急性上尿路梗阻无尿80例诊治分析

目的：分析急性上尿路梗阻性无尿80例的诊断和治疗方法,以尽早诊断,及时治疗。方法：报告1989-1999年收治的急性上尿路梗阻性无尿患者80例,诊断依据为少尿以致无尿、水肿、血尿素氮和肌酐进行性增高,初步诊断首选腹部平片（KUB）和B超及肾图检查。结果：10例患者术前行血液透析,手术治疗53例,包括输尿管切开取石术18例,肾造瘘术20例,狭窄段输尿管切除膀胱再植8例,输尿管腹壁皮肤造口术7例,双“J”管内引流术27例,结论：本病病因,病情复杂多变,应采取不同的治疗措施。     

输尿管镜在急性梗阻性无尿中的应用

目的:探讨输尿管镜在急性梗阻性无尿的临床应用价值。方法:回顾性分析46例急性梗阻性无尿患者输尿管镜治疗的临床资料。结果:本组46例输尿管镜碎石取石术或输尿管镜检,术中留置单侧或双侧输尿管双J管,成功42例,失败4例,成功率91%。术后39例肾功能恢复正常,7例无好转,其中2例需要定期血液透析治疗。结论:输尿管镜在处理急性梗阻性无尿中具有重要作用,可迅速解除梗阻,保护肾功能。     

Comparison of the Impact of “Fast Decline” in Residual Renal Function and “Initial Anuria” on Long-Term Outcomes in CAPD Patients

♦ Background: Residual renal function (RRF) is pivotal to long-term outcomes, while rapid RRF decline (RRFD) is associated with mortality risk for continuous ambulatory peritoneal dialysis (CAPD) patients. This study was conducted to compare the impact of “initial anuria” and rapid RRFD on the long-term prognosis of CAPD patients.♦ Method: According to the timing of anuria and the slope of RRFD, a total of 255 incident CAPD patients were divided into 3 groups. For the “anuria” group, anuria was detected from CAPD initiation and persisted for > 6 months (n = 27). Based on the median of the RRFD slope, the other 228 non-anuric patients were divided into a “slow decliner” group (n = 114), and a “rapid decliner” group (n = 114). The maximal observation period was 120 months.♦ Results: Logistic regression tests indicated that the “anuria” group was associated with previous hemodialysis > 3 months (odds ratio [OR]: 8.52, 95% confidence interval [CI]: 3.12 – 23.28), and female (OR: 0.29, 95% CI: 0.09 – 0.90), while the “fast decliner” group with higher Davies co-morbidity scores (DCS) (OR: 1.52; 95% CI: 1.08 – 2.14), body mass index (BMI) (OR: 1.12; 95% CI: 1.04 – 1.21), and male (OR: 1.12; 95% CI: 1.04 – 1.21). After adjusting for DCS, the “fast decliner” group (hazard ratio [HR]: 0.37; 95% CI: 0.17 – 0.80) showed a better outcome than that of the “anuria” group (reference = 1). Both baseline RRF (β = -0.24; p < 0.001) and DCS (β = -3.76; p < 0.001) showed inverse linear correlations to the slope of RRFD. From the Cox proportional analyses, higher baseline RRF (HR: 0.92; 95% CI: 0.88 –.97) and higher slope of RRFD (slower decline in RRF) (HR: 0.90; 95% CI: 0.85 – 0.96) were independent factors for less mortality risk in patients with DCS = 0. However, only a higher slope of RRFD (HR: 0.97; 95% CI: 0.94 – 0.99) was significant for better survival in CAPD patients with DCS > 0.♦ Conclusion: Compared to the baseline RRF, CAPD patients with co-morbidities that rapidly deteriorate RRFD are more crucially associated with long-term mortality risk.     

Anuric Acute Renal Failure Associated with Pericardial Effusion without Signs of Cardiac Tamponade

This article describes the anuric acute renal failure (ARF) secondary to massive pericardial effusion without tamponade in an 84 year-old man. He was referred to our emergency room with progressive dyspnea and azotemia. An electrocardiogram showed sinus tachycardia. A two-dimensional echocardiogram confirmed the presence of severe pericardial effusion without prominent ventricular diastolic collapse and there were no changes in his vital signs. Laboratory findings showed that his blood urea nitrogen and serum creatinine levels were 91.8 and 3.77 mg/dL, respectively. Renal ultrasonography showed no signs of hydronephrosis. Urine output did not increase in spite of giving a saline and furosemide infusion but increased immediately after pericardiocentesis with drainage. His renal function was completely restored 3 days after the procedure. A pericardial biopsy demonstrated invasion of malignant cells. We should keep in mind that pericardial effusion is one of the causes of anuric ARF, although it is not accompanied by tamponade.     

