Immobilization Hypercalcemia-Associated Acute Renal Failure in a Patient with Chronic Tophaceous Gout

We report a case of patient suffering from chronic tophaceous gout of multiple, large joints. The patient was diagnosed with acute renal failure by immobilization hypercalcemia and successfully treated with fluid and diuretics, rehabilitative exercises, and bisphosphonate, without further recurrence during six months follow-up. Acute renal failure can occur in the patient with gout as an acute uric acid nephropathy due to the deposition of uric acid within the renal tubules. Immobilization hypercalcemia is a rare cause of acute renal failure in patients with immobilization due to the limitation of motion. We suggest that immobilization can be a possible cause of hypercalcemia-induced acute renal failure in patients with chronic tophaceous gout involving multiple large joints, and clinical alertness is needed to avoid unnecessary evaluations and life-threatening complications.     

虫草制剂对延缓慢性肾衰竭进展的实验研究

目的：为观察中药治疗慢性肾衰竭(CRF)的疗效。方法：采用5／6肾切除大鼠CRF模型，对肾衰大鼠用中药治疗后的肾功能等血液生化指标及残余肾组织病理情况进行了检查。结果：发现中药可降低CRF大鼠的死亡率，降低血Scr和BUN水平，具有明显的延缓CRF进展的作用。在肾组织病理学改变上，中药能延缓肾小球硬化的进展。结论：中药能有效控制慢性肾衰竭的进展。     

黄芪注射液治疗慢性肾衰竭合并心力衰竭的临床疗效

目的:观察黄芪注射液治疗慢性肾衰竭合并心力衰竭的疗效。方法:将60例慢性肾衰合并心力衰竭病人分为两组。对照组30例予西医治疗。治疗组30例在西医治疗基础上加用黄芪注射液30 ml溶入10％G.S 250 ml中静脉滴注,qd连用10 d。结果:治疗组心功能明显改善,总有效率90％,明显高于对照组(P<0.05);治疗组左室射血分数(LVEF)和左室短轴缩短率(ΔD％)均显著提高(P<0.05)。结论:黄芪注射液能明显改善慢性肾衰病人的心功能。     

Parathyroid Hormone as a Marker for the Differential Diagnosis of Acute and Chronic Renal Failure

It is often difficult to distinguish acute renal failure clinically from chronic renal failure, especially in patients who do not have records of their medical history. We investigated the magnitude of iPTH increase in ARF and the potential role of iPTH as a marker for differential diagnosis of ARF and CRF in new patients referred to our renal unit. We prospectively analyzed 122 (ARF n?=?64, CRF n?=?58) patients referred to our renal unit with serum creatinine higher than 2 mg/dL. ROC curve analysis was performed to investigate role of iPTH for differentiating ARF from CRF. The sensitivity, specificity, and positive predictive value of iPTH in discrimination of ARF and CRF were calculated. There was no statistically significant difference regarding the means of age, sex distribution, and serum chemistry between patients with ARF or CRF. But serum iPTH (p < 0.0001) levels were lower in patients with ARF than in those with CRF. A cutoff, set at 170pg/mL for iPTH to discriminate patients with CRF, yielded a sensitivity of 88% and a specificity of 89%. This study confirms that the iPTH measurement is of clinical value in differentiating acute from chronic renal failure.     

慢性肾功能衰竭性勃起功能障碍大鼠阴茎海绵体有效成分的测定

目的:探讨慢性肾功能衰竭(CRF)性勃起功能障碍(ED)的发病机制。方法:应用SD雄性大鼠分两期行5/6肾脏切除术,建立CRF动物模型。将假手术组(NCRF组,n=30)、CRF模型大鼠(CRF组,n=45)分别随机均分为Ⅰ(2周)、Ⅱ(4周)、Ⅲ(6周)3组,并分别于2、4、6周注射阿朴吗啡(APO,80μg/kg)后观察大鼠阴茎勃起情况,筛选CRF性ED模型大鼠;测定阴茎海绵体组织一氧化氮合酶(NOS)的活性,及其组织的M asson染色图像分析。结果:CRF性ED大鼠阴茎海绵体组织NOS活性及平滑肌面积显著降低(P<0.01或P<0.05),胶原纤维略有增加,且上述变化与CRF病程密切相关。海绵窦血管腔无明显变化。结论:CRF严重影响阴茎勃起功能,阴茎海绵体组织NOS活性降低及阴茎海绵体平滑肌面积的减少可能是其重要的发病机制。     

