树脂灌血液灌流在顽固性高血压患者血液透析中的应用

目的：探讨树脂灌血液灌流对血液透析顽固性高血压患者血压及肾素-血管紧张素．醛固酮系统的影响。方法：选择我院82例,均分为I组和II组各41例,I组患者采用金宝8LR聚酰胺膜透析器进行常规透析,II组患者在常规透析的基础上串联树脂血液灌流,检测两组患者治疗前和治疗后3个月血清肌酐、尿素氮变化情况,和患者体内肾素活性、血管紧张素II和醛固酮变化情况,并对血压变化值进行比较。结果：两组患者治疗后3个月血肌酐、血尿素氮均明显较治疗前降低,I组患者治疗后3个月收缩压和舒张压较治疗前均无明显变化,II组治疗后3个月收缩压和舒张压均较治疗前明显降低,I组治疗后3个月肾素、血管紧张素II和醛固酮较治疗前无明显差异,II组治疗后3个月肾素、血管紧张素II和醛固酮较治疗前均明显降低。结论：血液透析联合树脂吸附灌在保证有效清除患者体内代谢物质的同时角色较好的控制患者血压。     

Low doses of lead

The effects of exposure to high doses of lead on reproduction and development have been established, but not so those caused by low lead doses or the influence that life stage at which contact with the metal takes place might have. The aim of this work was to study the effects of 200 and 400 ppm lead acetate in drinking water on reproduction and development as well as on renal and hepatic parameters of rats at different life stages, from gestation to 3 mo postweaning. The results indicate a dose-dependent effect on reproduction, with variations in the number of births and in pups' weight. Development was mostly affected at the weaning stage, with hemoglobin levels and erythrocyte numbers significantly decreased. The lead levels in tissues, blood, urine, and feces along with selected renal and hepatic parameters (blood urea nitrogen, creatinine, alanine aminotransferase, aspartate aminotransferase, and alkaline phosphatase) were determined. There were histological, blood urea nitrogen, alanine aminotransferase, and alkaline phosphatase changes in the first month postweaning. After 3 mo, these changes are no longer evident, possibly because of metabolic adaptation.     

Renal effects of atrial natriuretic factor in domestic fowl

The renal hemodynamic and tubular effects of ANF were investigated using the Sperber technique in chickens. This technique takes advantage of the unique portal circulation of the avian kidney and permits direct access to the renal peritubular space independent of renal arterial blood flow and glomerular filtration. Infusion of ANF into the avian renal portal system increased urine flow rate and sodium excretion by as much as 300% and 100%, respectively. These changes occurred in the absence of significant alterations in glomerular filtration rate or renal plasma flow. There was no significant difference in urine flow, sodium excretion or glomerular filtration rate between the ANF-infused kidney and the contralateral, non-infused kidney. We conclude that the diuretic and natriuretic effects of ANF do not depend on changes in glomerular filtration rate and that the site of action of ANF is the renal medulla.     

Unresponsiveness of forearm hemodynamics to omega-3 polyunsaturated fatty acids and asprin

Prostaglandin synthesis has been reported to change with aspirin ingestion via cyclooxygenase enzyme inhibition and with marine oil supplementation via an increase in the metabolism of 3-series eicosanoids. This study investigated the effects of pharmacological manipulations of prostaglandin metabolism on forearm hemodynamics and blood pressure. The agents studied were omega-3 fatty acids and aspirin.In the omega-3 fatty acid study, two groups of normal volunteers (N=10/group) supplemented their diets with either marine oil capsules or placebo. Hemodynamic variables (Mercury-in-Silastic forearm plethysmography) were measured initially and weekly for 4 weeks. There were no significant differences between the two groups in blood pressure, forearm blood flow, venous capacitance, or forearm vascular resistance. Parallel changes occurred for forearm blood flow and venous capacitance. Six normal volunteers took daily dosages of aspirin, increasing from 162 to 6200 mg. Hemodynamic measurements, ADP-induced platelet aggregation, and serum salicylate levels were obtained daily. Maximu inhibition of platelet aggregation occurred after 162 mg. (serum salicylate = 17.7+/−6.4 mg/l). Though serum salicylate levels rose to 165.0+/−20.0 mg/l, no significant changes occurred in blood pressure or forearm blood flow. Even at aspirin levels 16- fold greater than those required to impair platelet aggregation, the changes in forearm vascular resistance were not found to be significant. These results suggest that under resting conditions in normotensive males, neither pharmacological inhibition nor stimulation of vascular prostaglandin metabolism alters to forearm vascular resistance or arterial blood pressure.     

