急、慢性肾功能衰竭患者血清中唾液酸水平的变化及临床价值

目的探讨血清唾液酸检测对急、慢性肾功能衰竭患者的临床意义。方法选取2009年7月至2013年4月在我院诊治的72例肾功能衰竭患者,并选择同期在我院接受治疗的健康患者35例。两组患者分别为实验组和对照组。实验组分为A组(慢性肾功能衰竭组)和B组(急性肾功能衰竭组);对照组根据年龄分为C组和D组。两组测定唾液酸采用单一试剂显色法。实验组与对照组患者在一般资料的构成比上无显著性差异(P>0.05),可进行对比。结果唾液酸水平比较,A组(2.58±0.86)mmol/L和B组(3.09±0.96)mmol/L显著高于对照组(2.01±0.43)mmol/L,且差异比较有显著性差异(P<0.05);B组明显高于A组,有显著性差异(P<0.05);C组(1.83±0.38)mmol/L和D组(2.09±0.49)mmol/L明显低于A组(2.58±0.86)mmol/L,有显著性差异(P<0.05);而C组低于D组,无显著性差异(P>0.05);B组患者的尿肌酐清除率与血清唾液酸水平呈负相关性。结论血清唾液酸水平在急、慢性肾功能衰竭患者中显著升高,对于病情的判定及治疗具有重要的临床意义。     

血浆胱抑素C在慢性肾功能衰竭中的临床应用

目的测定慢性肾功能衰竭患者血浆胱抑素C(CyctalinC)的水平并探讨其临床意义。方法用免疫比浊法测定l5例肾病综合征,20例慢性肾功能衰竭患者的血浆胱抑素C,其中6例慢性肾功能衰竭患者经肾移植好转后再次测定,另外测定了15例血浆肌酐(Cr)含量正常的急性肾小球肾炎患者血浆胱抑素C含量。并以20例体检正常者作对照。结果肾病综合征和慢性肾衰竭患者的血浆胱抑素C含量显著高于正常对照组(P<0.01),5例慢性肾衰患者肾移植好转后胱抑素C明显下降(P<0.01),但仍高于正常对照组。急性肾炎组与正常对照组比较差异无统计学意义(P>0.05)。结论胱抑素C有助于肾小球滤过功能的评估,血浆胱抑素C是肾脏病患者肾小球损害程度判断和疗效观察有价值的检测指标。     

肾功能衰竭患者乳酸变化的研究

目的：观察乳酸在肾功能衰竭患者中的变化及其相关因素。方法：选取60名急诊肾功能衰竭患者为肾衰组。再分为急性与慢性两个亚组，感染与非感染两个亚组，健康正常人50名为对照组，分别测定血乳酸（Lac）、肌酐（Cr）、尿素氮（BUN）、血常规和血气分析。结果：肾衰组Lac明显高于对照组（P〈0．01），感染患者Lac明显高于非感染患者（P〈0．05），急性与慢性肾功能衰竭患者Lac无明显差异（P〉0．05），Lac与Cr明显正相关（P〈0．05）。结论：肾功能衰竭患者Lac增加且与Cr成正比，感染是引起Lac增加的重要因素。     

慢性肾功能衰竭患者骨密度及相关生化指标的变化

目的通过对慢性肾功能衰竭患者骨密度及相关生化指标的检测,探讨其对肾性骨病诊断的价值.方法将慢性肾功能衰竭患者按其肌酐清除率(Ccr)的不同分为A、B、C三组,应用双能量X线骨密度分析仪对患者正位腰椎L2～L4,股骨颈(NECK),WARDS三角和股骨粗隆(TROCH)部位进行检测,同时进行血清Cr、Ca、P、ALP、PTH水平测定.每组分别与正常健康对照组(D组)相比较.结果A、B两组所检测部位的骨密度值均明显降低,而C组骨密度值变化不明显.A、B两组血清PTH水平和血清P水平均显著升高,而血清Ca和ALP水平各组间差异无显著性.结论慢性肾哀竭患者当Ccr＜50 ml/min时,进行骨密度检测及测定血清PTH和P,对早期诊断肾性骨病有一定价值.     

