急性肾功能衰竭智能性肾图分析报告

本文对30例急性肾功能衰竭患者智能性肾图进行了分析。其中男性20例,女性10例,平均年龄32岁。经智能性肾图检查分析,30例急性肾功能衰竭的病员中27例智能性肾图曲线及指标均发生明显变化,阳性率占90％。智能性肾图曲线及指标对临床急性肾功能衰竭肾前性、肾性及肾后性疾病变化的各个阶段表现比较明显,给临床急性肾功能衰竭的治疗及判断疾病的预后提供了一定的依据。     

中西医结合治疗蝮蛇咬伤急性肾功能衰竭30例临床体会

目的探讨蝮蛇咬伤致急性肾功能衰竭的治疗方法。方法对30例蝮蛇咬伤急性肾功能衰竭的临床资料进行分析。结果30例蝮蛇咬伤致急性肾功能衰竭患者,治愈27例,疗程最短7天,最长60天。结论中西医结合治疗蝮蛇咬伤急性肾功能衰竭有明显优势,极大地降低了病死率。     

Ⅱ期经皮输尿管镜治疗输尿管上段结石梗阻致孤立肾急性肾功能衰竭

目的:探讨经皮肾微造瘘术后Ⅱ期经皮输尿管镜治疗输尿管上段结石致孤立肾急性肾功能衰竭的安全性与有效性。方法:从2004年7月～2009年5月,利用经皮肾微造瘘建立经皮肾通道,引流1周后肾功能明显好转,再行经皮肾输尿管镜碎石治疗孤立肾输尿管上段结石。结果:16例患者中,所有患者均为单通道取石,结石清除率例(81.2%),未出现高热、出血等并发症。术后1月复查13例无结石残留。结论:微创经皮输尿管镜分期治疗输尿管上段结石致孤立肾急性肾功能衰竭是安全、有效的,同传统经皮肾镜相比,具有对病人创伤小,易恢复等优点。     

血液净化治疗肾综合征出血热合并急性肾功能衰竭的疗效分析

目的:探讨血液净化治疗肾综合征出血热合并急性肾功能衰竭的疗效。方法:选取了60例肾综合征出血热合并急性肾功能衰竭患者,按住院单双号分为两组,观察组(31例)采用血液透析治疗,对照组(29例)采用连续性静脉-静脉血液滤过法治疗,观察并记录两组患者肾功能相关指标、血清离子、血常规相关指标及治疗期间不良反应情况,评估血液净化治疗肾综合征出血热合并急性肾功能衰竭的疗效。结果:治疗前两组K~+、HCO_3~-、血尿素氮(BUN)、血清肌酐(Cr)等指标无统计学差异(P0.05),治疗后两组K~+、BUN、Cr等指标均明显降低,且观察组上述指标低于对照组(P0.05);治疗后两组HCO_3~-水平升高,且观察组高于对照组(P0.05),治疗前,两组血红蛋白(Hb),红细胞压积(Hct),血小板(PLT)无统计学差异(P0.05),治疗后两组Hb,Hct,PLT均升高(P0.05),但组间比较没有统计学差异(P0.05),随访1年期间,观察组患者6个月和12个月生存率明显高于对照组(P0.05)。治疗期间,两组不良反应率无统计学差异(P0.05)。结论:血液透析对肾综合征出血热合急性肾功能衰竭具有较好的治疗效果,能调节体内电解质平衡,改善肾功能,提高生存率,改善血液状态的效果与连续性静脉-静脉血液滤过法相当。     

智能型肾图在诊断泌尿系结石中的价值

本文对３０例肾绞痛患者的智能性肾图作了分析结果８０％出现梗阻性肾面并伴有不同程度的肾功能损害。经Ｘ线或Ｂ超检查,与其相同的侧别有结石存在。梗阻解除后复查肾功能有恢复趋势。证实肾图检查能较正确显示结石有无梗阻和肾功能的情况。     

肾康注射液联合血液透析治疗慢性肾功能衰竭的临床效果及对肾功能、营养指标的影响

目的 探讨肾康注射液联合血液透析治疗对慢性肾功能衰竭患者的肾功能、营养指标及临床疗效的影响.方法 选取2018年3月～2019年2月我院肾内科收治的116例慢性肾功能衰竭患者作为研究对象,随机分为对照组和观察组各58例.对照组给予单纯血液透析治疗,观察组给予肾康注射液联合血液透析治疗,治疗16周后观察两组患者的肾功能及...     