The effects of starvation and force-feeding on the metabolism of the Northern pike, Esox lucius L.

The effects of starvation and force-feeding on certain tissue and blood constituents were studied in the Northern pike, Esox lucius L. Starvation resulted in a reduction of liver and muscle glycogen and liver lipid. Blood glucose concentration and haematocrit were reduced, total plasma cholesterol levels were increased, while the levels of plasma free fatty acids (FFA), amio acid nitrogen and protein remained unaltered. No significant changes were observed in either muscle protein, muscle water or the response to amino acid loading during the starvation period.
The force-feeding of pike starved for 3 months resulted in liver lipid and muscle glycogen being increased to levels higher than those observed in freshly-captured fish. Liver glycogen, however, increased to values only slightly higher than those of starved animals. Furthermore, while force-feeding had little effect on plasma FFA or protein concentrations, blood glucose, plasma cholesterol and haematocrit returned to the levels found in freshlycaptured fish and those of amino acid nitrogen were higher.
The results indicate that pike are well adapted for periods of prolonged starvation and that hepatic and extra-hepatic lipid and glycogen stores serve for metabolic needs during food shortage, while body protein is conserved. The endocrine basis for these changes in the tissue and blood constituents is discussed.     

Controlled trial of azathioprine in the nephrotic syndrome secondary to idiopathic membranous glomerulonephritis.

In a controlled double-blind trial five patients with the nephrotic syndrome due to idiopathic membranous glomerulonephritis received azathioprine, 2.5 mg/kg-d, while four others received placebo. After 1 year of treatment there was no significant difference between the two groups with regard to the changes in leukocyte count, values for hemoglobin, serum creatinine, blood urea nitrogen or serum albumin, 24-hour excretion of protein in the urine, or creatinine clearance. In this study azathiprine appeared not to be useful in the treatment of idiopathic membranous glomerulonephritis.     

Detection of early renal transplant rejection by minimally-invasive monitoring of impedance variability

BACKGROUND: Allograft rejection that occurs after renal transplants is identified by surveillance biopsies or by abnormal laboratory and/or hemodynamic data. The latter are insensitive markers of rejection that may not appear until significant histologic damage has already occurred. Therefore, a sensitive and specific non-invasive method of detecting early rejection of transplanted solid organs is needed. METHOD: A single canine renal allograft was implanted followed by bilateral nephrectomy. Bipolar pacing electrodes were implanted at each end of the transplanted kidney. A second set of electrodes was implanted in the liver, which served as a non-rejecting normal organ. Electrodes were connected to an implantable sensor placed in the subcutaneous tissue. Electrical tissue impedance levels were telemetrically downloaded daily. The clinical status of the transplanted organ was monitored by following the blood urea nitrogen and serum creatinine levels, urine output, and clinical appearance. After tissue impedance levels had stabilized, all immunosuppressants were abruptly discontinued. Clinical signs of rejection were then observed after a few days. RESULTS: Rejection was accompanied by changes in electrical impedance of the implanted organ. These changes, when observed, occurred 1-5 days before clinical signs of rejection appeared. CONCLUSION: Analyses of these data suggest that development of a minimally-invasive high-confidence sensor of early rejection of solid organ transplants is feasible.     

Effects of aromatase inhibition with aminoglutethimide in men with benign prostatic hypertrophy [Poster 28]

Fourteen men with benign prostatic hypertrophy were treated with the aromatase inhibitor aminoglutethimide for periods of up to 3 months. LH, FSH and testosterone levels rose within one week and remained elevated, while estradiol levels decreased. Despite significant changes in these hormones there was no change in urine flow rates or prostatic size over the study period.     

Taurine levels in blood and urine of vitamin B6-deficient and estrogen-treated rats

The objects of the present study were to determine whether a L-methionine or a L-cysteine test-load was more effective in evaluating the effects of estrogen on vitamin B6 deficiency in rats, and to determine whether urine or blood was the better test fluid to measure taurine levels. In animals fed a vitamin B6-supplemented diet, urinary excretion of taurine was twofold higher after administration of a L-cysteine test-load compared to a L-methionine test-load. Greater percentage reductions in the quantity of excreted taurine were observed in the vitamin B6-deficient rats when L-cysteine was utilized as the test-load than when L-methionine (2 mmole) was utilized. Treatment with estrogen demonstrated no significant differences in urinary taurine excretion. Vitamin B6 deficiency without estrogen treatment raised the levels of taurine in the blood of the animals treated with a L-methionine test-load. No changes in the blood taurine levels were observed in the animals administered a L-cysteine test-load.     

