原发性肾病综合征并急性肾功能衰竭9例治疗分析

原发性肾病综合征 (NS)并急性肾功能衰竭(ARF)临床上并非少见。我院肾病科近 5年收治的12 4例原发性肾病综合征中并特发性 ARF9例。发生率为 7.2 % ,经及时的诊断并予以合理治疗 ,肾功能恢复正常 ,取得了满意疗效 ,现报告如下。1　临床资料1.1　 9例 NS并 ARF患者均符合如下标准 [1] 1符合NS诊断 ,即 2 4小时尿蛋白定量≥ 3.5 g,血清白蛋白≤ 30 g/ L。 2排除继发性或系统性肾小球疾病 (如SLE、过敏性紫癜、淀粉样变、糖尿病肾病等 )。 3有ARF临床表现 (少尿、无尿、肾功能恶化 )。 9例患者中 ,男 7例 ,女 2例 ,年龄 16～ 65岁 ,7…     

乙肝相关性肾炎的临床特征

目的总结乙型肝炎病毒相关肾炎(HBV-GN)的临床资料,探讨其临床表现,病理及免疫组化特点。方法经肾活检确诊为HBV-GN的60例患者,按年龄分成3组,分析3组的临床表现和病理特点。结果 60例HBV-GN中,少年组占65%,青年组和中老年组共占35%。临床表现以肾病综合征最常见,在少年组和青年组中,肾病综合征所占比例分别为30.8%和46.7%。少年组膜性肾病(MGN)和膜增殖性肾炎(MPGN)分别占48.7%和28.2%,青年组分别占33.3%和33.3%。乙肝染色HBeAg、HBsAg的检出率少年组分别为46.2%和33.3%,青年组分别为46.7%和66.7%,老年组为50%和66.7%。结论 HBV-GN以少儿多见,男性发病率高于女性,临床表现主要是肾病综合征,病理类型主要是MGN和MPGN,肾组织中乙肝病毒抗原沉积以HBeAg和HBsAg为主,HBVAg免疫组化标记是诊断HBV-GN的重要指标。     

汶川地震中挤压综合征所致急性肾损伤

Objective To identify risk factors associated with the severity of acute kidney injury (AKI) in-duced by crush syndrome and whether the patient required hemodialysis (HD). Method A retrospective study was designed. Within 19 days after the Chinese Wenchuan earthquake (May 12, 2008), 63 victims (33 men, 30women) of 2139 cases were hospitalized at Mianyang Central Hospital (Siehuau, China) because of crush syn-drome caused by crush injuries. The patients with renal dysfimcfion before the earthquake were excluded. Totally 63 patients with AKI associated with crush syndrome were included in this study and were divided into two groups: group 1, 25 patients, requiring HD (when urine volume <250 mL/d;serum potassium> 6 mmol/L) ; and group 2, 38 patients, without HD. The following data were collected retrospectively for all patients: (1) epidemiological parameters: age, gender, race, time under the rubble, liquid treatmem before being rescued; (2) clinical param-eters: blood pressure, body area crushed, amputation, fasciotomy, blood transfusion, quantity of fluid infusion, urine output in the first 24 hours; (3) initial laboratory data: complete blood count, urine analysis, serum chem-istry, arterial blood gas analysis. Comparisons between the two groups were made using SPSS 10.0. The quantita-tive data and categorical data were analyzed using t tests and χ2 tests, respectively. P -values < 0.05 were consid-ered to indicate significant differences. The significant variables were entered into logistic regression models to de-termine the risk factors for the severity of AK1 in patients with crush syndrome and whether the patient required HD. Results Four significant risk factors with P -values < 0.05 were identified: fasciotomy, cystatin C (Cys C)level, myoglobin (MB) level and lactic acidosis. The odds ratios (95% confidence intervals) were 8.641 (3.027～76.479), 6.956 (3.027～76.479), 5.379 (3.027～76.479) and 4.833 (2.569～32.764), respectively. Conclusions In addition to urine output and potassium levels, we found that four risk factors, namely faseiotomy, Cys C and MB levels, and lactic acidosis, were significanfly associated with the severity of AKI and whether the patient required hemodialysis.     

左卡尼汀对腹膜透析患者营养状况的影响

目的探讨左卡尼汀对持续不卧床腹膜透析患者营养状况的影响。方法选择36例持续不卧床腹膜透析（CAPD）患者,随机分为左卡尼汀治疗组和对照组,检测两组治疗前、治疗1个月、3个月时血红蛋白、清蛋白、转铁蛋白、尿素氮、肌酐、ALT等指标并分别进行临床症状及体征评分。结果与治疗前及对照组治疗后比较,治疗3个月组患者治疗后临床症状及体征评分有明显下降,Alb、Hb、TF升高,差异有统计学意义（P〈0．05）。结论左卡尼汀可改善腹膜透析患者营养状态及与卡尼汀缺乏相关的临床症状体征。     

阴茎完全离断再植术2例

病例1,男,28岁.1999年6月22日在熟睡中被人用菜刀将阴茎齐根部切断.在当地医院经包扎后3 h 送达我院.查体:阴茎距根部约0.8 cm处离断,创面整齐,离断阴茎体长约7 cm.入院后即行抗休克治疗,并在连续硬膜外麻醉下行阴茎再植术.     

妊娠高血压合并肾损伤30例回顾性分析

目的 回顾性分析妊娠高血压合并肾损伤患者的情况.方法 选取我院收治的30例妊娠高血压合并肾功能损害患者病例资料作为研究对象,根据治疗方法不同分为使用中西医结合治疗的观察组及使用常规西医治疗的对照组,观察两组患者的治疗后血压及肾功能情况.结果 观察组患者接受治疗后的平均动脉压明显低于对照组患者(P<0.05);观察组患者接受治疗后的肾功能状况明显优于对照组患者(P<0.05).结论 妊娠高血压合并肾功能损害的产妇应当进行积极治疗,中西医结合的治疗方式可以明显降低血压及改善肾功能.     

