59例肾衰患者血液透析后皮肤瘙痒的分析

瘙痒是慢性肾衰血液透析患者的常见症状，为了探讨引起瘙痒的相关因素，将透析期在两月以上的59例病人作为观察对象，对其血液透析后的皮肤瘙痒及皮损进行检查，并做相关实验室检查。结果表明：（1）瘙痒程度与皮损分布范围、皮肤干燥程度呈正相关，而与透析年限、每周透析次数、原发肾脏疾病、年龄、透析方法无关。（2）与透析前后血液中的尿素氮、肌酐及离子浓度无关。（3）乙肝或丙肝感染的患者其瘙痒明显高于未感染者，其肝功异常也高于未感染者。提示肝炎病毒感染与透析瘙痒之间有一定的相关性。     

维持性血液透析女性肾病患者性功能障碍的调查分析

目的:探讨调查分析维持性血液透析女性肾病患者性功能障碍情况。方法:选自我院于2014年9月至2016年9月收治的维持性血液透析肾病患者71例,选择同期于我院健康体检者50例。应用性功能女性性功能指数(FSFI)评估量表对性功能进行评价,采用SF-36生活调查量表对生活质量进行评价。比较两组性功能障碍发生情况、性功能指数评分及SF-36S生活量表评分变化。结果:观察组发生性功能障碍患者27例、发生率为38.03%;观察组阴道润滑程度、性生活满意度、性唤起、性高潮、性欲、性交疼痛评分低于对照组,且均有统计学差异(P0.05);观察组PF、BP、VT、RE、MH、RP、GH及SF评分低于对照组,且均有统计学差异(P0.05)。结论:维持性血液透析女性肾病患者性功能障碍发病率高,且生活质量和性功能状况均差于正常人群。     

维持性血液透析患者皮肤并发症的临床和病因分析

目的:确定维持性血液透析治疗慢性肾衰患者的皮肤并发症及相关致病因素.方法:入选患者记录性别、年龄、原发疾病、相关血生化学指标及并发的皮肤改变.采用SPSS 12.0 统计软件进行资料分析.结果:97 例维持性血液透析患者中,75 例并发1 种或1 种以上皮肤损害,其中皮肤瘙痒54 例;皮肤干燥42 例;毛发变化42 例;色素改变40 例;口腔黏膜损害39 例;甲改变20 例;其他皮肤损害包括紫癜、感染、皮炎等49 例.结论:维持性血液透析的慢性肾衰患者易并发皮肤疾病,且皮损表现多样性.毛发异常、口腔黏膜损害及紫癜均与体内毒性物质沉积有关;贫血及血管壁弹性降低与紫癜发生有关.     

血液透析后发生结节性痒疹1例报告

男性，64岁，四肢躯干出现剧痒结节3年。4年前因慢性肾功能衰竭，尿毒症行血液透析每周3次。查体：躯干四肢多发半球状结节，直径1mm-2mm,部分呈疣状增生。病理示结节性痒疹。     

维持性血液透析患者合并带状疱疹的护理体会

<正>带状疱疹是由水痘-带状疱疹病毒引起的,以沿周围神经分布的簇集水疱和神经痛为特征的病毒性皮肤病,皮肤表面出现成簇的水疱或血疱,沿神经排列成带状,中医称"蛇串疮"、"火带疮"等,病毒侵犯神经,使神经发炎坏死,产生剧烈疼痛。维持性血液透析患者由于机体免疫功能低下,更易并发带状疱疹,若护理不当,可能会加重病情,因此对血液透析合并带状疱疹患者的治疗与护理显得尤为重要。我科于2008年1月至2012年12月共治疗此类患者     