血液透析和血液灌流治疗鱼胆中毒致急性肾功能衰竭的护理

食物中毒是日常生活中常有的,临床上接触较多的是鱼胆中毒,鱼胆中毒对人体损害以肝、肾损害为主,常导致急性肾功能衰竭,成为死亡的主要原因。而血液透析是治疗急性肾功能衰竭的主要方法,因此,在鱼胆中毒的治疗中起关键作用。我院2002年1月～2005年10月收治10例鱼胆中毒致急性肾     

重症急性肾损伤患者经连续性肾脏替代治疗后肾功能恢复的影响因素

目的：通过研究重症急性肾损伤患者经连续性’肾脏替代治疗后肾功能恢复的影响因素,为重症急性肾损伤患者的诊治及预后提供科学依据。方法：选取2009年7月至2013年10月本院住院且采用CRRT治疗的284例重症急性肾损伤患者,记录患者的一般资料、APACHEII评分、血液生化指标、伴随症状及肾功能预后情况,将预后情况和各影响因素进行Logistic回归分析得出影响。肾功能恢复的影响因素。结果：284例重症急性肾损伤患者中,肾功能恢复有89例（31．33％）;肾功能恢复组的年龄、衰竭器官数、APACHEⅡ评分、动脉血二氧化碳分压、合并慢性肾脏病率及合并严重基础疾病率均低于肾功能未恢复组,而平均动脉压和血小板计数高于肾功能未恢复组（P〈0．05）,两组间合并机械通气率和合并少／无尿率无统计学差异（P〉0．05）;衰竭器官数、APAC—HEⅡ评分、合并严重基础疾病及AKl分期为CRRT治疗重症急性肾损伤患者肾功能恢复的危险因素。结论：CRRT治疗重症急性肾损伤的主要危险因素为衰竭器官数、APACHEⅡ评分、合并严重基础疾病及AKl分期。在临床治疗中,应正确评估病情,早期及时采取CRRT治疗,以提高生存率,促进肾脏功能恢复。     

人工肾发展概况

一、概述 1913年Abel作了血液透析实验,1944年Kotff第一次研制成人工肾使用于临床至今已有三十多年历史,其间经历了探索实验阶段、临床应用阶段和不断完善、提高阶段。特别是在1960年Quinton,Di(?)land,Scri-dener发明了用硅橡胶制成动、静脉瘘后,使人工肾由原来一般只应用于急性肾功能衰竭患者而发展到对慢性肾功能衰竭患者作长期血液透析,以延长患者生命,并为以后的肾脏移植创造了过渡条件,这样,人工肾就为世界各国的医务人员所广泛采用,从而得到很快发展。目前国外生产的人工肾,无论在结构、性能、种类和治疗方法等方面都有很大的改进和提高。     

血液透析治疗鱼胆中毒致急性肾功能衰竭12例临床分析

食物中毒是引起急性肾功能衰竭(ARF)的重要原因之一,临床上接触较多的是鱼胆中毒.鱼胆中毒多以急性肾功能衰竭为最突出的表现,同时可合并消化道、肝脏、心脏等多脏器损害.本院自1996年4月～2004年1月应用血液透析治疗12例急性鱼胆中毒致急性肾功能衰竭患者,均获成功.现报告如下.     

Renal failure in otherwise uncomplicated acute viral hepatitis.

Twelve patients with otherwise uncomplicated acute viral hepatitis (two were HBsAg-positive) developed renal failure. Apart from dehydration due to repeated vomiting in one patient, no factor responsible for precipitating renal failure could be identified. The clinical course was characterised by renal failure with plasma urea concentrations reaching maximum values of 26-69 mmol/l (175-416 mg/100 ml). Ten patients needed dialysis for up to two weeks. Seven patients recovered completely, while the other five died from sepsis. The types of renal failure were similar to those described in fulminant hepatic failure and cirrhosis--namely, functional renal failure in five patients and acute tubular necrosis in seven. Two of the patients with functional renal failure later developed tubular necrosis. The mechanism responsible for renal failure in acute viral hepatitis is uncertain, though endotoxaemia may contribute.     

Should patients with renal failure associated with myeloma be dialysed?

In a study of renal function in multiple myeloma seven patients presented with renal failure and three developed it 16-106 months after diagnosis. All were dialysed. Infection with dehydration was a precipitating factor in all seven cases of acute or acute on chronic renal failure. Of these, two patients recovered normal renal function and one other was left with permanent renal impairment but no longer required dialysis. Results from the seven patients with acute renal failure and for the three with more chronic features support the practice of dialysis for all patients who present with renal failure. Dialysis is not indicated for those patients with progressive myelomatous disease. The study showed no evidence that chemotherapy permitted recovery from established renal failure. The prognosis in this elderly group is heavily dependent on the presence of cardiovascular or other degenerative disease.     

Value of renal biopsy in acute intrinsic renal failure.

Eighty-four patients presented with acute renal failure and features suggesting a diagnosis of intrinsic renal disease other than "acute reversible renal failure." Renal biopsy proved valuable in establishing the diagnosis, in indicating the reversibility of the lesion, and in helping to decide on treatment.     