慢性肾功能衰竭病人实施心理干预的研讨

对慢性肾功能衰竭病人进行心理干预以改善病人的生活质量。随机将１５６例病人分成观察组和对照组。观察组除常规中西药物治疗外，通过健康教育、自编自导肾病保健功，作放松治疗及心理咨询；对照组常规中西药物治疗。治疗前后两组均用ＳＣＬ－９０量表和慢性肾功能衰竭病人专用生活质量表进行评估。结果表明心理干预后观察组较对照组心理障碍发生率低（Ｐ〈０．０５），并且有较高的生活满意度（Ｐ〈０．０５）。提示对慢性肾功能衰     

益肾泄浊方对痛风性肾病并发慢性肾衰竭大鼠肾功能及病理影响的实验研究

目的:观察益肾泄浊方对痛风性肾病并发慢性肾衰竭大鼠模型血清尿素氮、肌酐、尿酸的影响及肾脏病理组织学变化的影响。方法:将大鼠随机分组处理:模型组予高酵母饲料喂养及腺嘌呤灌胃,建立痛风性肾病并发慢性肾衰竭大鼠模型;同时分别以别嘌醇、益肾泄浊方干预;正常对照组给予普通大鼠颗粒饲料喂养,生理盐水灌胃。监测大鼠血清尿酸、肌酐及尿素氮水平的变化,同时观察大鼠肾脏病理改变。结果:与正常对照组比,第5周末模型组大鼠尿素氮、血肌酐、血尿酸增高,P<0.05,肾脏病理为痛风性肾病并发慢性肾衰竭大鼠模型改变;与模型组比较,别嘌醇组血尿酸明显下降,P<0.05;益肾泄浊方大剂量组血肌酐下降明显,P<0.05;益肾泄浊方大剂量组病理修复最好,别嘌醇组次之。结论:益肾泄浊方可以保护痛风性肾病并发慢性肾衰竭大鼠肾功能、修复肾脏病理。     

Incidence of Demodex Folliculorum in Patients with End Stage Chronic Renal Failure

Background. Demodex folliculorum (DF), found in the pilosebaceous unit, is the most common ectoparasite in humans. It has been implicated in various clinical lesions such as pustular folliculitis, papulopustular scalp eruption, perioral dermatitis, and skin lesions of immunosuppressed patients on chemotherapy or with acquired immunodeficiency syndrome (AIDS). Objective. We aimed to determine DF carriers and location of DF among patients on chronic dialysis because of end stage renal failure (ESRF), to compare them with healthy controls, and to examine the relationship between DF incidence and dialysis method and symptoms. Methods. Sixty-seven patients on dialysis and 67 healthy controls were taken into the study. The patient groups were classified according to the diseases causing ESRF [diabetes mellitus (DM), polycystic disease (PCD), glomerulonephritis (GN), hypertensive nephrosclerosis (HTNS), others (OT), unknown etiology (UE)], and mode of dialysis. Five standardized skin surface biopsies (SSSB) were taken. The determination of five and more living parasites/cm² area was diagnosed as infestation. Results. The mean mite count in the ESRF group, 6.12/cm², was significantly higher than that in controls, 0.31/cm², (Independent Samples Test, p = 0.000). The DF positivity according to primary disease causing ESRF revealed that it was most frequent in DM with 12 patients (44.4%), followed by UE with nine patients (33.4%). Conclusions. Our findings indicate that the DF number is increased in ESRF patients on dialysis treatment. We recommend that demodicidosis should be included in the differential diagnosis of facial eruptions in patients with ESRF.     