NT-proBNP在急性肾功能衰竭诊断和替代治疗中的价值

目的检测急性肾功能衰竭少尿期和恢复期的NT-proBNP水平,探讨其在急性肾功能衰竭鉴别诊断以及肾替代治疗(RRT)中的临床意义。方法确诊急性肾功能衰竭患者62例,按其病因分为肾前性、肾性和肾后性3组。上述患者均行肾替代治疗,连续监测肾功能与NT-proBNP。结果急性肾功能衰竭少尿期3组间NT-proBNP水平两两比较,差异有统计学意义;而恢复期无统计学意义;终止RRT时,肾性与肾后性组间比较不显著,但两组与肾前组比较均有临床意义。结论 NT-proBNP鉴别肾前性和非肾前性急性肾功能衰竭,具有一定的临床诊断价值,对急性肾功能衰竭患者肾替代治疗的预示价值仍有一定影响。     

分析西医药剂肾功能衰竭路径在慢性肾功能衰竭中的应用

目的关于西医药剂肾功能衰竭路径在慢性肾功能衰竭应用的效果。方法本文患者为我院收治的慢性肾功能衰竭患者,调查时间为2016年12月至2018年8月,本文选择50例患者按照随机方法分为常规治疗组和路径治疗组,每组患者平均为25例。常规治疗组配合采用西医药剂常规治疗方案进行治疗,路径治疗组采用西医药剂肾功能衰竭路径进行治疗,评价两组患者治疗的效果。结果本文常规治疗组患者的治疗总有效率为60.00%(16/25),路径治疗组的治疗总有效率为88.00%,两组比较,P <0.05,差异具有统计学意义;常规治疗组不良反应发生率为32.00%(8/25),路径治疗组不良反应发生率为12.00%(3/25),两组之间差异明显,P <0.05;常规治疗组患者的住院时间为(13.5±2.4)d,路径治疗组住院时间为(7.2±1.4)d,P <0.05,差异具有统计学意义。结论在治疗慢性肾功能衰竭患者时,为患者选择西医药剂肾功能衰竭路径给药方案进行治疗能够取得良好效果,可缩短患者住院时间,并且具有一定的安全性,值得推广。     

老年慢性肾功能衰竭的血液透析滤过法治疗分析与临床研究

目的研究分析血液透析滤过对老年慢性肾功能衰竭患者的疗效与临床意义。方法将120例老年慢性肾功能衰竭患者随机分为治疗组(n=60)与对照组(n=60),分别予以血液透析滤过和血液透析治疗,疗程结束后行疗效对比。结果治疗组在血清肌酐、尿素氮、尿酸、总蛋白和血红蛋白等生化指标方面与对照组比较,差异均有统计学意义(均P <0.05)。结论血液透析滤过治疗老年慢性肾功能衰竭患者有较好的预后,值得在临床上推广应用。     

血液透析开展优质护理对慢性肾功能衰竭患者的临床效果

目的:探讨对慢性肾功能衰竭患者进行血液透析优质护理干预的临床效果。方法:选取2013年5月~2014年8月在某院进行血液透析的慢性肾功能衰竭的患者102例,随机分为对照组和观察组,对照组采用常规的护理模式,观察组在对照组的基础上采用优质护理干预,采用自测健康评定量表(SRHMSV1.0)对患者的生理健康、心理健康以及社会健康等方面进行评定,并比较两组患者护理的满意度。结果:观察组患者的满意度为96.08%,明显高于对照组的80.39%,两组相比具有统计学意义(P0.05);观察组患者在生理健康以及心理健康等方面的评分与对照组相比具有显著性差异(P0.05),而在社会健康方面两组相比无显著性差异(P0.05)。结论:对慢性肾功能衰竭进行血液透析的患者进行优质护理干预,在一定程度上能够控制疾病的发展,并且患者的满意度较高,值得在临床上推广使用。     

