中医药治疗肝硬化合并慢性肾功能衰竭验案一例

介绍陈以平教授治疗肝硬化合并慢性肾功能衰竭的经验，认为治疗当以温补脾肾，泻浊解毒为主，并以1例验案详细分析临床辨证用药。     

Histomorphological assessment of non-neoplastic renal diseases at autopsy: an institutional experience in Southwestern Nigeria

BackgroundAutopsy remains an invaluable resource for medical education and establishing diagnosis of diseases that were missed prior to death. Many patients on admission in hospitals suffer kidney diseases that may contribute to their morbidity and/or mortality. The kidneys from autopsies provide opportunity to diagnose and understand some of these non-neoplastic renal lesions. This study aimed to present the frequency of non-neoplastic renal diseases at autopsy.MethodsWe conducted a five-year retrospective review of post-mortem records of deceased who had autopsy. Data such as age, sex, cause of death, and kidney lesions were extracted from the post-mortem records and clinical details were gotten from the clinical summaries in the autopsy reports. The kidneys were examined for pathological findings that were then classified into glomerular, tubulointerstitial (tubulointerstitial nephritis and other tubular lesions such as tubular necrosis, casts and fibrosis) and vascular lesions.ResultsA total of seventy (70) cases met the inclusion criteria with 91.4% having significant non-neoplastic renal lesions. The mean age of the deceased was 57.7years (18years – 91years). Males accounted for 65.7% of the cases. Glomerular lesions were seen in 84.3% of the cases, tubulointerstitial nephritis in 41.6% of cases, vascular lesions were seen in 30% of the cases and other tubular lesions (such as stones, casts and tubular necrosis) were seen in 52.9% of the cases. Cardiovascular diseases and infections were the major causes of death in these patients, accounting for 40% and 27% respectively. Renal diseases were attributed to immediate cause of death in 10% of the cases.ConclusionThe kidney at autopsy provides a valuable renal pathology educational tool, as a wide range of medical renal lesions can be seen from kidneys examined at post mortem.     

Tamm-Horsfall glycoprotein in streptozotocin diabetic rats: a study of kidney in situ hybridization,immunohistochemistry, and urinary excretion

Summary Tamm-Horsfall glycoprotein, present only in the kidney thick ascending limb of Henle's loop, was studied here in streptozotocin diabetic rats. Tamm-Horsfall glycoprotein mRNA in situ hybridization was performed on snap-frozen left kidneys; the right kidneys were perfusion-fixed with 4% paraformaldehyde and embedded either in paraffin, for Tamm-Horsfall glycoprotein immunohistochemistry, or in Epon for stereologic measurements. The length of the thick ascending limb of Henle's loop and the amount of glycogen were measured and the ultrastructure of the cells was evaluated. Urinary excretion of Tamm-Horsfall glycoprotein, calcium, magnesium and albumin was measured. After 10 and 50 days' duration of diabetes, kidney weight increased 20 and 41%, respectively and the length of the thick ascending limb of Henle's loop increased 28 and 56%, respectively, compared with controls. Substantial glycogen accumulations were present in the thick ascending limb of Henle's loop, and electron microscopy revealed a significant decrease in organelles and basolateral membranes. After 10 and 50 days' duration of diabetes, in situ hybridization of Tamm-Horsfall glycoprotein mRNA revealed a fourfold decrease, and the immunostaining for Tamm-Horsfall glycoprotein showed a threefold decrease as measured by densitometry. However, urinary Tamm-Horsfall glycoprotein excretion rate was increased fivefold and urinary concentration about twofold. Urinary calcium excretion increased threefold and magnesium twofold, but urinary albumin excretion was not significantly increased. The increased amount of Tamm-Horsfall glycoprotein, calcium and magnesium in the urine in diabetes occurs here concomitant with severe cellular damage in the thick ascending limb of Henle's loop.Abbreviations THP Tamm-Horsfall protein - TAL Thick ascending limb of Henles loop - AE Armanni-Ebstein lesion - OSOM outer stripe of outer medulla - ISOM inner stripe of outer medulla     