Molsidomine, a nitric oxide donor and L-arginine protects against rhabdomyolysis-induced myoglobinuric acute renal failure

Rhabdomyolysis-induced myoglobinuric acute renal failure accounts for about 10-40% of all cases of acute renal failure (ARF). Nitric oxide and reactive oxygen intermediates play a crucial role in the pathogenesis of myoglobinuric acute renal failure (ARF). This study was designed to investigate the effect of molsidomine and L-arginine in glycerol induced ARF in rats. Six groups of rats were employed in this study, group I served as control, group II was given 50% glycerol (8 ml/kg, intramuscularly), groups III and IV were given glycerol plus molsidomine (5 mg/kg, and 10 mg/kg p.o. route respectively) 60 min prior to the glycerol injection, group V animals were given glycerol plus L-arginine (125 mg/kg, p.o.) 60 min prior to the glycerol injection, and group VI received L-NAME (10 mg/kg, i.p.) along with glycerol 30 min prior to glycerol administration. Renal injury was assessed by measuring plasma creatinine, blood urea nitrogen, creatinine and urea clearance. The oxidative stress was measured by renal malondialdehyde levels, reduced glutathione levels and by enzymatic activity of catalase, reduced glutathione and superoxide dismutase. Tissue and urine nitrite levels were measured as an index of total nitric oxide levels. Glycerol treatment resulted in a marked decrease in tissue and urine nitric oxide levels, renal oxidative stress and significantly deranged the renal functions along with deterioration of renal morphology. Pre-treatment of animals with molsidomine (10 mg/kg) and L-arginine 60 min prior to glycerol injection markedly attenuated fall in nitric oxide levels, renal dysfunction, morphological alterations, reduced elevated TBARS and restored the depleted renal antioxidant enzymes. The animals treated with L-NAME along with glycerol further worsened the renal damage observed with glycerol. As a result, our results indicate that molsidomine and L-arginine may have beneficial effects in myoglobinuric ARF.     

Profound urinary protein loss and acute renal failure caused by cyclooxygenase-2 inhibitor

Cumulative evidence has shown that nonsteroidal anti-inflammatory drugs (NSAIDs) can induce acute renal failure and nephrotic-range proteinuria. Cyclooxygenase-2 (COX-2) inhibitors have less nephrotoxicity; however, recent data indicate that they may cause the same renal problems as NSAIDs do. Herein, we present a case of celecoxib-associated minimal change disease (MCD) with profound urinary protein loss and acute renal failure. Renal function and nephrotic syndrome in this patient resolved completely after discontinuation of celecoxib and treatment with methylprednisolone. Clinicians should keep high index of suspicions in patients developing nephrotic syndrome and acute renal failure after taking COX-2 inhibitors since secondary MCD responds well to timely cessation of COX-2 inhibitors and administration of steroid therapy.     

Drug-induced acute interstitial nephritis: report of 10 cases.

Between January 1979 and June 1985, 10 patients with acute allergic interstitial nephritis were seen in a clinical nephrology service at a large regional hospital. The onset of renal failure was temporally related to the use of a drug: a nonsteroidal anti-inflammatory agent (NSAID) (in four patients), cimetidine (in three), antibiotics (in two) or allopurinol (in one). The onset of renal failure was acute in three patients and insidious in seven. Two patients also exhibited marked proteinuria. Clinical features such as fever, rash, hematuria, pyuria with or without eosinophiluria, and mild to marked proteinuria had led to suspicion of the disease. The diagnosis was confirmed by renal biopsy findings of inflammatory cells, predominantly lymphocytes, plasma cells and eosinophils. Three patients required hemodialysis; two of them received steroids as well. Steroid therapy was also used in two patients with NSAID-induced proteinuria. Renal function improved in nine patients by 35 days, but one patient continued to have slow but progressive deterioration of renal function. Acute interstitial nephritis can be distinguished from other forms of acute renal failure by heavy renal uptake of gallium 67, maximal 48 hours or more after injection. The improvement in renal function after discontinuation of the implicated drug, the characteristic histopathological findings of allergic interstitial nephritis, and the presence of eosinophils and sometimes IgE in the blood suggest a hypersensitivity reaction.     

Acute renal failure due to rhabdomyolysis associated with use of a straitjacket in lysergide intoxication.

Acute renal failure is a known sequel to rhabdomyolysis, both traumatic and non-traumatic. Two patients who had been placed in straitjackets after taking lysergide (LSD) developed acute renal failure and rhabdomyolysis. One subsequently died. The rhabdomyolysis probably resulted from a combination of severe restraint and the violent movements induced by the drug. The use of straitjackets cannot be considered to be completely safe in such cases.     