连续性和间歇性血液透析治疗急性肾功能衰竭的临床对比分析

目的 对比分析连续性和间歇性血液透析治疗急性肾功能衰竭的临床疗效.方法 将本院2010年10月～2013年1月收治的90例急性肾功能衰竭患者随机分为观察组（n=45）和对照组（n=45）,观察组患者采用连续性血液透析治疗,对照组患者采用间歇性血液透析治疗,测定记录两组患者治疗前后的心率、血肌酐（SCr）、尿素氮（BUN）以及住院天数、并发症发生率、治愈率、转为慢性肾衰率、死亡率.结果 治疗后观察组患者的心率、SCr、BUN显著小于对照组（P＜0.05）,住院天数、并发症发生率、转为慢性肾衰率、死亡率显著低于对照组（P＜0.05）,治愈率显著高于对照组（P＜0.05）.结论 与间歇性血液透析相比,连续性血液透析治疗急性肾功能衰竭疗效更好,并发症发生率低,值得临床推广.     

类风湿性关节炎患者血清免疫球蛋白和补体水平变化及其临床意义

目的 探讨类风湿性关节炎(RA)患者血清免疫球蛋白(IgG、IgA、IgM)和补体(C3、C4)水平变化及其临床意义.方法 选择初诊RA患者41例,其中活动期27例,非活动期14例,并选择同期体检健康者20例作为对照组,采用免疫比浊法检测3组血清免疫球蛋白(IgG、IgA、IgM)和补体(C3、C4)水平.结果 RA活动组、RA非活动组血清IgG水平均高于对照组,差异均有统计学意义(P＜0.01,0.05),RA活动组与RA非活动组血清IgG水平差异无统计学意义(P＞0.05);RA活动组血清C3水平均高于RA非活动组和对照组,差异均有统计学意义(P ＜0.05,0.01),RA非活动组与对照组血清C3水平差异无统计学意义(P＞0.05);3组间血清IgA、IgM、C4水平差异均无统计学意义(P＞0.05).结论 血清IgG可作为RA的辅助诊断指标,血清C3可作为观察RA活动状态的指标.     

混合性结缔组织病患者血清免疫球蛋白含量和补体C3C4的相关性的研究

目的 探讨混合性结缔组织病患者血清免疫球蛋白含量和补体C3C4相关性的关系及其临床意义. 方法用免疫速率比浊法测定68例混合性结缔组织病患者血清免疫球蛋白和补体C3C4含量,并与70名健康体检者进行对比分析.结果 患者组免疫球蛋白I gA、I gG和补体C3C4的含量与对照组相比有明显差异,差异具有统计学意义(P<0.05).患者组补体C3C4的含量具有直线相关性,(P<0.05).结论 混合性结缔组织病患者血清免疫球蛋白I gA、I gG和补体C3C4的含量与病情有关,可用于病情判断和预后评价.     

Influenza antibody titers after vaccination of chronic renal failure patients; before and during hemodialysis, or on continuous ambulatory peritoneal dialysis

Anti-influenza antibody (Ab) titers were measured in order to elucidate whether there are any disturbances in Ab production in chronic renal failure (CRF) patients. A total of 55 CRF patients plus 15 normal individuals were vaccinated with influenza vaccine twice, 4 weeks apart of the 55 CRF patients, 15 were not on dialysis, 10 were undergoing hemodialysis (HD), and 30 were on continuous ambulatory peritoneal dialysis (CAPD). Of the 30 CAPD patients, 14 had peritonitis. Serum Ab titers were measured by complement fixation (CF) and hemagglutination inhibition (HI) tests, and IgG and IgM class specific antibodies by ELISA. All groups responded to immunization, but CAPD patients with peritonitis and CRF patients not yet on dialysis did not show a significant elevation in IgM class Ab titers. The number of CAPD patients with peritonitis who achieved positive titers was significantly lower in HI (p less than 0.01) and IgG class antibodies (p less than 0.05) compared with normal controls. Two patients with frequent peritonitis did not show any response to vaccination. It was concluded that patients with renal dysfunction have some abnormalities in Ab production against influenza vaccine, the effects of which were more pronounced in the CAPD patients with frequent peritonitis.     

