per g/dL. Using this slope, anion gap could be adjusted for abnormal serum albumin levels: anion gap(adjusted) =anion gap + 2.3 (4-albumin). The initial assessment of an anion gap as being increased, normal, or decreased changed in 44% of the patients with hypo- or hyperalbuminemia once anion gap had been adjusted with this formula. CONCLUSIONS: Before considering whether a disorder associated with an increased or decreased anion gap is present, the anion gap should be first adjusted for abnormal serum albumin concentrations. Our data suggest that physicians use 2.3 times the change in serum albumin, whereas those of Figge et al suggest 2.5; either approach gives similar results.     

Hypoalbuminemia as an indicator of diarrheal incidence in critically ill patients

Recently, we noted that substantial numbers of critically ill patients admitted to a medical ICU developed diarrhea. We checked them for infectious, metabolic, and untoward medication effects, which were negative. We next considered a possible causal relation between reduced serum albumin and diarrhea. To document the frequency of diarrhea in this population, explore the relation between hypoalbuminemia and diarrhea, and make a preliminary assessment of a peptide-based, chemically defined diet in these catabolic patients, a study of consecutive medical ICU patients was begun. For each patient, we recorded the principal diagnosis, type of diet received, the frequency and volume of stool, and the serum albumin concentration at admission. When diarrhea developed, attention was paid to the serum albumin levels as well as the effects of various diets. Overall, 12 (34%) of 35 study patients developed diarrhea. No patient had a previous history of diarrhea, malabsorption, weight loss, or GI symptoms that may precede the onset of diarrhea. The stools from each patient with diarrhea were examined for enteric pathogens, ova and parasites, Clostridium difficile culture and cytotoxin assay, and qualitative stool fat, which were all negative. Every patient with a serum albumin level less than 2.6 g/dl developed diarrhea. No patient with a serum albumin level of 2.6 g/dl or greater developed diarrhea, regardless of the type of nutritional support received. Four of the 12 patients with hypoalbuminemia and diarrhea were placed on a peptide-based, chemically defined diet, after which their diarrhea resolved and their serum albumin concentrations increased.     

泼尼松和胱抑素C及肌酐联合检测在肾病综合征中的临床价值

目的探讨泼尼松、胱抑素C与肌酐浓度监测在肾病综合征中的临床价值。方法对54例肾病综合征患者分别用高效液相色谱法、乳胶增强散射免疫比浊法及酶比色法对泼尼松、胱抑素C及肌酐水平进行检测。结果治疗前除微小病变肾病综合征外,健康对照组和肾病综合征组胱抑素C与肌酐浓度差异均有统计学意义(P<0.01);治疗后泼尼松保持稳态血药浓度时,胱抑素C浓度降低(P<0.05)且相对稳定,而肌酐浓度变异较胱抑素C大,但与治疗前相比差异无统计学意义(P>0.05)。结论胱抑素C是肾病综合征疗效观察更敏感的指标,泼尼松与胱抑素C联合检测更具有临床价值。     

Lovastatin ameliorates depressed intraglomerular proteolytic activities in experimental nephrotic syndrome

Lipid abnormalities have been implicated in the pathogenesis of glomerulosclerosis in experimental models of kidney disease. In previous studies it has been shown that Adriamycin-induced nephropathy is associated with reduced activities of glomerular proteinases. This observation led to the hypothesis that reduced proteolytic activities may be responsible for mesangial protein accumulation, which ultimately leads to global sclerosis of the glomerular tuft. The aim of the present study was to investigate whether lovastatin treatment, which prevents progressive glomerulosclerosis in experimental nephrotic syndrome, would also have an effect on glomerular proteinase activities. Adriamycin administration resulted in a persistent nephrotic syndrome with gross proteinuria (377±26 mg/24 h), hypoalbuminemia (2.1±0.12 vs. 2.8±0.02 g/dl), hypercholesterolemia (575±74 vs. 68±1.5 mg/dl) and elevated triglyceride levels (1,155±78 vs. 57±8 mg/dl). Glomerular azocaseinolytic activities both at pH 5.4 (−21%) and 7.4 (−37%) were significantly reduced. In contrast to human subjects, nephrotic rats that were treated with lovastatin displayed reduced triglyceride levels (767±134 mg/dl); their serum cholesterol, however, remained unchanged. In terms of glomerular proteolytic enzyme activities, the decline in azocaseinolysis at both pH values was, at least partly, prevented by lovastatin. On the basis of these data, it appears that the beneficial effect of lovastatin on the evolution of glomerulosclerosis in the nephrotic rat is associated with the conservation of glomerular proteolytic activities.     

激素敏感型和耐药型肾病综合征患儿血清免疫复合物的水平及其意义

【目的】比较激素敏感型肾病综合征（SSNS）、激素耐药型肾病综合征（SRNS）和健康儿童血清及肾脏免疫复合物水平,评估血清免疫复合物对肾病综合征激素治疗反应性的预测作用。【方法】液相免疫沉析法检测住院病人与健康对照组血清免疫复合物水平,检测患儿肾脏免疫荧光改变,分析患儿血清免疫复合物水平与激素治疗反应性的相关性。【结果】肾病综合征患者存在血清免疫复合物的异常,IgM、IgE水平上升,IgG、IgA水平下降,SRNS更为明显,而C3、C4无明显差异,病理检查免疫荧光显示IgM阳性率较高,而SRNS相对更高,存在相关性。【结论】血清免疫球蛋白的水平是肾病综合征患者重要的血清学指标,对于临床预测激素治疗反应性有积极意义。