利福平过敏致急性肾小管坏死二例

例一 女,３７岁．入院前２５ｄ于当地医院被诊为“肺结核”,服用利福平等抗结核药 用药第２ｄ自停利福平,７ｄ后重新服用,眼后２ｈ出现寒战、发烧、恶心、呕吐、上腹痛、皮肤黄染．当地医院化验尿蛋白＋＋＋,糖＋,潜血＋＋＋;Ｈｂ６０～１０５ｇ／Ｌ．Ｐｌｔ（１５～２２）×１０～９／Ｌ,尿量＜１００ｍｌ／ｄ,ＡＳＴ １０５ Ｕ／Ｌ,Ｔ．Ｂｉｌ １４８．６μｍｏｌ／Ｌ,Ｄ－Ｂｉｌ ８０．８μｍｏｌ／Ｌ,血清淀粉酶８１２ ｎｋａｔ／Ｌ,Ｓｃｒ ７００ μｍｏｌ／Ｌ,ＢＵＮ ４２．９７ｍｍｏｌ／Ｌ,给予规律血液透析,并子地…     

几种特殊疾病导致的老年人急性肾衰竭

老年人急性肾衰竭 (ＡＲＦ)较常见 ,80年代后期国外文献报道 ,在ＡＲＦ患者中老年人占 6 0 %左右。老年人口渴感低 ,饮水量少 ,肾小管浓缩功能下降 ,保钠能力差 ,排尿量多 ,机体常处于“缺水状态” ,故易于发生肾前性ＡＲＦ。老年人肾脏已退行性变 ,储备及代偿力不足 ,在缺血或毒物作用下易发生急性肾小管坏死。老年人肿瘤发病率高 ,因肿瘤或前列腺肥大导致尿路梗阻时 ,易发生肾后性ＡＲＦ。这些常见的ＡＲＦ已为临床医师熟知。本文将介绍几种特殊疾病导致的老年人ＡＲＦ ,望能引起临床医师充分重视。1　原发性小血管炎所致急性肾衰竭显微镜…     

冬虫夏草人工繁育品拮抗糖尿病肾病大鼠足细胞损伤的研究

目的:探讨冬虫夏草人工繁育品(ACOS)对糖尿病肾病(DN)大鼠足细胞损伤的保护作用。方法:将雄性SD大鼠分成对照组、DN模型组(高脂饲料及链脲佐菌素造模)、低剂量及高剂量ACOS干预组(分别用2.5 g/kg及5.0 g/kg每天灌胃,共8周)。观察尿蛋白、血生化指标、肾功能、肾脏病理及足细胞标志蛋白表达变化。结果:13周试验结束时,模型组大鼠与对照组比较,胰岛素抵抗指数、血糖、尿蛋白及血肌酐水平显著增加;肾小球增大、系膜基质增多及足突增宽;nephrin、podocin、WT-1的mRNA和蛋白表达下调,desmin的mRNA和蛋白表达上调。上述差别均具有统计学意义(P0.05)。ACOS干预后,上述所有指标均显著改善(P0.05)。结论:大鼠模型试验显示ACOS可显著改善2型糖尿病并减轻DN的足细胞损伤。     

慢性肾脏病的定义与分期-从KDOQI到KDIGO:贡献与问题

慢性肾脏病（CKD）的定义和分期标准是美国国家肾脏基金会（National Kidney Foundation，NKF）所属“肾脏病预后质量倡议”（Kidney Disease Outcomes Quality Initiative，KDOQI）工作组于2002年制定。     

老年人慢性肾功能不全的蛋白营养治疗

在保证足够热量供应前提下，给慢性肾功能不全患者予低蛋白饮食治疗非常必要，这已成为共识。因为它有如下好处：（1）减少尿毒素产生，减轻氮质血症，改善代谢性酸中毒；（2）促进蛋白质合成，减少降解，改善蛋白质代谢；（3）减轻胰岛素抵抗，改善糖代谢；（4）提高脂酶活性，改善脂代谢；（5）降低高血磷，改善低血钙，减轻继发性甲状旁腺功能亢进；（6）减少蛋白尿排泄，延缓慢性肾脏病进展。     

马兜铃酸损伤大鼠肾小球足细胞的研究

目的 探讨马兜铃酸是否能损害肾小球足细胞.方法 用关木通浸膏水溶液间断灌胃制作马兜铃酸肾损害大鼠模型,分别于第1、4周末检测早期马兜铃酸肾损害大鼠24 h尿蛋白量,并以十二烷基磺酸钠-聚丙烯酰胺凝胶电泳观察尿蛋白成分.随后处死大鼠取肾组织,用激光显微切割捕获技术分离肾小球;用实时荧光定量PCR检测肾小球中nephnn、podocin、CD2AP、podocalyxin、podoplanin的mRNA表达;电镜下测量肾小球足突的平均宽度.结果 模型大鼠4周末尿蛋白量较对照组显着增多(P＜0.01),其中白蛋白含量明显增加.电镜结果显示肾小球足突平均宽度较对照组显著增宽(P＜0.01).肾小球中nephrin、podocin、CD2AP、podocalyxin、podoplanin的mRNA表达均较对照组显著减少,分别下调34％、62％、56％、50％(P＜0.01)及27％(P＜0.05).结论 马兜铃酸能损伤肾小球足细胞,导致足细胞相关蛋白mRNA表达下调,足突节段增宽,并出现白蛋白尿.     

