阿霉素肾病模型大鼠细胞因子的变化及低分子肝素对其影响

目的　探讨细胞因子在阿霉素 (ADR)肾病模型大鼠中的作用及低分子肝素 (LMWH)对其影响。方法　健康SD♂大鼠随机分为 3组 ,正常对照组 (Ⅰ组 ) 12只 ,尾静脉一次注入生理氯化钠溶液 1ml,后予生理氯化钠溶液 1ml,ip ,qd ;模型组 (Ⅱ组 )12只 ,尾静脉一次注入阿霉素 6 .0mg·kg-1,后予生理氯化钠溶液 1ml,ip ,qd ;低分子肝素组 (Ⅲ组 ) 12只 ,尾静脉一次注入阿霉素 6 .0mg·kg-1,后予LMWH 2 0 0IU·kg-1,ip ,qd ,所有各组共给药 14d。所有的大鼠于注射前及注射后第 3、7、14d抽血测肿瘤坏死因子a、白介素 6及放入代谢笼留 2 4h尿测蛋白定量。结果　用药后Ⅱ组、Ⅲ组的TNF a、IL 6水平、尿蛋白定量上升 ,且TNF a,IL 6水平与尿蛋白程度相关 ,与Ⅰ组比较 ,Ⅱ组有显著性差异 (P <0 .0 1)、Ⅲ组有显著性差异 (P <0 .0 5 ) ;Ⅱ组与Ⅲ组比较有显著性差异 (P<0 .0 5 )。结论　本实验提示TNF a ,IL 6水平与阿霉素肾病模型大鼠的尿蛋白程度有关 ,LMWH能减轻TNF a ,IL 6对肾小球的损害。     

系统性红斑狼疮妊娠合并妊高征的前瞻性研究

目的：探讨系统性红斑狼疮（ＳＬＥ）对重度妊高征（ＰＩＨ）发病影响及对母儿危害。方法：８０例ＬＳＥ妊娠的临床资料前瞻性研究。结果：活动期ＳＬＥ肾炎孕妇合并重度ＰＩＨ的发生率１０／２２例（４５％）。稳定期ＳＬＥ肾为１／１２例（８．３％），其它皮肤型ＳＬＥ２／４６例（４．３％）。文献报告活动期ＳＬＥ肾炎与重度ＰＩＨ很喟 母死亡率可提高５０－８０％，胎儿死亡率１２．９－４５．５％。结论：两者诊断正确时，分     

益气化痰活血法干预中老年原发性高血压气虚痰瘀证患者早期肾损害临床观察

目的观察益气化痰活血法治疗中老年原发性高血压气虚痰瘀、痰湿壅盛证（简称气虚痰瘀证）患者早期肾损害的临床疗效及时患者纤维蛋白原（FIB）、D一二聚体及血、尿β2-微球蛋白（β2-MG）的影响。方法将220例原发性高血压气虚痰瘀证患者随机分为2组。对照组110例予西医常规治疗,治疗组110例在对照组治疗基础上加用益气化痰活血中药复方汤剂。疗程12周,观察2组治疗前后症状积分、血压、FIB、D-二聚体及血、尿β2-MG变化。结果治疗组总有效率75．5％,对照组总有效率78．2％,2组比较差异无统计学意义（P〉0．05）;2组治疗后收缩压、舒张压、中医症状积分、FIB及血、尿β2-MG均降低（P〈0．01,P〈0．05）;与对照组相比,治疗组血、尿β2-MG降低明显（P〈0．05）,其他指标2组比较差异无统计学意义（P〉0．05）。结论益气化痰活血中药复方汤剂能有效降低气虚痰瘀证中老年原发性高血压患者的血压,减轻高凝状态,减轻早期肾损害。     

滋肾平肝利咽汤治疗肾炎性血尿50例

目的：观察滋肾平肝利咽汤治疗肾阴虚或肝肾阴虚型肾炎性血尿的临床疗效。方法：用滋肾平肝利咽汤治疗肾阴虚或肝肾阴虚型肾炎性血尿50例,观察治疗前后血尿改善情况,以及整体疗效。结果：50例患者治疗前后红细胞半定量结果有显著性差异（P〈0．01）,治疗结果为：显效2l例,有效22例,无效7例,总有效率达到86％。结论：滋肾平肝利咽汤治疗肾阴虚或肝肾阴虚型肾炎性血尿有显著性疗效     

Management and outcomes of acute post-streptococcal glomerulonephritis in children