Effects of an intrauterine copper device on serum copper, endometrial histology, and ovarian, hepatic, and renal functions in the Japanese monkey (Macaca fuscata fuscata).

A copper intrauterine device (Cu-IUD) was inserted transabdominally into the uterine cavity of eight Japanese monkeys (Macaca fuscata fuscata) for 4 to 6 months, and effects on various organ functions were examined. Results showed no significant effects on the menstrual cycle length, serum levels of LH, estradiol-17 beta, progesterone or clinical biochemical data such as serum copper, glutamic oxaloacetic transaminase, glutamic pyruvic transaminase, lactic dehydrogenase, and blood urea nitrogen. Histology revealed edema and infiltration of eosinophilic leukocytes in the endometrium treated with a Cu-IUD.     

Hormone replacement therapy increases renal kallikrein excretion in healthy postmenopausal women

Hypertension and its related increase in cardiovascular morbidity in postmenopausal women is a major public health problem. The hypotensive property of urinary kallikrein has been described since 1909. Despite the controversy surrounding the effects of hormone replacement therapy on blood pressure regulation, its mechanisms remain incompletely understood, and no evidence has yet been provided for its effects on renal kallikrein excretion in postmenopausal women. In a double-blind, randomized study we examined the effects of hormone replacement therapy in the form of 2 mg 17-beta estradiol (ERT) or 2 mg 17-beta estradiol combined with continuous 5 mg medroxyprogesterone acetate (HRT) on urinary kallikrein excretion in postmenopausal women. Thirty-nine postmenopausal women collected their urine for 24 hours on two separate occasions 3 months apart. During the 3 month period women were randomized to placebo, ERT, or HRT. Urine samples were assayed for kallikrein activity, normalized to urine creatinine and expressed as mU/gm creatinine. Urinary kallikrein excretion increased significantly after 3 months in the ERT (p < 0.001) and HRT (p < 0.01) groups, and decreased non-significantly in the placebo group (p > 0.06). There were no significant blood pressure changes after 3 months of therapy. The findings demonstrate that hormone replacement therapy in the form of estrogen or estrogen combined with continuous medroxyprogesterone is effective in increasing urinary kallikrein excretion. Given that a decrease in kallikrein excretion may mark risk for development of hypertension, the findings of this study are of value in demonstrating a novel mechanism underlying cardioprotective properties of postmenopausal hormone replacement therapy in women without pre-existing coronary disease.     

苯磺酸氨氯地平对维持性血液透析患者残余肾功能的保护作用

目的:研究苯磺酸氨氯地平对维持性血液透析(MHD)患者残余肾功能的保护作用,为MHD患者降压方案的治疗提供依据。方法:选取2014年4月至2016年2月我院收治的MHD患者90例,按照随机数字表法分为硝苯地平组(A组)、血管紧张素抑制剂或血管紧张素转化酶抑制剂组(B组)、苯磺酸氨氯地平组(C组),每组各30例。各组分别给予相应药物进行治疗12个月,观察治疗前、治疗后6个月、治疗后12个月尿量、血生化指标、尿素清除指数(Kt/V)、残余肾尿素清除率(KRU)及心血管事件发生率。结果:治疗前各组患者尿量、KRU和Kt/V比较无统计学差异(P0.05),治疗后3组患者尿量、KRU均显著降低(P0.05),治疗后6个月、12个月B组和C组尿量、KRU显著高于A组(P0.05),B组C组尿量、KRU比较无统计学差异(P0.05),治疗后6个月、12个月三组Kt/V比较无统计学差异(P0.05)。三组患者治疗中急性心血管事件比较无统计学差异(P0.05),治疗后6个月、12个月A组和C组透析前高血钾发生率显著高于B组(P0.05)。治疗前、治疗后6个月、12个月三组患者平均动脉压、脱水量比较比较无统计学差异(P0.05)。结论:苯磺酸氨氯地平具有维持血液透析患者残余肾功能的作用,相较血管紧张素抑制剂或血管紧张素转化酶抑制剂其高血钾发生率较低,值得临床推广应用。     