Histological and histochemical assessment of the effects of a single dose adriamycin on fetal rat kidney

Adriamycin (ADR) induces nephritic syndrome (NS) in adult rats. Therefore, effects of ADR in a single dose of 5mg/kg body weight given intraperitoneally to the mothers at 4 weeks before pregnancy were assessed on fetal rat kidneys in the present study. It induces increased amounts of PAS(+)-positive mesangial matrix, glomerulosclerosis, dilatation of the urinary space and thickening of basement membranes in glomeruli. In tubules, it damages or completely destroys epithelial cells, it induces dilatation of the tubular lumen and disintegration of the brush border. Changes in fetal rat kidney as observed light microscopically appeared to be similar to those described in kidneys of adult rats with NS induced by adriamycin, but were less distinct.     

Renal Vascular System in Stenosis of the Pulmonary Trunk with Different Level of Circulatory Compensation

Stenosis of the pulmonary trunk impaired outflow of venous blood from the kidneys and oxygen supply to renal tissues. This was paralleled by adaptation increase in renal artery tone and rearrangement of some renal artery by the terminal type. Under conditions of decompensated stenosis these reactions are less pronounced in comparison with compensated defect and do not correspond to the level of hemodynamic disorders, which leads to more pronounced structural changes in glomeruli.     

Role of the interstitial cells in prostaglandin synthesis in the renal medulla

An electron-microscopic investigation was made of the interstitial cells of the renal medulla after injection of indomethacin, an inhibitor of prostaglandin synthesis, into rats. The number of lipid granules in the interstitial cells was greatly increased under these circumstances. This fact demonstrates the participation of lipid granules in the synthetic function of the interstitial cells as reserve depots for chemical precursors of the prostaglandins, synthesized by the interstitial cells.Laboratory of Pathological Anatomy, A. L. Myasnikov Institute of Cardiology, Academy of Medical Sciences of the USSR, Moscow. (Presented by Academician of the Academy of Medical Sciences of the USSR E. I. Chazov.) Translated from Byulleten' Éksperimental'noi Biologii i Meditsiny, Vol. 81, No. 4, pp. 503–505, April, 1976.     

Design analysis for an ultrafilter adsorber artificial kidney

An adsorber-ultrafilter system can serve as an alternative to the conventional artificial-kidney dialysis system. To this end, the characteristics of the parametric design analysis of the absorber-ultrafilter artificial kidney and its interaction with a uraemic patient is provided. The activated-carbon adsorber is modelled as a 2-phase homogeneous system, accounting for fluid-particle and intraparticle mass-transfer resistances and the axial dispersion of solute in the interstitial fluid phase of the adsorber bed. It is assumed that the ultrafilter is highly permeable to uraemic substances, and that the ultrafiltration rate is 15–25% of the inlet blood flow rate. The detailed design analysis of the ultrafilter has been provided in an earlier paper. The uraemic patient is modelled, for solute transfer, as comprising three major compartments. The results indicate that a single activated-carbon adsorber unit, with a hold-up volume of 50 ml, is adequate for the removal of uric acid and creatinine in a 6 to 8 h treatment period. However, the poor adsorption capacity of activated carbon for urea, necessitates that the adsorber unit be switched to a freshly activated unit in a very short period of time (11 min in this example). Hence, the need for the development of a better adsorbent for urea is emphasised. A parametric design analysis of the adsorber is also presented, so as to provide the basis for arriving at an optimum size of the adsorber unit.     

The meckel syndrome in the Hutterites

At least three cases of the Meckel syndrome have been identified in the Hutterites. Two of these were sibs and were studied during life; the other, a close relative, was diagnosed retrospectively by a review of hospital records. All parents were consanguineous. The phenotype ranged in severity from the association of occipital meningocele, cystic kidneys, postaxial polydactyly, and microphthalmia to a milder expression consisting of cystic kidneys, ocular defects apparent only on funduscopic examination, and a brain abnormality demonstrated by computer tomography. Survival ranged from 5 to 13 months. In one patient, the renal lesion was manifested as a tubular rather than a glomerular defect, and was probably not the primary cause of death.