尿毒症患者尿红细胞形态、MCV及血红细胞MCV联合检测的临床意义

目的：探讨尿毒症患者尿红细胞形态、MCV及血红细胞MCV联合检验的临床价值。方法：用AVE-763尿沉渣分析仪观察尿毒症组、肾小球肾炎血尿组和非肾小球血尿组患者的尿红细胞形态并计算畸形率,再用XT-2000i全自动血细胞分析仪检测尿红细胞及外周血红细胞MCV。结果：尿毒症组尿红细胞畸形率、MCV及血MCV／尿MCV与肾小球肾炎血尿组比较差异有统计学意义（P〈0．01）,与非肾小球血尿组比较差异无统计学意义（P〉0．05）。结论：尿毒症患者尿红细胞形态、MCV与非肾小球性血尿接近,临床医生诊断和观察病情变化时必须重视。     

活血化瘀法治疗IgA肾病40例临床观察

目的观察活血化瘀法治疗IgA肾病患者血尿及蛋白尿的变化。方法以活血化瘀为主，方用复肾汤加减，观察治疗前后患者症状、血尿及蛋白尿的变化。结果活血化瘀法为主治疗IgA肾病疗效显著，患者的临床症状均有不同程度的改善，大多数患者血尿、蛋白尿均有明显的好转。结论以活血化瘀为主治疗IgA肾病能有效的降低患者血尿及蛋白尿，改善患者临床症状，保护肾功能，延缓病情进一步发展，为IgA肾病从瘀论治疗提供了临床的依据。所以，对kA肾病患者，临床上治疗时应当加用活血化瘀的药物，从而达到活血止血，止血不留瘀，化瘀而不动血的效果。     

血尿中游离血红蛋白比例鉴别肾小球源性血尿与非肾小球源性血尿的意义

目的:观察血尿中游离血红蛋白占总血红蛋白的比例与肾小球源性血尿和非肾小球源性血尿的关系。方法:用干化学法检测肾小球性疾病组和非肾小球性疾病组血尿中离心尿液的隐血程度和未离心并冰冻处理的尿液的隐血程度,通过不同隐血程度所对应的血红蛋白浓度算出游离血红蛋白的比例。对两组值进行比较。结果:肾小球性疾病组血尿中游离血红蛋白比例为0.54±0.31,非肾小球性疾病血尿中游离血红蛋白比例为0.03±0.04。两组比较差异有显著性(P<0.01)。同时发现游离血红蛋白比例≥0.31诊断肾小球性疾病的符合率为97.5%;游离血红蛋白比例≤0.13诊断非肾小球性疾病的符合率为100%。结论:用血尿中游离血红蛋白比例可作为鉴别肾小球源性血尿和非肾小球源性血尿的指标之一。能否用游离血红蛋白比例≥0.31作为判定肾小球源性血尿的界限和游离血红蛋白比例≤0.13作为判定非肾小球血尿的界限有待进一步大批量的观察研究。     

Clinical presentation and natural course of idiopathic hypercalciuria in children

Idiopathic hypercalciuria (IHC) has been reported mainly in children with hematuria in the 1980s and early 1990s, when renal sonography was just becoming routine. The presence of microcalculi, i.e., of hyperechogenic spots <3 mm in diameter in renal calyces, was not taken into account in those studies. We attempted to outline clinical presentation and natural course of IHC not only in children with hematuria, but also in those with dysuria and/or recurrent abdominal/flank pain and a family history of nephrolithiasis, taking into account the finding of microcalculi. We analyzed retrospectively the data at diagnosis from 74 consecutive children aged 2.4–18 years (mean 8.6) with IHC (calciuria 4.1–15.1 mg kg^–1 24 h^–1, mean 6.1) and the outcome of 30 of them who were followed ≥1 years (mean 3.2) with no specific therapy. At diagnosis, 38 patients (51%) had no hematuria, 42 (57%) had microcalculi and four (5%) had calculi. Of the patients with normal urinalysis, 71% had microcalculi or stones. The subjects with microcalculi and those with stones were significantly older than those without microcalculi and stones (P=0.004 and 0.007). A normal urinalysis at our evaluation and a history of abdominal/flank pain were significantly more frequent in patients with microcalculi than in those without (P=0.02 and 0.0001, respectively). During the follow-up, four of 30 patients formed stones 1–3 years after first diagnosis of IHC. More than half of children with IHC have microcalculi. The risk of formation of microcalculi or stones increases with age. The lack of hematuria does not exclude the presence of microcalculi or calculi. Hypercalciuria has to be suspected in children with dysuria and/or recurrent abdominal/ flank pain and a family history of nephrolithiasis, even when they have no hematuria. Received: 13 December 1999 / Revised: 26 April 2000 / Accepted: 19 May 2000     

Hepatitis and hematuria in scarlet fever

Scarlet fever is a common and usually benign course when treated properly. Hepatitis due to scarlet fever has been described mostly in adults. A 2 1/2year-old boy presented with scarlet fever and jaundice, hematuria and elevated liver enzymes.     