Monitoring of urine nitric oxide (NO) related substrates and immunological competence in hematological malignancy

It has been reported that concentrations of neopterin in the urine are changed according to the host immunological conditions. In the present study, we measured urinary concentration of neopterin in patients with malignant hematological disorders and investigated the relationship between urinary neopterin levels and laboratory indices for cellular immunity. Urine neopterin levels were correlated with serum sIL-2R levels in the patients with malignant lymphoma, and inversely correlated with lymphocyte reactivity with ConA in the patients with acute myelocytic leukemia. However, no significant correlation was observed between urine neopterin levels and lymphocyte reactivity with phytohemagglutinin and pokeweed mitogen, CD4/8 ratio, CD56+ 16+ subset or serum IFN-gamma levels. In the patients with malignant lymphoma, parallel changes in serum sIL-2R and urine neopterin were observed. The presented results suggest that urine neopterin levels are related to the activation of T cells in malignant lymphoma.     

糖尿病肾病合并非糖尿病肾病的临床病理分析

目的：分析糖尿病肾病合并非糖尿病肾病的临床病理特点。方法：选取我院肾内科收治的临床诊断为糖尿病肾病的患者56 例,肾脏穿刺进行肾脏活体组织检查,通过病理诊断将患者分为两组,分别为糖尿病肾病组和糖尿病肾病合并非糖尿病肾病组, 比较两组患者的糖尿病病程、糖化血红蛋白、血压、血肌酐、血尿素氮、血尿酸、血清白蛋白、尿蛋白定量、血尿、视网膜病变。结果： 经肾脏组织活检,56例患者中NDRD 患者24 例(42.9%),DN患者32 例(57.1%);对24 例NDRD患者进行病理类型分类,其中IgA 肾病33.0%,膜性肾病25.0%、系膜增生性肾小球肾炎20.2%、高血压肾损害8.3%、微小病变4.2%、局灶节段硬化性肾炎4.2%、新 月体性肾小球肾炎4.2%。与DN组比较,NDRD 组糖尿病病程、糖化血红蛋白、血尿、视网膜病变均有差异(P＜0.05);而血肌酐、血 尿素氮、血尿酸、血清白蛋白、尿蛋白定量均无明显差异(P＞0.05)。结论：临床诊断的糖尿病肾病患者中有很大一部分实际上为糖 尿病肾病合并非糖尿病肾病,且以IgA 型肾病比较多见,糖尿病病程、糖化血红蛋白、血尿、视网膜病变对鉴别二者具有一定的指 导意义。     

硝苯地平与硫酸镁治疗妊娠高血压综合征的临床疗效及对患者血清肌 酐、HSP70 及尿微量白蛋白水平的影响

目的:探讨硝苯地平联合硫酸镁对妊娠高血压综合征患者血清肌酐、HSP70及尿微量白蛋白水平的影响。方法:选取近5年在我院接受治疗的妊娠高血压综合征患者60例,随机分为实验组和对照组,每组30例。对照组患者采用硫酸镁治疗,实验组患者采取硝苯地平联合硫酸镁治疗。观察并比较治疗前后两组患者血清肌酐(Scr)、血尿素氮(BUN)、血尿酸(UA)热休克蛋白70(HSP70)及24 h尿微量白蛋白水平以及收缩压及舒张压的变化。结果:与治疗前相比,两组患者Scr、BUN、UA、HSP70及24 h尿微量白蛋白水平和收缩压及舒张压均显著降低(P0.05);与对照组相比,实验组患者上述指标均明显降低(P0.05)。结论:硝苯地平联合硫酸镁能够降低妊娠高血压综合征患者血压,保护患者肾功能。     

