胰肾联合移植治疗Ⅰ型糖尿病合并终末期肾病

目的 探讨胰肾联合移植治疗Ⅰ型糖尿病合并终末期肾病的临床效果。方法 ８例Ⅰ型糖尿病合并终末期肾病的患者接受胰肾联合移植,平均年龄４３．４６岁,２例合并视网膜病变,双目失明,病史２～２２年。胰腺移植于右髂窝,胰腺外分泌经膀胱引流,肾脏移植于左髂窝。免疫抑制方案开始四联用药,以后三联用药继续治疗。结果 ８例虱其中７例术后即不需要应用胰岛素,空腹血糖可维持在正常范围,１例术后应用胰岛素４０ｄ后停用。１例     

改良式胰肾联合移植1例并文献复习

目的探讨改良式胰肾联合移植治疗2型糖尿病合并终末期肾病的移植效果。方法为1例2型糖尿病合并终末期肾病患者行改良式胰肾联合移植,其中移植胰腺的外分泌采用胰液空肠内引流术式,将供胰十二指肠节段与受体上段空肠直接行侧侧吻合。结果术后围手术期移植肾稳定泌尿,3800～4500ml/24h,3d后血清肌酐降至正常水平。术后胰腺功能恢复顺利,血、尿淀粉酶逐渐下降并稳定在正常范围,空腹血糖也于术后10d恢复至正常值范围以内。切口一期愈合,于术后两周出院。随访27个月移植肾功能正常,胰腺功能正常,未发生血栓、胰瘘、胰腺炎、排斥反应等并发症。结论改良式胰肾联合移植技术简单、安全,胰液经空肠引流更接近消化生理,是治疗糖尿病合并终末期肾病的有效手术方式。     

胰肾联合移植治疗糖尿病终末期肾病11例临床分析

目的：探讨胰肾联合移植（SPK）治疗糖尿病合并终末期肾病的临床效果。方法：回顾性分析2016年11月至2019年3月11例糖尿病合并终末期肾病患者行SPK的临床资料,总结手术疗效以及并发症情况。结果：所有患者均接受随访,资料统计截至2019年12月1日,随访观察9～37月,人、肾、胰腺存活率分别为100%、100%、91%。11例患者术后1月血肌酐（101±28）μmol/L;末次复查血肌酐（96±24）μmol/L,糖化血红蛋白为（5.6±0.5）%。至资料统计截止时间,10例患者移植肾功能正常,1例患者新发移植肾肾病（血肌酐71～202μmol/L）。术后并发胰腺血栓形成2例,其中1例经肠系膜下静脉自脾静脉中取出血栓,胰腺功能恢复;另1例行移植胰腺切除。胰腺门静脉扭转1例,胰腺排斥反应1例,胰周脓肿1例,消化道出血1例,切口愈合不良5例。9例患者术后空腹、餐后血糖均正常,1例患者午餐后血糖稍高,口服二甲双胍血糖控制可。结论：SPK治疗糖尿病合并终末期肾病疗效确切,但围手术期并发症发生率较高,积极防治围手术期并发症可有效提高手术成功率。     

胰肾联合移植治疗糖尿病合并糖尿病肾病(附13例报告)

目的　探讨胰肾联合移植治疗糖尿病合并糖尿病肾病的疗效。方法　 1999年 9月至2 0 0 2年 1月 ,我院施行了 13例胰肾联合移植手术 ,包括 6例 1型糖尿病及 7例 2型糖尿病病人 ,胰岛素用量为 0 5～ 1 5IU/ (kg·d) ,13例病人均合并糖尿病肾病 ,及心衰、高血压、视网膜病变、周围神经病变等糖尿病慢性并发症 ,并行透析治疗。 13例手术均采用体循环 膀胱内引流式。结果　 6例 1型糖尿病病人于胰腺通血后 1 5～ 2 3h后停用外源性胰岛素 ,7例 2型糖尿病病人于术后第 5～ 9天停用外源性胰岛素。 13例病人均于术后第 2～ 4天移植肾功能恢复正常。术后出现排斥反应、血尿、感染并发症 ,其中 1例术后 5d发生加速性排斥反应 ,抗排斥治疗无效 ,术后 11d切除移植胰肾。其余均痊愈出院 ,定期随访 ,移植物功能良好 ,糖尿病慢性并发症得到缓解。结论　胰肾联合移植是治疗糖尿病合并糖尿病肾病的最有效方法。达到胰岛素依赖期的 2型糖尿病也是胰腺移植的适应证之一。供胰肾原位灌注、快速整块切取、以预防为主、加强围手术期管理是减少各种并发症 ,取得良好疗效的有效措施。     