联合检测 PTH、 β2-MG 及 hs-CRP 在鉴别诊断急、 慢性#br# 肾功能衰竭中的价值

摘要:目的 探讨联合检测甲状旁腺素 （PTH）、 β2-微量球蛋白 （β2-MG） 及超敏 C 反应蛋白 （hs-CRP） 对急性肾功 能衰竭（ARF）和慢性肾功能衰竭（CRF）的鉴别诊断价值。方法 138 例肾功能衰竭（RF）患者分为 ARF 组 64 例, CRF 组 74 例。同时选取其他非肾功能衰竭的肾病 （NRF） 组 80 例和健康对照组 80 例, 检测并比较 4 组的 PTH、 β2- MG 及 hs-CRP 水平, 串联分析各组合 （PTH+β2-MG、 PTH+hs-CRP、 β2-MG+hs-CRP 及 PTH+β2-MG+hs-CRP） 的诊断 效率, 选择适合诊断 ARF 和 CRF 的最优组合。结果 ARF 组的 hs-CRP 高于 CRF 和对照组, PTH 及β2-MG 低于 CRF 组（P＜0.01）, 而 PTH 与对照组差异无统计学意义。CRF 组的 PTH 及β2-MG 显著高于对照组,而 hs-CRP 与对 照组无统计学意义。ARF 患者 hs-CRP 及β2-MG 多中度+重度升高（68.7%和 81.2%）并伴 PTH 轻度升高（25.0%）, CRF 患者 PTH 及β2-MG 多中度+重度升高（56.8%和 98.6%）并伴 hs-CRP 轻度+中度升高（39.2%）。β2-MG 及 hsCRP 可明显提高 ARF 的总符合率（TCR）及 Youden 指数（YI）, PTH 及β2-MG 可明显提高 CRF 的 TCR 及 YI。结 论 联合检测 PTH、 β2-MG 及 hs-CRP 有助于 ARF 与CRF 的鉴别诊断。     

慢性肾衰竭肾性贫血与血脂及钙磷代谢的相关性

目的 探讨血脂及钙磷代谢对慢性肾衰竭(CRF)患者贫血的影响.方法 CRF伴贫血患者60例分为轻度贫血血红蛋白(Hb>90 g/L,A组)、中度贫血(Hb 60～90g/L,B组)和重度贫血(Hb<60 g/L,C组),30例健康人为对照(D)组.测定血尿素氮(BUN)、肌酐(Cr)、甲状旁腺素(PTH)、钙(Ca)、磷(P)、Hb、甘油三酯(TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)水平,分析Hb与各项指标之间的关系.结果 A、B、C三组血BUN、Cr、PTH、P较D组明显升高,Ca、Hb明显降低(P<0.05);CRF患者上述改变随着贫血加重而明显.C组PTH明显高于A、B两组(P<0.01);血Ca随贫血加重略有降低.血Hb与TC、HDL-C呈显著正相关性,与LDL-C呈显著负相关(P<0.01).结论 钙磷代谢紊乱、继发性甲旁亢是导致及加重肾性贫血的原因之一,脂质代谢亦参与肾性贫血的发生发展.     

Acute renal failure provoked by toxin from caterpillars of the species Lonomia obliqua.

Acute renal failure (ARF) is a complication of envenoming by contact with caterpillars of the species Lonomia obliqua. A cohort study was conducted to evaluate development of acute and chronic renal failure (CRF) in patients who been in contact with L. obliqua during the period from 1989 to 2003 in the State of Santa Catarina, southern Brazil. Patients were evaluated in two distinct groups: those prior to 1995, who did not receive specific treatment of any type, and those after this date who were treated with antilonomic serum (SALon). The presence of creatinine > or = 1.5 mg/dl in patients who had no history of previous renal illness was considered to be indicative of acute kidney failure. Of the 2067 patients evaluated, 39 (1.9%) developed ARF. Eleven (32%) of these patients were treated with dialysis and four (10.3%) developed CRF. The seven deaths (4%) occurred in the period before treatment with SALon. Blood coagulation measures (TC, TP, and TTPA), were significantly longer in the group with ARF. All patients with ARF and 67% of the control group presented hematuria. The majority of the patients recovered prior renal function, however, four (10.3%) needed chronic dialysis. Envenoming by L. obliqua can be considered an important risk factor for the development of potentially fatal ARF, as well as for developing CRF.     