Garlic Extract Ameliorates Renal and Cardiopulmonary Injury in the Rats with Chronic Renal Failure

Abstract

Chronic renal failure (CRF) is associated with oxidative stress that promotes production of reactive oxygen species and cytokine release. We aimed to investigate the possible protective and antioxidant effects of aqueous garlic extract (AGE) in a rat model of CRF. Male Sprague-Dawley rats were randomly assigned as either CRF group with 5/6 reduction in the renal mass or sham-operated control group. CRF group received either saline or AGE (250 mg/kg/day/1 mL) orally for 3 weeks. At the end of the 3 weeks, rats were decapitated and trunk blood was collected. Creatinine, blood urea nitrogen (BUN) and lactate dehydrogenase (LDH) activity, and TNF-α and IL-1β levels were measured in the serum samples, while malondialdehyde (MDA), glutathione (GSH) levels, and myeloperoxidase (MPO) activity were determined in the kidney, lung, and heart samples. CRF caused significant decreases in tissue GSH, which were accompanied with significant increases in MDA levels and MPO activities, while the circulating levels of the LDH activity, creatinine, BUN, TNF-α, and IL-1β were elevated. AGE treatment alleviated CRF-induced oxidative changes in the injured tissues, while CRF-induced elevations in the blood levels of the pro-inflammatory cytokines and LDH were reduced. In conclusion, CRF-induced oxidative tissue injury occurs via the activation of pro-inflammatory mediators and by neutrophil infiltration into tissues and that the protective effects of garlic on CRF-induced injury can be attributed to its ability to inhibit neutrophil infiltration and pro-inflammatory mediators. These findings suggest that garlic, as a supplementary to diet, may have a potential therapeutic use in delimitating the systemic oxidant effects of CRF on remote organs.     

Bupivacaine Cardiotoxicity in a Patient with Renal Failure

Bradycardia and hypotension were the first major signs of toxicity from a 250 mg bupivacaine axillary brachial plexus block experienced by a patient with chronic renal failure, who had an anion gap acidosis and hyperkalemia. Without these metabolic abnormalities, this patient received four similar blocks: three were without incident and one was complicated by seizure. Acidosis and/or hyperkalemia in man appears to increase the myocardial susceptibility to bupivacaine toxicity into the range of arterial concentrations of the drug normally produced by plexus blocks, even in the absence of drug-induced cerebral toxicity, seizures and hypoxia.     

慢性肾功能衰竭病人的性功能障碍

慢性肾功能衰竭病人性功能障碍十分常见 ,且已成为影响其生活质量的一个重要问题 ,却很少得到关注。其病因包括生理、心理和器质性因素。本文就近年来有关慢性肾功能衰竭病人性功能障碍的发病情况、主要表现形式、评定方法、发病的危险因素和治疗方法等进行了综述。     

Estrogen Protects against Oxidative Multiorgan Damage in Rats with Chronic Renal Failure

The impact of sex dimorphism on chronic renal failure (CRF)-induced oxidative multiorgan damage and the effects of estradiol (E₂) loss and E₂ supplementation on the progress of CRF were studied. Sprague-Dawley rats underwent 5/6 nephrectomy (CRF), and a group of female rats had bilateral ovariectomy (OVX), while the sham-operated rats had no nephrectomy or OVX. Rats received either estradiol propionate (50 μg/kg/day) or vehicle for six weeks. Serum BUN levels were elevated in both male and female CRF groups treated with vehicle, while creatinine level was not significantly changed in the female CRF group. CRF-induced elevation in serum TNF-α of male rats was abolished when the animals were treated with E₂, while OVX exaggerated TNF-α response. In OVX and male rats with CRF, E₂ treatment reversed the malondialdehyde elevations in all the studied tissues (kidney, heart, lung, ileum, brain, liver, and gastrocnemius muscle), while depletion of glutathione in these tissues was prevented by E₂ treatment. Similarly, increased levels of myeloperoxidase activity, lucigenin chemiluminescence, and collagen in most of the tissues were reversed by E₂ treatment. The findings show that the extent of tissue injuries was relatively less in females, while ovariectomy exacerbated all the indices of oxidative injury. Moreover, the administration of E₂, with its potent anti-oxidant and anti-inflammatory effects, markedly improved CRF-induced systemic inflammatory outcomes in both male and female rats by depressing tissue neutrophil infiltration and modulating the release of inflammatory cytokines.     