胰肾联合移植治疗1型和2型糖尿病合并终末期肾病的五年临床疗效比较

目的比较胰肾联合移植(simultaneous pancreas-kidney transplantation, SPK)治疗1型(type 1 diabetes mellitus, T1DM)和2型糖尿病(type 2 diabetes mellitus, T2DM)合并终末期肾病的五年临床疗效差异, 探讨T2DM合并终末期肾病是否可成为SPK治疗的适应症。方法回顾性分析华中科技大学同济医学院附属同济医院器官移植研究所实施SPK的受者, 根据基线相同原则, 按照糖尿病原发病将62例受者分为两组:T1DM组(30例)和T2DM组(32例), 分析术前资料和术后5年随访资料。结果在入选研究的T1DM组和T2DM组受者中, 男性性别、术前血红蛋白和糖化血红蛋白比较差异均无统计学意义。手术年龄[(31.8±5.2)vs(49.5±5.7)岁(P<0.001)]和体重指数[(body mass index, BMI)(21.8±1.3)vs(25.0±3.8)kg/m2(P<0.001)]比较, T1DM组均低于T2DM组。与T2DM组相比, T1DM组胰岛素用量更高, 无C肽释放...     

1型糖尿病肾病尿毒症期患者胰肾联合移植与单独肾移植远期疗效观察

目的研究1型糖尿病肾病尿毒症期患者胰肾联合移植（simultaneouspancreas—kidneytransplantation,SPK）与单独肾移植（kidneytransplantationalone,KTA）的长期临床效果。方法选取2001年10月至2004年7月在南方医科大学南方医院接受SPK和KTA的1型糖尿病肾病尿毒症期患者共16例,其中SPK组6例,KTA组10例。回顾性分析和比较两组5年人／移植物存活率、急性排斥反应和蛋白尿的发生率及空腹血糖、血肌酐、血脂（甘油三酯、胆固醇）、血压水平。结果16例受者至今存活。SPK组移植胰腺功能正常,1例于移植后第5年血肌酐升至450μmol／L左右,尿蛋白阳性,其余受者血肌酐均不超过130μmol／L,尿蛋白阴性,5年人／移植物存活率均为100％。KTA组3例血肌酐浓度为150～180μmol／L,尿蛋白阳性,1例于移植后第4年因血肌酐升至700μmol／L以上开始规律血液透析治疗,5年人／移植物存活率为100％和90％。两组急性排斥反应的发生率差异无统计学意义（P〉0．05）。移植后5年SPK组和KTA组血肌酐平均浓度为（166．3±139．3）μmol／L和（209．8±188．6）μmoL／L,蛋白尿、高血脂、高血压的发生率分别为16．7％、33．3％、50％和40％、60％、80％,SPK组均低于KTA组,但差别无统计学意义（均P〉0．05）;而血糖水平、胆固醇浓度、收缩压水平SPK组均低于KTA组,差别有统计学意义（均P〈0．05）。结论SPK是1型糖尿病肾病尿毒症期患者的有效治疗方法,与KTA比较,其移植后5年的移植肾功能较好,高血脂、高血压的发生率较低。     

胰、肾联合移植一例报告

本中心于2005年1月为1例1型糖尿病并发尿毒症患者施行胰液空肠引流式胰、肾联合移植，报告如下。     

胰肾联合移植的临床疗效观察

目的: 总结胰肾联合移植的临床经验,分析I型糖尿病合并终末期肾衰的治疗效果.方法: 回顾分析一例胰肾联合移植的治疗过程,移植胰采用肠道引流,术后采用四联序贯免疫抑制方案:抗淋巴细胞球蛋白诱导免疫,用环孢素A、泼尼松、霉酚酸酯维持治疗.结果: 术后胰肾功能恢复良好,停用外源性胰岛素,血糖水平正常.第22天出现轻度移植肾排斥,激素冲击治疗后逆转.随访12个月,移植胰、肾功能正常,血电解质、酸碱平衡无紊乱,生活工作与常人无异.结论: 胰肾联合移植是I型糖尿病合并终末期肾衰的有效治疗手段.     