Emerging drugs for renal failure

Renal failure involves a significant impairment of the essential functions of the kidney, which can be either acute with sudden and rapid onset (acute renal failure [ARF]) or chronic with gradual onset (chronic renal failure [CRF]). ARF, if detected early, may be halted or reversed, whereas CRF is generally irreversible. Without treatment or intervention, both forms of renal failure lead to end stage renal failure (ESRF) or end stage renal disease (ESRD), requiring renal replacement therapy (RRT) in the form of dialysis or renal transplantation for survival. However, provision of RRT requires expert teams working in specialised units, making therapy of patients with renal failure expensive; furthermore, RRT is complex, with its own complications. Although pharmacological interventions have shown promise in experimental models, these have not been as successful in the clinical setting (e.g., administration of atrial natriuretic peptide, low-dose dopamine). At present, drugs are administered during CRF to either reduce one of the many risk factors of CRF (e.g., angiotensin-converting enzyme inhibitors, statins) or to deal with the consequences of CRF (e.g., erythropoietin, calcitriol). Recent evidence suggests that some of these interventions may provide further direct beneficial effects via reduction of renal inflammation. Although these interventions have greatly improved the prospects for patients suffering ESRF, the development of novel drugs and therapies with which to reduce the consequences of renal failure and ESRD remain topics of great interest. This article reviews the therapies available for the prevention and management of renal failure in adults and describes, in detail, emerging drugs and novel interventions that may soon become available for the treatment or prevention of ESRF.     

Effect of severe renal failure and haemodialysis on the pharmacokinetics of levosimendan and its metabolites

BACKGROUND AND OBJECTIVES: Levosimendan is a calcium sensitiser developed for the treatment of congestive heart failure. It increases myocardial contractility, reduces the filling pressure and dilates both the peripheral and coronary vessels. The circulating metabolites of levosimendan, OR-1855 and OR-1896, are formed and eliminated slowly after intravenous administration of levosimendan. The aim of this study was to investigate the effect of impaired renal function and haemodialysis on the pharmacokinetics of levosimendan, OR-1855 and OR-1896. STUDY DESIGN: This study was an open-label, nonrandomised, phase I pharmacokinetic study. Levosimendan was administered as a single-dose infusion of 0.1 microg/kg/minute for 24 hours. The follow-up period lasted 3 weeks. STUDY SETTING: Twenty-fivepatients were included:12 patients with severe chronic renal failure (CRF) with creatinine clearance of < 30 mL/minute/1.73 m(2) and 13 patients with end-stage renal disease (ESRD) undergoing haemodialysis. A group of 12 healthy subjects served as controls. RESULTS: Levosimendan, the parent drug, was eliminated rapidly from the plasma after discontinuation of its infusion, with an elimination half-life (t(1/2)) [mean +/- standard error of mean] of 1.5 +/- 0.09 hours in ESRD patients undergoing haemodialysis, 1.0 +/- 0.2 hours in patients with severe CRF and 0.91 +/- 0.03 hours in healthy subjects. The t(1/2) of levosimendan was significantly longer (p < 0.001) in ESRD patients undergoing haemodialysis than in healthy subjects. The t(1/2) of OR-1855 and OR-1896 were 94.0 +/- 20.4 hours and 96.5 +/- 19.5 hours, respectively, in ESRD patients undergoing haemodialysis compared with 60.8 +/- 5.2 and 61.6 +/- 5.2 hours, respectively, in healthy subjects (p = not significant). The t(1/2) of OR-1855 was significantly longer (85.0 +/- 13.6 hours) in patients with severe CRF than in healthy subjects (60.8 +/- 5.2 hours, p < 0.05). The area under the plasma concentration-time curve (AUC) and the peak plasma concentration (C(max)) of the metabolites were approximately 2-fold in patients with ESRD undergoing haemodialysis and patients with severe CRF compared with healthy subjects. The mean unbound fraction (f(u)) of levosimendan in plasma was approximately 2% in each study group, whereas the f(u) of the metabolites was considerably higher (63-70%). In contrast to levosimendan, the metabolites were dialysable, with dialysis clearance of approximately 100 mL/minute. The haemodynamic responses and adverse event profiles were similar in the study groups, with headache, palpitations and dizziness being the most frequently recorded adverse events. CONCLUSION: The t(1/2) of the levosimendan metabolites was prolonged 1.5-fold and their AUC and C(max) were 2-fold in patients with severe CRF and ESRD patients undergoing haemodialysis as compared with healthy subjects. These results suggest that the dose should be reduced when levosimendan is used for the treatment of congestive heart failure in patients with severe renal insufficiency.     