航校飞行员飞行前后及运动前后血尿蛋白尿发生率分析

目的探讨航校飞行员飞行前后及运动前后血尿、蛋白尿发生率及在航空医学鉴定中的价值。方法212例航校飞行教员和学员为受试对象，用干化学法筛查飞行前后及运动前后血尿、蛋白尿。以镜检法红细胞≥3个／HP；加热醋酸法尿蛋白≥( )者为阳性判定值，统计其阳性发生率。结果血尿、蛋白尿阳性发生率特点是：运动后血尿、蛋白尿的发生率高于飞行后；运动后蛋白尿的发生率明显高于血尿的发生率；飞行学员运动后血尿、蛋白尿的发生率明显高于飞行教员。飞行后血尿、蛋白尿的发生率较低；飞行后发生血尿、蛋白尿者运动后同样产生血尿、蛋白尿。飞行前或运动前有轻度血尿者，在飞行后或运动后血尿仍为阳性，个别血尿程度加重。结论建议建立和完善尿液检测标准化方法和制度。飞行员无症状血尿、蛋白尿的防治以个体化防治为宜。运动试验可用做评价肾功能状态的客观方法。     

Nutcracker or left renal vein compression phenomenon: multidetector computed tomography findings and clinical significance

The use of multidetector computed tomography (MDCT) in routine abdominal explorations has increased the detection of the nutcracker phenomenon, defined as left renal vein (LRV) compression by adjacent anatomic structures. The embryology and anatomy of the nutcracker phenomenon are relevant as a background for the nutcracker syndrome, a rare cause of hematuria as well as other symptoms. MDCT examples of collateral renal vein circulation (gonadal, ureteric, azygous, lumbar, capsular) and aortomesenteric (anterior) and retroaortic (posterior) nutcracker phenomena in patients with no urologic complaint are shown as well as studies performed on patients with gross hematuria of uncertain origin. Incidental observation of collateral veins draining the LRV in abdominal MDCT explorations of asymptomatic patients may be a sign of a compensating nutcracker phenomenon. Imbalance between LRV compression and development of collateral circulation may lead to symptomatic nutcracker syndrome.     

Factors influencing the development of end-stage renal disease

Epidemiological evidence is needed to design effective strategies for preventing chronic kidney disease (CKD) and end-stage renal disease (ESRD). Several types of health check are routinely performed in Japan, including the screening of asymptomatic individuals, but the potential benefits of these procedures remain unknown. We evaluated the predictors of ESRD, using community-based mass screening and a dialysis registry. This approach revealed the significance of proteinuria, hypertension, obesity, anemia, and high fasting plasma glucose levels (which indicate diabetes mellitus; DM), for the risk of developing ESRD. Lifestyle-related factors, such as smoking, alcohol consumption, and low levels of exercise, are also associated with these conditions and, in particular, with a high risk of ESRD. Over-nutrition and low levels of exercise can ultimately lead to DM, hypertension, hyperlipidemia, and obesity, and are important risk factors worldwide for cardiovascular diseases, CKD, and ESRD. The early detection and treatment of predictors of ESRD, along with appropriate treatment for CKD, may decrease the incidence of ESRD. In addition, the economic burden caused by the costs of dialysis presents a compelling argument for implementing a cost-effective preventive strategy against ESRD.     

Bilateral universal nephroblastomatosis in an 8-month-old infant treated with chemotherapy

We report the case of an 8-month-old female infant presenting with bilateral, diffusely enlarged kidneys. A diagnosis of bilateral, universal nephroblastomatosis was made on tissue biopsies from both kidneys after correlation with the radiological findings. As far as we know, this is the oldest patient reported with this diagnosis in the English literature (they are usually younger than 4 months). The patient was treated with chemotherapy with very good response and almost 1 year later she is showing no signs of recurrence of her disease.