慢性肾功能衰竭患者死亡原因和影响因素分析

目的：对慢性肾功能衰竭患者死亡原因和影响因素进行分析,为改善患者预后提供参考依据。方法：回顾性分析本院2009年8月～2012年8月收治的87例慢性肾功能衰竭的临床资料,对患者的死亡原因及影响因素进行分析。结果：死亡19例患者,占21．84％;死亡原因前三位是严重感染、心律失常、心肌梗塞,分别占36．84％（7／19）、21．06％（7／19）、15．79％（3／19）;通过单因素结果分析,年龄、高血压、控制饮食、严重感染、性生活、心律失常、心肌梗塞、营养不良是慢性肾功能衰竭患者死亡的危险因素（P〈0．05）。结论：对高危因素患者进行干预治疗及健康指导,有助于改善患者预后。     

慢性肾功能衰竭患者血清心肌肌钙蛋白Ⅰ的研究

目的观察慢性肾功能衰竭（CRF）血清心肌肌钙蛋白（cTnI）的异常变化及其与心血管疾病的相关性。方法131例慢性肾衰竭患者（56例有胸闷、心悸等症状,75例无症状）和70例正常人于空腹状态抽取外周静脉血,用双抗夹心酶联免疫吸附法检测cTnI,并检测血清肌酐、糖化血红蛋白,进行12导联心电图（EKG）、二维超声心动图（UCG）检查,同时记录血压、临床症状。结果慢性肾功能衰竭组的cTnI水平为（0．103±0．451）ng／ml,显著高于健康对照组[（0．016±0．062）ng／ml,P〈0．05]。慢性肾衰患有症状组的cTnI水平为（0．382±1．610）ng／ml,显著高于无症状组[（0．073±0．158）ng／ml,P〈0．05]。有症状组cTnI异常率分别为33．9％,显著高于无症状组（8．0％,P〈0．05）;有症状组、EKG、UCG异常率分别为87．5％和69．64,与无症状组相比均无显著性差异（76．0％和56．0％,均P〉0．05）。cTnI升高与肌酐水平、血压、血糖、透析方式均无相关性。结论CRF患者cTnI水平显著高于健康人群,心肌损伤发生率极高,cTnI可作为心肌损伤的更特异的预测指标并用以判断预后。     

血液透析及灌流联合治疗毒蛇咬伤20例分析

毒蛇咬伤是较常见的急诊之一，毒蛇释放的各种毒素使人类发生毒性反应，累及各个脏器，重者甚至导致死亡，肾脏常常是各种毒素最常受累的器官之一。     

广州地区1335例变态反应性皮肤病患者变应原分析

目的：总结＂阿罗格＂点刺原液测试变态反应性皮肤病患者过敏原的效果。方法：随机选择变态反应性皮肤病1 335例,采用标准测量方法用＂阿罗格＂点刺原液进行过敏原测试,分析其结果并与文献比较。结果：检出主要变应原的阳性率以蟑螂、屋尘螨、粉尘螨等较高。而年龄分布态势特征与文献报道有所不同。结论：＂阿罗格＂点刺原液具有准确、敏感、安全等特点,可用于测试变态反应性皮肤病患者的过敏原。     

皮肤病住院患者31例死亡回顾性分析

我院皮肤科每年的门诊约有10余万人次,病种繁多,收住院的多是病情较重或复杂的患者,为了解死亡情况,总结经验和教训,对我院皮肤科近18年来31例住院死亡患者的临床资料进行分析.     

Nail changes in chronic renal failure patients under haemodialysis

Background Chronic renal failure is known to cause various nail pathologies. They may be directly related to the renal condition itself or its complications or to the therapy. Objective To compare nail changes in end‐stage renal failure patients under haemodialysis with healthy persons and to study the potential relationship with various parameters in the patients. Patients and Methods The study comprised 100 patients with chronic renal failure under regular haemodialysis as well as 100 healthy control subjects of matched age and sex. Both groups were subjected to full history taking and thorough general and nail examination. Complete blood picture, liver and kidney function tests and fasting blood glucose level were investigated. Results Nail disorders were more prevalent in patients (76%) than in control group (30%). The half and half nail was the most common finding (20%) followed by – in descending manner – absent lunula, onycholysis, brittle nail, Beau's lines, clubbing, longitudinal ridging, onychomycosis, subungual hyperkeratosis, koilonychias, total leukonychia, splinter hemorrhage, pitting and pincer nail deformity. There was non‐significant correlation between nail changes and age of the patients or duration of haemodialysis. In addition, no evidence of significant relation was found between nail changes and both haemoglobin and albumin levels. Conclusion Frequent nail changes are observed on systematic nail examination of uraemic patients undergoing haemodialysis; however, the cause of them remains obscure and could not be traced to a particular abnormality in the renal condition, medication or the procedure itself and it needs further investigations.     