汶川地震中挤压综合征所致急性肾损伤

Objective To identify risk factors associated with the severity of acute kidney injury (AKI) in-duced by crush syndrome and whether the patient required hemodialysis (HD). Method A retrospective study was designed. Within 19 days after the Chinese Wenchuan earthquake (May 12, 2008), 63 victims (33 men, 30women) of 2139 cases were hospitalized at Mianyang Central Hospital (Siehuau, China) because of crush syn-drome caused by crush injuries. The patients with renal dysfimcfion before the earthquake were excluded. Totally 63 patients with AKI associated with crush syndrome were included in this study and were divided into two groups: group 1, 25 patients, requiring HD (when urine volume <250 mL/d;serum potassium> 6 mmol/L) ; and group 2, 38 patients, without HD. The following data were collected retrospectively for all patients: (1) epidemiological parameters: age, gender, race, time under the rubble, liquid treatmem before being rescued; (2) clinical param-eters: blood pressure, body area crushed, amputation, fasciotomy, blood transfusion, quantity of fluid infusion, urine output in the first 24 hours; (3) initial laboratory data: complete blood count, urine analysis, serum chem-istry, arterial blood gas analysis. Comparisons between the two groups were made using SPSS 10.0. The quantita-tive data and categorical data were analyzed using t tests and χ2 tests, respectively. P -values < 0.05 were consid-ered to indicate significant differences. The significant variables were entered into logistic regression models to de-termine the risk factors for the severity of AK1 in patients with crush syndrome and whether the patient required HD. Results Four significant risk factors with P -values < 0.05 were identified: fasciotomy, cystatin C (Cys C)level, myoglobin (MB) level and lactic acidosis. The odds ratios (95% confidence intervals) were 8.641 (3.027～76.479), 6.956 (3.027～76.479), 5.379 (3.027～76.479) and 4.833 (2.569～32.764), respectively. Conclusions In addition to urine output and potassium levels, we found that four risk factors, namely faseiotomy, Cys C and MB levels, and lactic acidosis, were significanfly associated with the severity of AKI and whether the patient required hemodialysis.     

血液透析联合碳酸氢钠治疗地震挤压综合征伴高钾血症临床效果观察

目的 评价常规血液透析联合碳酸氢钠注射液治疗5·12地震中挤压综合征伴高钾血症的临床疗效.方法 挤压综合征伴高钾血症伤员19例分为2组,治疗组10例采用常规血液透析联合碳酸氢钠注射液治疗,对照组9例采用常规血液透析治疗,比较两组高钾血症的纠正情况.结果 两种方法 都能纠正高钾血症,但12小时后,对照组的高钾血症复发,需要再次透析;而治疗组血钾水平稳定,疗效明显优于对照组(P<0.05).结论 常规血液透析联合碳酸氢钠注射液能有效治疗挤压综合征伴高钾血症,防止致死性心律失常.     

地震伤后154例挤压综合症的诊治体会

目的探讨地震伤后挤压综合症诊断和治疗的有效方法。方法对154例挤压综合症患者依据病史、症状、体征及实验室检查结果进行诊断,并主要针对急性肾损伤和局部创伤给予综合治疗。结果128例基本治愈,26例行血透患者肾功能明显改善,无一例发生持续肾功能损害和死亡。结论内、外科配合,采用以补液、利尿、血液透析、局部切开减压和全身营养支持为主的综合疗法治疗挤压综合症并急性肾功能损伤可很好地控制病情发展,促进转归。     

汶川地震中挤压综合征所致急性肾损伤

Objective To identify risk factors associated with the severity of acute kidney injury (AKI) in-duced by crush syndrome and whether the patient required hemodialysis (HD). Method A retrospective study was designed. Within 19 days after the Chinese Wenchuan earthquake (May 12, 2008), 63 victims (33 men, 30women) of 2139 cases were hospitalized at Mianyang Central Hospital (Siehuau, China) because of crush syn-drome caused by crush injuries. The patients with renal dysfimcfion before the earthquake were excluded. Totally 63 patients with AKI associated with crush syndrome were included in this study and were divided into two groups: group 1, 25 patients, requiring HD (when urine volume <250 mL/d;serum potassium> 6 mmol/L) ; and group 2, 38 patients, without HD. The following data were collected retrospectively for all patients: (1) epidemiological parameters: age, gender, race, time under the rubble, liquid treatmem before being rescued; (2) clinical param-eters: blood pressure, body area crushed, amputation, fasciotomy, blood transfusion, quantity of fluid infusion, urine output in the first 24 hours; (3) initial laboratory data: complete blood count, urine analysis, serum chem-istry, arterial blood gas analysis. Comparisons between the two groups were made using SPSS 10.0. The quantita-tive data and categorical data were analyzed using t tests and χ2 tests, respectively. P -values < 0.05 were consid-ered to indicate significant differences. The significant variables were entered into logistic regression models to de-termine the risk factors for the severity of AK1 in patients with crush syndrome and whether the patient required HD. Results Four significant risk factors with P -values < 0.05 were identified: fasciotomy, cystatin C (Cys C)level, myoglobin (MB) level and lactic acidosis. The odds ratios (95% confidence intervals) were 8.641 (3.027～76.479), 6.956 (3.027～76.479), 5.379 (3.027～76.479) and 4.833 (2.569～32.764), respectively. Conclusions In addition to urine output and potassium levels, we found that four risk factors, namely faseiotomy, Cys C and MB levels, and lactic acidosis, were significanfly associated with the severity of AKI and whether the patient required hemodialysis.