晚期Ⅱ型糖尿病行胰肾联合移植三例报告

目前胰肾联合移植已成为治疗糖尿病合并尿毒症的理想方法。据国际胰腺移植登记处最新统计，至2001年8月，全世界巳做胰移植15710例，其中84％为胰肾联合移植。我们于2000年8月4日至2001年9月实施3例胰肾联合移植术，并取得满意疗效。报告如下：     

改良胰液空肠引流式胰肾一期联合移植一例

胰肾联合移植（SKPT）是治疗胰岛素依赖型糖尿病合并终末期尿毒症的理想方法。我院2004年7月6日成功地采用改良的胰液空肠引流术式行胰肾一期联合移植1例，取得了满意效果，报告如下。     

Brucella glomerulonephritis resulting in end-stage renal disease: a case report and a brief review of the literature

Brucella glomerulonephritis is a rare condition with only a few reported cases. We review the literature, and describe a 24-year-old female who presented with edema and proteinuria. Blood grew Brucella melitensis. Renal biopsy showed diffuse proliferative glomerulonephritis. The patient progressed to end-stage renal disease despite antibiotic and steroid therapy.     

肾移植术后布鲁氏菌病1例报道并文献复习

目的 分析并总结肾移植术后布鲁氏菌病的临床特点和诊疗经验。 方法 收集解放军第309医院2016年10月收治的1例肾移植术后布鲁氏菌病患者的临床资料,分析其临床特点和诊疗经过,并结合文献复习总结临床经验。 结果 患者肾移植术后3个月出现无明显诱因体温升高,以上午发热为主,持续时间3 d,感染途径不明、其他感染症状不明显,经验性抗感染治疗1周效果不佳。经血培养确诊为羊布鲁氏菌感染。及时给予利福平、多西环素、复方磺胺甲抗感染,积极防治并发症,保护肝、肾功能等治疗,疗效良好。随访至该患者出院后1年,移植肾功能稳定,再未出现发热等感染症状。 结论 肾移植术后感染途径不明的布鲁氏菌病极为罕见,常见症状为波浪热。当经验性抗感染治疗效果不佳时,应及早多次进行血培养等相关检测尽快确诊,治疗方案为利福平与多西环素联合使用。     

2型糖尿病合并肾脏损害的病理与临床分析

目的 分析2型糖尿病患者出现肾脏病变时病理诊断与临床表现的关系.探讨肾活检在2型糖尿病伴有肾脏病变诊断的意义.方法 分析52例尿检异常和（或）Scr升高的2型糖尿病患者的临床特征和病理改变特点.结果 52例2型糖尿病患者经肾活检,32例确诊为糖尿病肾病（DN）,占61.5%,其中3例为糖尿病肾病合并非糖尿病性肾脏疾病（NDRD）;余20例为非糖尿病性肾脏疾病,占38.5%.肾活检前后诊断符合率46.15%,误诊率19.23%.两组间除BUN、Scr、糖尿病病程和是否伴有糖尿病性视网膜病变有显著差异外,其他临床表现和实验室检查的差异均无统计学意义.结论 2型糖尿病伴肾脏病变时相当部分是非糖尿病性肾脏病变,单纯依靠临床资料常难以鉴别,肾活检对明确糖尿病伴肾病变的性质具有重要的意义.     

Quality of life after organ transplantation in type 1 diabetics with end-stage renal disease