Expression of apoptosis regulatory proteins p53 and Bcl-2 in skin of patients with chronic renal failure on maintenance haemodialysis

BACKGROUND: Chronic renal failure results in multi-organ system derangement including cardiovascular, gastrointestinal, neurological, endocrinal, blood and dermatological abnormalities. Maintenance of skin homeostasis requires a delicate balance between proliferation, differentiation and apoptosis. p53 and Bcl-2 proteins play a central role in the regulation of apoptosis. OBJECTIVE: Evaluation of the expression of apoptosis regulatory proteins p53 and Bcl-2 in apparently normal skin of patients, with chronic renal failure on maintenance haemodialysis, with respect to their role in the apoptotic process. METHODS: Biopsy specimens were obtained from 10 patients with chronic renal failure on maintenance haemodialysis, as well as seven age-matched control subjects. Computer-assisted image analysis was employed to measure epidermal thickness in H&E-stained sections. Immunoperoxidase technique was also used to demonstrate p53 and Bcl-2 proteins and the TUNEL technique for detection of apoptotic cells in these specimens. RESULTS: The mean epidermal thickness was significantly higher (P < 0.0001) in patients than controls. Meanwhile, no apoptotic cells were detected in the epidermis of patients. On the other hand, a statistically significant difference was observed in both p53 (P = 0.0001) and Bcl-2 expression (P = 0.0003) when comparing patients and controls. Expression of p53 (2.74 +/- 0.84) and Bcl-2 (3.45 +/- 1.35) proteins was higher in skin samples obtained from patients with chronic renal failure and on maintenance haemodialysis than those from control cases (0.5 +/- 0.96 and 0.8 +/- 0.6, respectively). Moreover, Bcl-2 expression in patients was observed in basal as well as squamous cell layers of skin, whereas in control subjects it was confined to the basal cell layer only. CONCLUSION: These findings suggest that an alteration in the proliferation/apoptosis balance may be present in the skin of such patients.     

Cutaneous manifestations in patients with chronic renal failure on hemodialysis

BACKGROUND: Chronic renal failure (CRF) presents with an array of cutaneous manifestations. Newer changes are being described since the advent of hemodialysis, which prolongs the life expectancy, giving time for these changes to manifest. AIM: The aim of this study was to evaluate the prevalence of dermatologic problems among patients with chronic renal failure (CRF) undergoing hemodialysis. METHODS: One hundred patients with CRF on hemodialysis were examined for cutaneous changes. RESULTS: Eighty-two per cent patients complained of some skin problem. However, on examination, all patients had at least one skin lesion attributable to CRF. The most prevalent finding was xerosis (79%), followed by pallor (60%), pruritus (53%) and cutaneous pigmentation (43%). Other cutaneous manifestations included Kyrle's disease (21%); fungal (30%), bacterial (13%) and viral (12%) infections; uremic frost (3%); purpura (9%); gynecomastia (1%); and dermatitis (2%). The nail changes included half and half nail (21%), koilonychia (18%), onychomycosis (19%), subungual hyperkeratosis (12%), onycholysis (10%), splinter hemorrhages (5%), Mees' lines (7%), Muehrcke's lines (5%) and Beau's lines (2%). Hair changes included sparse body hair (30%), sparse scalp hair (11%) and brittle and lusterless hair (16%). Oral changes included macroglossia with teeth markings (35%), xerostomia (31%), ulcerative stomatitis (29%), angular cheilitis (12%) and uremic breath (8%). Some rare manifestations of CRF like uremic frost, gynecomastia and pseudo-Kaposi's sarcoma were also observed. CONCLUSIONS: CRF is associated with a complex array of cutaneous manifestations caused either by the disease or by treatment. The commonest are xerosis and pruritus and the early recognition of cutaneous signs can relieve suffering and decrease morbidity.     