心外科术后急性肾损伤实施连续性肾替代治疗的预后分析

目的 心脏外科术后急性肾损伤（CSA-AKI）实施连续性肾替代治疗（CRRT）的患者预后分析. 方法 回顾首都医科大学附属北京安贞医院2013年1月-2013年12月实施CRRT的114例CSA-AKI患者的临床资料.结果 114例患者中男性73例,年龄21-83岁,平均55.8±13.1岁.通过首都医科大学附属北京安贞医院创建的“成人心脏外科手术后急性肾损伤的预警评分系统”进行评分,≥12分的高危患者占64.9％ （73/114）,平均12.9±3.3分.开始CRRT的时机在术后2-144h,中位数26.5 h （20.0,68.0）,CRRT的总治疗时间24-692h,中位数77 h （36.0,148.5）.114例患者中死亡63例（55.3％）、肾功能恢复36例（31.6％）、进入维持性肾替代治疗15例（13.1％）.死亡组63例患者与存活组51例患者在年龄、预警评分、CRRT的总时间存在显著性差异（P＜0.05）;死亡组患者接受联合手术机率（17.5％比3.9％）及低心排综合征等并发症的发生率明显多于存活组（P＜0.05）;114例患者中早期实施CRRT的54例患者比晚期CRRT的60例患者有显著的肾功能恢复率（P＜0.05）.多元Logistic回归分析显示,术后肺机械通气＞24h、术后低血压是CSA-AKI实施CRRT患者死亡的独立危险因素（P＜0.05）. 结论 CSA-AKI的死亡率非常高,尤其接受肾替代治疗的患者.预警评分能预测AKI的发生及死亡的风险.术后肺机械通气＞24h、术后低血压是死亡的独立危险因素.患者高龄、接受联合手术、术后发生低心排综合征等因素也与其死亡有关.早期实施CRRT能促进CSA-AKI患者肾功能恢复.     

肾小球系膜细胞培养

1969年Bernik首次将肾小球在体外培养存活,1970年Quadrucci等首次用光学和电子显微镜证实体外培养的肾小球可生长出三种细胞,1975年Fish等首次在体外培养中分离获得纯系膜细胞(M_sC)。现在大鼠、小鼠、仓鼠、豚鼠、兔、人、猴、狗、猫、牛、绵羊、山羊及猪M_sC的培养都已有报道,为体外利用该细胞进行细胞生物学及细胞病理学研究开辟了道路。     

低蛋白饮食对环孢素A肾病大鼠肾间质纤维化的作用

Objective To investigate whether low-protein diet has protective effect on the progression of renal interstitial fibrosis in rats with cyclosporine A (CsA)-induced nephropathy. Methods Eighteen male Sprague-Dawley rats were randomly divided into three groups (6 rats in each group). The rats in control group (C group) received common diet; in model group (M group) low-salt diet; in intervention group (Ⅰ group) low-salt and low-protein diet. After diet adaptation period of one week, the rats in C group received subcutaneous injection of olive oil 1 mg/kg daily for 5 weeks, while M group and Ⅰ group subcutaneous injection of CsA (diluted into 25 g/L with olive oil) 1 ml/kg for 5 weeks. All the rats were sacrificed at the end of the 5th week. The food-intake and body weight were measured daily. The creatinine clearance (Ccr) was examined before rats were sacrificed. The semi-quantitative pathological analysis on kidney sections was performed. The mRNA and protein expression of transforming growth factor-β1 (TGF-βI) and type Ⅰ collagen (Col Ⅰ) in kidney tissue was determined with real time PCR and immunohistochemical staining, respectively. Results The food-intake and body weight of rats in M and I groups were significantly lower than those in C group (P<0.05). Compared with C group, the Ccr levels in M and Ⅰ groups were significantly reduced [(0.65±0.15) ml/min, (0.40+0.13) ml/min vs (1.55±0.29) ml/min, P<0.05], the relative fibrosis areas of kidney interstitium in M and I groups were significantly increased (3.60%±0.46%, 3.26%±0.75% vs 0.44%±0.24%, P<0.05), the mRNA and protein expression of TGF-β1 in M and I group was significantly up-regulated (by 2.6 and 3.1 times in mRNA and by 1.5 and 1.6 times in protein, respectively, P<0.05), and the mRNA and protein expression of Col Ⅰ in M and I groups was also significantly up-regulated (by 3.0 and 3.5 times in mRNA and by 2.3 and 2.1 times in protein, respectively, P<0.05). There were no significant differences between M and I groups in every parameters above-mentioned except the rat body weight and Ccr. Both the body weight and Ccr in Ⅰ group were significantly lower than those in M group (P<0.05). Compared with C group, the urine osmotic pressure in M group and in I group were deceased (for M group, P>0.05; for I group, P<0.05). Compared with C group, the serum cholesterol levels in M and I groups were significantly increased (P<0.05), and the serum phosphorus level in I group was significantly decreased (P<0.05). The levels of serum albumin and serum calcium of all three groups had no statistical differences (P>0.05). Conclusion Low-protein diet has no renoprutective effects on the rat model of cyclosporin A nephropathy, on the contrary, may induce body weight loss.