Staphylococcal Pericarditis in a Chronic Renal Failure Patient

A 34-year-old female with end-stage renal disease was admitted for severe metabolic acidosis, uremic encephalopathy, pericarditis and severe anemia following a bout of acute gastroenteritis. She improved on aggressive medical management including intensive hemodialysis and was initiated onto maintenance heparin-free hemodialysis (twelve hours per week) and discharged. After a week, she presented with fever with chills and rigors for three days, was toxic, severely orthopenic and had a pulsus paradoxus of 36 mmHg. Echocardiography suggested cardiac tamponade. Aspiration revealed frank pus with polymorphonuclear predominance and Staphylococcus aureus on culture. CT of the thorax revealed pericardial effusion. In the absence of any obvious septic foci, concomitant pleuro-pulmonary sepsis, mediastinal or intra-abdominal pathology; a diagnosis of “acute primary purulent pericarditis” was made. Patient was put on parenteral antibiotics-ceftriaxone and metrogyl. Vancomycin was added after sensitivity results. Pericardial drainage was required initially. After toxemia improved, paradox decreased and fever subsided, the pericardial catheter was removed and antibiotics continued for a period of four weeks. Maintenance hemodialysis was continued during hospital stay and after discharge.     

慢性肾炎致慢性肾衰竭患者心衰发生相关危险因素分析

目的：了解慢性肾炎致慢性肾衰竭患者血压、血红蛋白、血清白蛋白、血脂、血肌酐、电解质及尿素氮、胱抑素C、同型半胱氨酸及高敏C反应蛋白等指标与心力衰竭发生之间的关系,分析并探讨相关危险因素。方法：回顾性分析我院343例慢性肾炎致慢性肾衰竭患者心衰发生及其同期血压等指标变化情况,了解其规律及相互关系。结果：（1）343例患者有77例合并发生心衰（22．4％）,其中19岁～39岁占20．5％,40岁～59岁占22．8％,〉60岁占33．3％;合并发生心衰多为CKD5期患者（97．4％）。（2）血压、血红蛋白、CO2CP、血肌酐、高敏C反应蛋白在有无心衰发生组存在统计学差异（P〈0．01）,其中血压、血肌酐、光抑素C、高敏C反应蛋白等与心衰发生呈负相关（P〈0．05）,而年龄、钙磷、血清白蛋白及血脂、尿素氮、同型半胱氨酸组间无统计学差异。结论：慢性肾炎致慢性肾衰竭患者心力衰竭发生率很高,其发生可能与高血压、贫血、酸中毒、血肌酐及微炎症状态等因素有关。     

生血肾灵治疗肾性贫血的临床研究

目的：观察生血肾灵对肾性贫血的疗效和机制。方法：收集31例慢性肾衰竭（CRF）处于失代偿期和肾功能衰竭期的患,给予生血肾灵治疗2个月,观察患的一般症状和体征,并于治疗前后分别测定病人的血色素（Hb)、红细胞压积（Hct)、血肌酐（Scr)、血尿素氮（BUN）、中分子物质（MMS）、血红细胞超氧化物歧化酶（SOD）活性和脂质过氧化物（LPO）,并进行治疗前后的对比。结果：经生血肾灵治疗后患的症状和体征明显改善;治疗后的Hb、Hct及SOD较治疗前明显升高（P＜0．01）;Scr、BUN、MMS及LPO较治疗前显降低（P＜0．01）。结论：生血肾灵能够明显改善CRF患的症状和体征,延缓肾衰进程,纠正肾性贫血。     

Antidepressant Treatment Increases Quality of Life in Patients with Chronic Renal Failure

To evaluate the effect of citalopram treatment on quality of life (QoL) and depression in 141 patients with chronic renal failure (CRF), QoL was measured by means of the Short Form 36 (SF-36). Patients diagnosed with depression were treated with citalopram for eight weeks and evaluated for the effect of treatment on depressive symptoms and QoL. Thirty-four of 141 patients (24.1%) had depression and treatment with citalopram decreased Beck Depression Inventory Scores and increased the emotional role limitation and the mental health subscale scores of SF-36. This study suggests that citalopram can treat depression and improve QoL in patients with CRF.     