Quality of life (QOL) should be an important consideration while choosing therapeutic options for patients with type 1 diabetes mellitus (DM) and end-stage renal disease (ESRD) including dialysis, cadaver (CKT) or living kidney transplant (LKT) or simultaneous pancreas-kidney (SPK) transplant. METHODS: QOL was assessed in four groups of patients with history of type 1 DM and ESRD: recipients of SPK (n = 43), CKT (n = 43), LKT (n = 11) and wait listed (WL) patients (n = 23). Diabetes Quality of Life (DQOL), Short Form-36 (SF-36) and Quality of Well-Being (QWB) questionnaires were utilized. A subset of SPK (n = 19) and CKT (n = 12) recipients underwent longitudinal QOL evaluation. RESULTS: On DQOL questionnaire, SPK group had better satisfaction subscore compared with CKT (1.8 +/- 0.5 vs. 2.2 +/- 0.6, p < 0.01) LKT (1.8 +/- 0.5 vs. 2.4 +/- 0.7, p < 0.05) and WL (1.8 +/- 0.5 vs. 2.6 +/- 0.6, p < 0.001) groups and better impact subscore compared with CKT (1.7 +/- 0.6 vs. 2.1 +/- 0.6, p < 0.05) and WL (1.7 +/- 0.6 vs. 2.3 +/- 0.6, p < 0.01) groups. There were no significant differences on physical/mental composite scores of SF-36. QWB score was better in SPK group vs. WL group (0.62 +/- 0.11 vs. 0.55 +/- 0.04, p < 0.05). Longitudinal decline in satisfaction (2.3 +/- 0.5 vs. 2.6 +/- 0.9, p = 0.058) and impact (2.0 +/- 0.5 vs. 2.2 +/- 0.5, p = 0.019) subscores of DQOL were noted in CKT group. There were no significant changes in the composite scores of SF-36 in both groups. QWB scores declined in the CKT group (0.67 +/- 0.10 vs. 0.61 +/- 0.05, p = 0.01). CONCLUSION: QOL was better in type 1 diabetics with ESRD following transplantation when compared with remaining on WL. SPK transplantation had significant positive effect on diabetes-related QOL which was sustained longitudinally but it was difficult to show an overall improvement in general QOL.     

Therapeutic camping for children with end-stage renal disease

Therapeutic camping experiences for children with end-stage renal disease (ESRD) have proliferated in the United States and abroad. This report is based on the results of a survey designed to accumulate data on the development and implementation of 20 such camps. Children attending camp ranged in age from 1 year to 19 years. Single disease-specific camps were most common, while camps for children with a variety of chronic illnesses, including ESRD, and mainstream camps were also conducted. Facilities were available for hemodialysis and continuous ambulatory peritoneal dialysis, but not automated peritoneal dialysis, in the majority of surveryed camps. Dialysis nurses, pediatric nephrologists, dietitians and social workers were the medical personnel that most frequently participated in the camps. On average, 32 dialysis/transplant patient campers (range 6–100) attended camp for a 1-week session. Therapeutic camping experiences for children with ESRD are extremely successful and attempts to increase the availability of similar camps should be encouraged.Presented in part at the 13th Annual Conference on Peritoneal Dialysis, 7–9 March 1993, San Diego, California, USA.     

Development and internal validation of machine learning algorithms for end-stage renal disease risk prediction model of people with type 2 diabetes mellitus and diabetic kidney disease

AimsDiabetic kidney disease (DKD) is the most common cause of end-stage renal disease (ESRD) and is associated with increased morbidity and mortality in patients with diabetes. Identification of risk factors involved in the progression of DKD to ESRD is expected to result in early detection and appropriate intervention and improve prognosis. Therefore, this study aimed to establish a risk prediction model for ESRD resulting from DKD in patients with type 2 diabetes mellitus (T2DM).MethodsBetween January 2008 and July 2019, a total of 390 Chinese patients with T2DM and DKD confirmed by percutaneous renal biopsy were enrolled and followed up for at least 1 year. Four machine learning algorithms (gradient boosting machine, support vector machine, logistic regression, and random forest (RF)) were used to identify the critical clinical and pathological features and to build a risk prediction model for ESRD.ResultsThere were 158 renal outcome events (ESRD) (40.51%) during the 3-year median follow up. The RF algorithm showed the best performance at predicting progression to ESRD, showing the highest AUC (0.90) and ACC (82.65%). The RF algorithm identified five major factors: Cystatin-C, serum albumin (sAlb), hemoglobin (Hb), 24-hour urine urinary total protein, and estimated glomerular filtration rate. A nomogram according to the aforementioned five predictive factors was constructed to predict the incidence of ESRD.ConclusionMachine learning algorithms can efficiently predict the incident ESRD in DKD participants. Compared with the previous models, the importance of sAlb and Hb were highlighted in the current model.

Highlights

• What is already known? Identification of risk factors for the progression of DKD to ESRD is expected to improve the prognosis by early detection and appropriate intervention.
• What this study has found? Machine learning algorithms were used to construct a risk prediction model of ESRD in patients with T2DM and DKD. The major predictive factors were found to be CysC, sAlb, Hb, eGFR, and UTP.
• What are the implications of the study? In contrast with the treatment of participants with early-phase T2DM with or without mild kidney damage, major emphasis should be placed on indicators of kidney function, nutrition, anemia, and proteinuria for participants with T2DM and advanced DKD to delay ESRD, rather than age, sex, and control of hypertension and glycemia.