Nail disorders in patients with chronic renal failure and undergoing haemodialysis treatment: a case–control study

BACKGROUND: Few controlled studies have compared nail disorders in patients with chronic renal failure (CRF) and haemodialysis (HD)-dependent individuals with a healthy population. OBJECTIVE: The aim of this study was to compare the prevalence of nail disorders in patients with CRF and patients undergoing HD treatment with a healthy population, and evaluate the relationship between nail changes and various demographic, medical and laboratory parameters in these groups. METHODS: In this case-control study we recruited 73 patients affected with CRF, 77 patients undergoing regular HD and 77 healthy individuals. All patients were examined for the presence of nail disorders. Various parameters [age, gender, type of kidney disease, regular medications, duration of renal failure and HD, dialysis efficacy (Kt/v), haemoglobin, neutrophil count, calcium, phosphorus, albumin, creatinine, urea, alkaline phosphatase and parathyroid hormone (PTH) levels] of the patients were determined by multivariate analysis and compared. RESULTS: Forty-four patients (60.3%) with CRF and 48 patients (62.3%) undergoing HD treatment had at least one type of nail pathology. The most common nail alterations found in patients with CRF and those undergoing HD were absence of lunula (AL) and half-and-half nails (HHN), respectively. Prevalence of nail disorders among patients with CRF was influenced significantly by PTH level (P = 0.03). In the HD group, male sex, age above 65 years and comorbidities (diabetes mellitus, hypertension and heart failure) were significantly associated with nail pathologies. CONCLUSION: Patients with CRF and those undergoing HD therapy have higher rates of nail disorders when compared to a healthy population. Efficient HD does not improve nail changes.     

Dermatologic complications in renal transplant recipients versus uraemic patients under maintenance haemodialysis treatment

One hundred and twelve renal transplant recipients and 40 patients with chronic renal failure undergoing maintenance haemodialysis were included in this study. Skin infections were the most common complication in renal transplant recipients (67.8%), with fungal infections being the most frequent (58%). Kaposi's sarcoma was found in three of our transplant patients (2.6%); no other skin tumors were observed in our cases. The second most frequent skin complication after infections was acne lesions (43.7%). On the other hand, pallor and dryness were the most common skin signs observed in uraemic patients; fungal infections were found in 15%. No skin neoplasms were found in the uraemic patients. In conclusion, skin infections and Kaposi's sarcoma are more common in renal transplant recipients than in uraemic patients under haemodialysis maintenance treatment.     

血液透析患者皮肤瘙痒相关因素分析

目的:分析血液透析(MHD)治疗慢性肾衰患者皮肤瘙痒及皮肤干燥的相关因素.方法:对山东省立医院血液透析治疗慢性肾衰患者的皮肤瘙痒及皮肤干燥的临床资料进行回顾性分析.结果:97例MHD患者中,54例(55.67%)伴发皮肤瘙痒,其中全身性皮肤瘙痒38例(70.4%),16例(29.6%)为局限性瘙痒.皮肤瘙痒与患者的年龄、性别、原发疾病、透析时间、血红蛋白及血钙无明显相关性.结论:血液透析患者易并发皮肤瘙痒,原因有待进一步研究.     