血红素氧合酶2在慢性肾衰大鼠阴茎海绵体中的表达

目的:检测血红素氧合酶2(HO-2)在慢性肾衰(CRF)大鼠阴茎海绵体中的变化,探讨HO-2在阴茎勃起过程中的作用及与睾酮的关系。方法:采用10周龄雄性SD大鼠行5/6肾切除术构建CRF模型成功后,测定对照组(CTL组,n=15)、CRF组(n=15)平均颈动脉压(MAP)及海绵体内压最大值(ICPmax)、血清睾酮,并检测阴茎海绵体中eNOS、nNOS、HO-2的表达。结果:CRF组在3V、5V电刺激海绵体神经后ICPmax/MAP(0.121±0.084,0.135±0.088)均显著低于对照组(0.263±0.147,0.244±0.089,P<0.01),CRF组血清睾酮浓度[(1.190±0.946)nmol/L]显著低于对照组[(7.800±5.001)nmol/L,P<0.01],CRF组海绵体中nNOS、eNOS表达低于对照组,CRF组海绵体中HO-2表达(0.510±0.397)显著低于对照组(2.672±1.720,P<0.01),海绵体中HO-2表达下降与血清睾酮下降存在相关性(r=0.902,P<0.01)。结论:CRF组大鼠阴茎海绵体中nNOS、eNOS、HO-2、血清睾酮水平降低等可能是CRF并发勃起功能障碍机制之一。     

Validation of an Experimental Model to Study Less Severe Chronic Renal Failure

Purpose: The 5/6 nephrectomy, mimics the stages of human chronic renal failure (CRF), but the procedure causes severe renal functional and morphological damage that could interfere with the evaluation of therapies for slowing the progression of the disease. This study summarizes the results of renal function, histology, and immunohistochemical findings in rats undergoing a 2/3 nephrectomy. Methods: The rats were distributed in groups according to the type of nephrectomy: CRF5/6: induced by a 5/6 renal mass reduction and CRF2/3: less severe CRF. The body weight and blood pressure were monitored, and the serum creatinine (SCr), creatinine clearance (CCr), urine osmolality, and 24-h proteinuria (PT24h) were measured. CRF progression was evaluated by the rate of decline of CCr (RCCr). Histology and immunohistochemistry were performed in the remnant kidneys. Statistical analysis was done by unpaired t-test, and a P-value < 0.05 was taken as a statistical significance. Results: Compared to the CRF5/6 group, the CRF2/3 model had a lower SCr, PT24h, CCr, and variations of the SCr from baseline. The disease progression was also significantly slower. The renal histopathological findings revealed fewer chronic lesions in rats with CRF2/3. Similarly, we observed less macrophage accumulation as well as lower proliferative activity and expression of fibronectin and a-smooth muscle-actin in the CRF2/3 model. Conclusions: The CRF2/3 model presented with a pattern of less severe CRF, functionally and morphologically, compared to the classical CRF5/6 model, and the CRF2/3 model may be useful for evaluating therapeutic interventions that target the early stages of CRF.     

Renal Transplantation for Chronic Renal Failure in Acute Porphyria

A woman with acute intermittent porphyria and a man with variegateporphyria developed chronic renal failure in middle age. Afterperiods on haemodialysis, both received successful cadavericrenal transplants. On the basis of animal porphyrinogenicitystudies prednisolone and azathioprine were used in preferenceto cyclosporin as immunosuppressive agents. Neither of the patientsshowed any evidence of activation of their porphyria during,or following, transplantation. The findings in these two patientsand a review of two previous reports indicate that acute porphyriais not a contraindication to renal transplantation.     

Effects of Thyroid Function on the Course of Experimental Chronic Renal Failure in Rats

Thyroid hormone has been reported to affect renal function. To investigate the effects of thyroid hormone on the progression of renal deterioration, thyroid hormone (dried thyroid) and an antithyroid drug (thiamazole) were administered to adriamycin (ADR)-induced renal failure rats. The rats were divided into four groups, including 1) ADR-DT, given dried thyroid and thiamazole; 2) ADR-T, given thiamazole; 3) ADR; and 4) control. The survival rate at the end of the study (22 weeks) was 62.5% in ADR-DT group and 100% in ADR-T, ADR, and control groups, respectively. There was a significant difference in the body weight and pulse rate between ADR-DT and ADR-T or ADR groups, except for the pulse rate at week 6 (P < 0.05). The creatinine clearance was greater in the ADR-T group than in the ADR or ADR-DT groups at week 22, and was significantly different between the ADR-T and the ADR-DT groups (P < 0.05). The fractional kidney weight and tubular changes were significantly greater in the ADR-DT group than in the ADR-T or ADR groups (P < 0.05). The interstitial volume was significantly greater in the ADR-DT group than in the ADR-T group (P < 0.05). We therefore conclude that a dried thyroid has an aggravative effect in the tubular changes and relative interstitial volume induced by ADR.