Acute post-streptococcal glomerulonephritis (APSGN) is the major cause of acute glomerulonephritis among children, especially in low- and middle-income countries. APSGN commonly occurs following pharyngitis due to the activation of antibodies and complements proteins against streptococcal antigens through the immune-complex-mediated mechanism. APSGN can be presented as acute nephritic syndrome, nephrotic syndrome, and rapidly progressive glomerulonephritis, or it may be subclinical. The management of APSGN is mainly supportive in nature with fluid restriction, anti-hypertensives, diuretics, and renal replacement therapy with dialysis, when necessary, as the disease is self-limiting. Congestive heart failure, pulmonary edema, and severe hypertension-induced encephalopathy might occur during the acute phase of APSGN due to hypervolemia. APSGN generally has a favorable prognosis with only a small percentage of patients with persistent urinary abnormalities, persistent hypertension, and chronic kidney disease after the acute episode of APSGN. Decreased complement levels, increased C-reactive protein, and hypoalbuminemia are associated with disease severity. Crescent formations on renal biopsy and renal insufficiency on presentation may be the predictors of disease severity and poor outcomes in APSGN in children.     

急进性肾炎的诊治进展

急进性肾小球肾炎(rapidly progressive glomerulonephritis,RPGN)以急性肾炎综合征伴肾功能急剧恶化为临床特征,病理为新月体肾炎.早期诊断主要依靠血清免疫学检查及尽早肾活检.早期治疗应根据病理类型及患者情况采用个体化的治疗方案,包括强化治疗和免疫抑制治疗.     

Dense deposit disease

Dense deposit disease (DDD) is an orphan disease that primarily affects children and young adults without sexual predilection. Studies of its pathophysiology have shown conclusively that it is caused by fluid-phase dysregulation of the alternative pathway of complement, however the role played by genetics and autoantibodies like C3 nephritic factors must be more thoroughly defined if we are to make an impact in the clinical management of this disease. There are currently no mechanism-directed therapies to offer affected patients, half of whom progress to end stage renal failure disease within 10 years of diagnosis. Transplant recipients face the dim prospect of disease recurrence in their allografts, half of which ultimately fail. More detailed genetic and complement studies of DDD patients may make it possible to identify protective factors prognostic for naïve kidney and transplant survival, or conversely risk factors associated with progression to renal failure and allograft loss. The pathophysiology of DDD suggests that a number of different treatments warrant consideration. As advances are made in these areas, there will be a need to increase healthcare provider awareness of DDD by making resources available to clinicians to optimize care for DDD patients.     

昆明山海棠联合泼尼松治疗原发性肾病综合征的临床分析

目的观察昆明山海棠联合泼尼松治疗原发性肾病综合征的疗效。方法 32例患者随机分为两组,对照组采用标准剂量泼尼松治疗,观察组在对照组治疗基础上加用昆明山海棠,观察4周。4周后比较两组治疗前后尿蛋白、血清白蛋白、血脂、肾功能等变化。结果治疗4周后治疗组尿蛋白减少,血浆白蛋白升高,与对照组比较差异有统计学意义(P<0.05),血脂下降程度和肾功能变化两组无差异(P>0.05)。结论在标准剂量激素基础上加用昆明山海棠治疗原发性肾病综合征是一种有效方法。     

健康教育对肾病综合征患儿能动性的影响

目的：对肾病综合征患儿及家长进行系统的健康教育,促进患儿早日的康复,降低疾病的复发率。方法：对住院的肾病综合征患儿及家长进行入院、住院、出院的阶段性健康教育。结果：患儿及家长对肾病的相关知识有一定了解,积极配合治疗和护理,降低了复发率。结论：对肾病综合征患儿及家长进行系统的健康教育,可提高其对诊疗的主观能动性,达到提高治愈率,减少疾病复发的目的。     

以肾病综合征为表现的毛细血管内增生性肾小球肾炎的临床与病理

目的探讨毛细血管内增生性肾小球肾炎并发肾病综合征的临床病理特点与发病机制。方法12例患者肾穿刺术后,标本经常规固定、包埋、切片,进行HE、六胺银、Masson和免疫荧光染色,其中3例予以电镜观察。结果肾小球系膜细胞、内皮细胞增生;小球内可见中性多核白细胞渗出。10例毛细血管襻和(或)灶性系膜区有免疫复合物沉积。3例上皮细胞足突融合消失,上皮下电子致密物沉积。结论EPGN发生大量蛋白尿的机制与肾小球滤过膜状态的改变关系密切,使其对蛋白的通透性大大增加。