Vegetative pyoderma gangrenosum in chronic renal failure

We report the case of a 58-year-old woman with painful recurrent erythematous lesions on both legs of 6 months' duration. The patient had been treated with haemodialysis for chronic renal failure for the previous 10 years. Physical examination revealed pea-sized erythematous nodules with sinus formation and discharge of bloody pus, which yielded neither bacterial nor fungal cells in culture. These lesions healed leaving cribriform scars, after bed rest, topical disinfection and systemic and in some areas intralesional corticosteroids. Cases of pyoderma gangrenosum are usually classified as one of four clinical variants: ulcerative, pustular, bullous and vegetative. Our case might correspond to a vegetative form in view of the development of sinuses, neutrophilic abscesses and palisading granuloma, even though no ulceration was observed.     

慢性饮水型砷中毒患者皮肤表现和合并疾病及影响因素分析

目的 分析慢性饮水型砷中毒患者的皮肤表现、合并疾病以及可能的影响因素。方法 对内蒙古95例慢性饮水型砷中毒患者的人口学特征、皮肤表现、合并疾病进行流行病学调查和分析。建立logistic回归模型,分析性别、年龄、开始饮用高砷水年龄、水砷浓度及饮用高砷水时间年龄与皮肤表现、合并疾病间的相关性。结果 95例患者中共有77例患者发生色素沉着,75例发生色素减退,93例发生掌跖部皮肤角化,27例患者发生皮肤癌,其中多发性皮肤癌8例。合并结核5例、高血压15例、类风湿性关节炎2例、脑梗死4例、冠心病7例、内脏恶性肿瘤3例、肝硬化6例、贫血2例。回归分析发现色素沉着与水砷浓度相关（OR = 0.32,95% CI = 0.10 ~ 0.98）;校正OR = 0.27,95% CI = 0.08 ~ 0.90）。冠心病的发生与饮用高砷水时间具有相关性（OR = 6.41,95% CI = 1.09 ~ 37.88;校正OR = 8.55,95% CI = 1.212 ~ 60.41）。肝硬化的发生与水砷浓度具有相关性（OR = 24.67,95% CI = 2.69 ~ 226.57;校正OR = 22.51,95% CI = 2.38 ~ 213.11）。结论 慢性砷中毒患者色素代谢异常、掌跖部皮肤角化、皮肤癌发生率高。水砷浓度、饮用高砷水时间不同对人体可能产生不同的影响。     

Desferrioxamine treatment of porphyria cutanea tarda in a patient with HIV and chronic renal failure

Porphyria cutanea tarda (PCT) can occur in HIV patients. Current evidence suggests that HIV infection may interfere with the hepatic cytochrome oxidase system, leading to porphyrin metabolism impairment. Moreover, chronic hemodialysis in renal failure may be a risk factor for PCT. In addition to the contributory factors for PCT associated to HIV infection, it is possible that porphyrin accumulation secondary to renal failure may play a role in the expression of this disease. We report a case of PCT in an HIV‐1 infected patient under blood dialysis, refractory to antimalarials and controlled with desferrioxamine.     

Residual renal function in peritoneal dialysis with failed allograft and minimum immunosuppression

Immunosuppression (IS) is often withdrawn in patients with end stage renal disease secondary to a failed renal allograft, and this can lead to an accelerated loss of residual renal function (RRF). As maintenance of RRF appears to provide a survival benefit to peritoneal dialysis (PD) patients, it is not clear whether this benefit of maintaining RRF in failed allograft patients returning to PD outweigh the risks of maintaining IS. A 49 year-old Caucasian male developed progressive allograft failure nine years after living-donor renal transplantation. Hemodialysis was initiated via tunneled dialysis catheter (TDC) and IS was gradually withdrawn. Two weeks after IS withdrawal he developed a febrile illness, which necessitate removal of the TDC and conversion to PD. He was maintained on small dose of tacrolimus (1 mg/d) and prednisone (5 mg/d). Currently (1 year later) he is doing exceedingly well on cycler-assisted PD. Residual urine output ranges between 600-1200 mL/d. Total weekly Kt/V achieved 1.82. RRF remained well preserved in this patient with failed renal allograft with minimal immunosuppressive therapy. This strategy will need further study in well-defined cohorts of PD patients with failed allografts and residual RRF to determine efficacy and safety.