孤立肾急性梗阻性无尿诊治分析

目的探讨孤立肾急性梗阻性无尿的诊治经验。方法回顾分析5年来收治的孤立肾急性梗阻性无尿患者15例,对其临床表现、实验室及影像学检查结果、手术方法以及围手术期处理原则进行总结分析。结果15例孤立肾患者急诊手术解除梗阻3 d后,13例(86.7%)肾功能恢复正常,其中11例结石患者通过输尿管镜术、经皮肾穿刺术以及二期手术在1月内成功去除结石,4例肿瘤患者通过输尿管镜置管或经皮肾穿刺造瘘解除了梗阻。结论孤立肾患者出现梗阻性无尿时病情进展很快,肾功能损害重,治疗时应尽早解除梗阻,最大限度保护肾功能,手术方法首选微创治疗。     

Influence of Serum Protein Binding on the Pharmacokinetics of Quinidine in Normal and Anuric Rats

Abstract The pharmacokinetics of quinidine were investigated in normal and anuric rats after intravenous injection (25 mg per kg b. wt.). In normal rats only 2.6 percent of the injected dose was excreted as unchanged quinidine in the urine. Quinidine concentrations were determined in the blood and in different tissues after injection, and the serum protein binding was measured. Results were applied to a one compartment model. In normal rats a total body clearance of 18.5 ml/min. and a renal clearance of 0.5 ml/min. was found. The residual non-renal clearance (18.0 ml/min.), presumably taking place in the liver, exceeds the estimated liver blood flow (16.8 ml/min.), indicating efficient extraction of quinidine from plasma and blood cells (non-restrictive elimination). The apparent volume of distribution was greatly reduced, biological half-life slightly longer and the body clearance greatly reduced in anuric as compared to normal rats. The fraction of unbound quinidine in serum was 30.6 ± 0.6 (n=23) and 16.7 ± 0.5) (n=23) percent in normal and anuric rats. The reduction in the apparent volume of distribution is mainly explained by increased serum binding. The decline of body clearance of quinidine is most likely caused by a decreased liver blood flow in this complex state of renal insufficiency.     

肾移植术后早期无尿或少尿的诊治(附66例报告)

目的:探讨肾移植术后早期无尿或少尿的原因及诊治方法.方法:回顾性分析66例肾移植术后早期无尿或少尿患者的发生情况.并分别应用以FK506或CsA为主的免疫抑制剂(FK506/CA+MMF+Pred)等综合治疗方案.结果:66例肾移植术后早期无尿或少尿的主要原因是急性肾小管坏死(77.27%),其次是急性排斥反应(10.61%),其中有2例移植肾原发无功能和移植肾破裂、肾动脉栓塞各1例术后切除移植肾.FK506组的34例移植肾功能在术后5～35天内均恢复正常,CsA组有1例因急性排斥反应合并严重肺部感染而死亡,24例移植肾功能在术后7～48天内均恢复正常,3例血肌酐在142～215 μmol/L之间.结论:肾移植术后早期出现无尿或少尿后应及时分析原因,并给予相应的综合治疗.FK506+MMF+Pred的三联免疫治疗有助于移植肾功能的早期恢复.     

Ureteroscopic holmium laser lithotripsy in patients with renal impairment

Objectives In this study, we try to evaluate the efficacy and safety of holmium lasers for treatment of ureteric stones in patients with renal impairment or obstructive anuria. Patients and methods Twenty-six patients were included in this study, of which 20 patients presented with elevated blood urea and serum creatinine (2.1–7.6 mg%), and six patients presented with calcular anuria (mean serum creatinine 22 mg%). None of the patients had a ureteric stent or nephrostomy tube before the ureteroscopy. All patients were treated with holmium laser. A stone basket or grasper was used to remove significant stone fragments at the end of the procedure in seven patients. In these seven patients, ureteric stents were placed at the end of the procedure. Results All patients were free of any stone fragments at 1 week and at 3 months postoperatively. In all patients, including the six with obstructive anuria, the renal impairment resolved or improved as evidenced by normalization or fall in blood urea and creatinine. Thus, in this small group of uremic patients, the success rate for treatment of ureteral stone was 100%. Conclusions A holmium laser is a safe and effective modality of ureteroscopic lithotripsy in patients with significant renal impairment or even obstructive anuria. The use of holmium laser with ureteroscopy may be considered in this group of patients as long as the general condition of the patient permits the safe administration of anesthesia.     

肾性尿少尿闭时口服汤药的利弊浅析

本文分析了肾性尿少尿闭时危险因素的机制及口服中药汤剂的危险性因素 ;认为口服中药汤剂不仅会因增加体内的水分而加剧高血容量所致的并发症 ,更会因进入人体内的钾不能及时排出而导致高钾血症 ;提出了洗浴疗法、通腑泄浊、结肠灌注三种治疗用药方法 ,可供临床选择运用。     

山莨菪碱对肾移植术后并发症的治疗

目的：研究山莨菪碱对移植肾术后并发症的治疗作用。方法：肾移植术后３２人。术后１４人未发生少尿时ｉｖ山莨菪碱４７±ｓ１２（３０～６０）ｍｇ／ｄ，连续给药７．１±２．９ｄ（４～１０ｄ）（预防组）。术后１８人出现少尿时ｉｖ山莨菪碱９１±２７（６０～１２０）ｍｇ／ｄ、呋塞米与免疫抑制剂（治疗组）。结果：预防组多尿期缩短１～３ｄ，２４ｈ尿量明显少于治疗组，血肌酐达正常值较治疗组提前１．５ｄ，无继发少尿或无尿。治疗组亦全部恢复正常，肾功能达显效所需时间为２．５±１．０ｄ（１～４ｄ）。结论：山莨菪碱具有改善和保护移植肾功能，预防和治疗移植肾术后出现的少尿或无尿的作用。