脑钠肽对慢性肾衰竭合并心力衰竭的诊断价值

目的观察肾小球滤过率（eGFR）与脑钠肽（BNP）之间的关系,比较慢性肾衰竭合并心力衰竭（心衰）患者不同eGFR水平BNP的诊断界值（cut—off值）,研究肾功能对BNP应用于心衰诊断的影响。方法对老年eCRF合并心衰未透析患者52例及无心衰29例和老年健康体检者30例（健康对照组）采用酶联免疫吸附法测定血清BNP浓度,根据eGFR分组进行对比。结果eGFR小于30ml、30～60ml心衰组BNP水平均高于eGFR小于30ml、30—60ml无心衰对照组和eGFR大于60ml健康对照组（P〈0．05）,eGFR小于30ml、30—60ml无心衰对照组BNP水平较eGFR大于60柚健康对照组显著升高（P〈0．05）。eGFR小于30ml心衰组与eGFR30—60ml心衰组BNP相比较,差异无统计学意义（t=0．62,P〉0．05）。eGFR与BNP心衰组无相关,无心衰对照组呈负相关（心衰组γ=-0．081,P〉0．05,对照组γ=-0．581,P〈0．01）。eGFR30～60ml心衰组ROC曲线下面积（AUC）为0．951,1500ng／L作为临界值的敏感度为96．4％,特异度为86．7％;eGFR小于30ml心衰组AUC为0．860,1850ng/L作为临界值的敏感度为66．7％,特异度为92．9％。结论CRF合并心衰时心衰是导致BNP升高的主要原因,BNP可作为判断CRF患者是否合并心衰的诊断指标。     

Pharmacokinetics and biliary excretion of rose bengal in rats with acute and chronic renal failure

The effects of glycerol-induced acute renal failure (ARF) and surgically induced chronic renal failure (CRF) on the pharmacokinetics and biliary excretion of rose bengal have been examined in the rat. Both the pharmacokinetics and biliary excretion of rose bengal were unaltered in either ARF or CRF. The latter results in CRF contrast with those of Tse et al (1976, Int. J. Nucl. Med. Biol. 3: 134-137) who reported decreased removal of the dye from blood and reduced biliary excretion. In addition, rose bengal behaves differently from bromosulphophthalein and indocyanine green whose hepatic uptake and initial biliary excretion are known to be decreased in ARF. The results suggest that rose bengal may have a hepato-biliary transport route which differs from that of bromosulphophthalein and indocyanine green, and the findings also emphasize the selective nature of altered organic anion uptake by the liver in ARF.     

Carotid artery intima-medial thickness is increased in chronic renal failure

1. Chronic renal failure (CRF) is associated with rapidly progressive atherosclerotic vascular disease. In the present study, carotid arterial intima-medial thickness (IMT) was assessed in a large cohort of patients with CRF and matched controls and related to risk factors. 2. A total of 159 subjects with CRF (serum creatinine > or =0.40 mmol/L) aged > 50 years (mean (+/-SD) 63.8+/-7.7 years) and 159 healthy controls matched for age, sex and smoking status were studied. 3. The IMT was determined using B-mode ultrasound measurements of the far wall of both common carotid arteries and presented as the mean IMT. Fasting plasma homocysteine (tHcy) was measured in the CRF group. 4. Intima-medial thickness was significantly greater in CRF patients than controls (0.89+/-0.17 vs 0.73+/-0.13 mm, respectively) after matching for age, sex and smoking status. Heart rate and pulse pressure were also significantly increased. The tHcy was increased two-fold in the CRF group (27.7+/-11.3 micromol/L; normal < 13.0 micromol/L) and did not correlate with carotid IMT. 5. Compared with controls after adjusting for traditional risk factors, patients with CRF exhibit significantly increased IMT.