Incidence of Uraemia and Requirements for Maintenance Haemodialysis

The biochemistry laboratory records of a 400-bed general hospital serving a population of about 120,000 showed that during the three-year period 1966-8 inclusive 487 patients had at some stage during their admission a blood urea of 100 mg/100 ml or more. Ninety per cent. were aged 50 or over, 79% were 60 or over, and 52% were 70 or over.The case notes of all patients with renal failure admitted during 1966 and 1967 were examined together with those of patients under 60 admitted during 1968. Three observers agreed about the most likely cause of the renal failure in 90% of patients whose case notes were available, or 74% of the total. The raised blood urea was thought to be due to “prerenal” factors in 60% of the patients, to acute tubular necrosis in 80%, to obstructive uropathy in 12%, and to “intrinsic” renal disease in 20%. Renal failure precipitated by such factors as cardiac failure, chest infections, cerebrovascular accidents, and shock was particularly common in old people.The hospital survey and replies to a questionnaire sent to all general practitioners in the area suggest that in the three-year period 14 patients may have been suitable for treatment by maintenance haemodialysis or renal transplantation. This represents a rate of about 39 per million per year under the age of 60 and 28 per million per year under 50.     

Free tissue transfer in patients with renal disease

Several authors have cited renal disease as a risk factor for free flap failure. The authors performed a retrospective analysis of all patients who underwent free tissue transfer with concomitant renal disease, including acute renal failure, end-stage renal disease, chronic renal insufficiency, and functional kidney transplants, to determine what effect renal disease has on flap survival and overall reconstructive outcome. More than 1053 free flaps were examined. Renal disease was identified in 32 patients who underwent 33 free tissue transfers. Average patient age was 57 years (range, 36 to 80 years). Twelve patients (38 percent) were on chronic dialysis (end-stage renal disease), 18 patients (56 percent) had chronic renal insufficiency, and three patients (9 percent) had the diagnosis of acute renal failure at the time of surgery. Three patients in the chronic renal insufficiency group had a functioning renal transplant. Average follow-up was 16 months. Immediate postoperative complications occurred in 14 patients (42 percent of the 33 flaps). Overall perioperative mortality was 3 percent. Within the first 30 days there were two cases (6 percent) of primary flap failure; an additional four legs were lost as the result of complications related to their bypass grafts. There were no primary flap failures after 30 days; however, within the first year after surgery an additional seven limbs were lost as the result of progressive ischemia or infection, and an additional three patients died. This resulted in a 52 percent incidence of major morbidity or mortality during the first year and a 55 percent reconstructive success rate in survivors at 1 year. No significant difference was seen in postoperative morbidity or mortality when comparing the end-stage renal disease group to the chronic renal insufficiency group; however, patients with renal disease and diabetes tended to have poorer outcomes. Renal disease, especially renal disease associated with diabetes and peripheral vascular disease, can be a strong indicator of possible reconstructive failure. The surgeon and patient should be aware of the medical and surgical complications associated with this procedure at the outset.     

Plasma concentrations of endothelin in patients with abnormal vascular reactivity. Effects of ergometric exercise and acute saline loading

We measured circulating concentrations of endothelin, a recently discovered vasoconstrictor peptide produced by vascular endothelial cells, in healthy subjects and in patients with abnormal vascular reactivity. Endothelin concentrations were determined by radio-immunoassay after extraction of plasma using Sep-Pak C-18 cartridges in healthy subjects (n = 20), in patients with diabetes mellitus type I (n = 10), in patients with mild to moderate essential hypertension (n = 12) and in non-dialyzed patients with stable chronic renal failure (n = 12). Plasma concentrations were similar in healthy controls, in diabetics and in hypertensive patients averaging 5.0 +/- 0.6 pg/ml, 4.7 +/- 0.2 pg/ml and 6.5 +/- 1.0 pg/ml, respectively. In contrast, plasma concentrations of endothelin were markedly elevated in patients with chronic renal failure averaging 16.6 +/- 2.9 pg/ml (p less than 0.005). No correlations were observed between serum creatinine concentrations ranging from 124 to 850 mumol/l or blood pressure and plasma concentrations of endothelin. Bicycle ergometric exercise in six healthy subjects and an acute modest i.v. saline load of 1,000 ml of 0.45% NaCl administered within 60 min in six patients with mild essential hypertension did not affect plasma concentrations of endothelin. Thus, it is unlikely that vascular synthesis of endothelin is related to acute physiological changes in systemic hemodynamics or to the circulatory and renal responses to acute extracellular fluid volume (ECFV) expansion. A potential role of endothelin, however, in the control of regional blood flow cannot be excluded. Elevated plasma concentrations of endothelin observed in patients with chronic renal failure require further investigations.