前列地尔联合氯吡格雷治疗早期糖尿病肾病疗效观察

目的:观察前列地尔与氯吡格雷联合治疗早期糖尿病肾病(DN)的临床疗效。方法:选择我院2013年10月至2014年10月期间收治的早期DN患者120例为研究对象,采用随机数表法将患者随机分为观察组62例和对照组58例,两组患者均给予血管紧张素受体拮抗剂(ARB)或血管紧张素转化酶抑制剂(ACEI)类药物1个月后,对照组给予前列地尔治疗,观察组给予前列地尔联合氯吡格雷治疗,两组患者均进行20d的治疗,观察并比较两组患者治疗前后β2-微球蛋白(β2-MG)、尿微量白蛋白(U-malb)、高敏C反应蛋白(hs-CRP)、尿素氮(BUN)、血肌酐(Cr)、平均动脉压(MPA),全血低切边率、全血高切变率、血浆粘滞度、血小板聚集率的变化情况及不良反应的发生情况。结果:治疗前两组患者间各项指标比较差异均无统计学意义(P0.05);治疗后两组患者β2-MG、U-malb、hs-CRP、血浆粘滞度、全血粘滞度、血小板聚集率较治疗前均出现明显降低,且观察组患者各项指标均低于对照组,差异均有统计学意义(P0.05);治疗前后两组患者Cr、BUN、MPA水平均未发生明显变化(P0.05);两组患者均未发生严重并发症。结论:早期DN患者给予前列地尔联合氯吡格雷治疗可以降低其尿蛋白,减轻炎症反应,缓解疾病进展,具有明显的临床疗效。     

绞股蓝多糖对糖尿病肾病大鼠肾功能的保护作用及其机制研究

目的:探讨绞股蓝多糖对糖尿病大鼠肾功能的影响及其保护的可能机制。方法:采用大鼠高脂高糖饲料结合腹腔注射链脲佐菌素建立2型糖尿病模型。灌胃给予绞股蓝多糖8周后,测定大鼠空腹血糖(FBG),血清肌酐、血清尿素氮、24 h尿量及尿蛋白等指标;组织病理切片观察肾形态,肾小球体积;Western blot法检测肾皮质NF-κB的表达。结果:绞股蓝多糖(GPS)可剂量依赖性的降低DN组的FBG、血肌酐、24 h尿量和尿蛋白;但血尿素氮模型组与GPS组无统计学差异;中、高剂量GPS治疗后,肾脏指数较模型组明显降低(P0.05);与模型组(149.8±12.2%)比较,高剂量GPS可抑制肾小球体积肥大至108.9±9.6%。进一步研究发现,GPS可剂量依赖性的降低DN组肾脏NF-κB蛋白的表达,高、中剂量组水平与模型组相比有统计学差异(P0.05)。结论:绞股蓝多糖对实验性糖尿病肾病具有保护作用,其机制可能与抑制肾炎症相关通路NF-κB的表达有关。     

A Preliminary Clinical Study on an Antihypertensive Agent,Troxonium Tosylate

The effects of a new antihypertensive agent, troxonium tosylate, were studied in a group of 22 patients whose ages ranged from 48 to 88 years. Fourteen of these were classified as hypertensive because of a diastolic pressure over 95 mm. Hg. Eight were normotensive. This was a double-blind study. A dose of 600 mg. daily produced a significant fall in systolic and diastolic pressure relative to control levels in the hypertensives, while in the normotensives a dose of 600 mg. produced no significant effect. A dosage of 1000 mg. daily produced a significant fall in diastolic pressure from control levels in both these groups.Blood counts, urinalyses, blood urea nitrogen and cholesterol levels remained unchanged throughout the study, and no side effects were experienced by the patients.     

长期饮用富氢水对正常大鼠生理功能的影响

大量动物实验和临床试验显示,氢气可能对疾病的预防或治疗有积极作用。尽管目前氢气的安全性已被广泛认可,但是长期氢气干预是否会对机体的生理功能产生影响还缺乏实验数据支持。为了探究长期饮用富氢水（hydrogen-rich water, HRW）对生理功能的影响,测试了长期饮用富氢水大鼠的体重、脏器重量、饮水进食及排泄量、心脏功能、血常规和血清生化指标。研究发现：富氢水对血常规/空腹血糖/肝功能无显著影响;富氢水能够显著提高大鼠血清甘油三酯水平（P＜0.05）,而胆固醇、胆汁酸和尿酸水平无显著变化;富氢水对大鼠心脏功能无显著影响;富氢水能够显著提高大鼠脑组织重量（P＜0.05）;富氢水对大鼠体重、其他脏器重量、饮食进水量和排泄量无显著影响。对富氢水干预后的长期影响效果的观察具有一定的基础研究价值和临床参考意义。     

SPORADIC ACUTE GLOMERULONEPHRITIS IN ADULTS

Nineteen adults who had acute glomerulonephritis were reviewed with respect to the clinical course and long-term follow-up. The age range was from 17 to 55 years. Only one patient died during the acute episode. In 11 cases, onset occurred between November and January and 15 of the patients had a known respiratory tract infection three to 30 days before the onset. The most important symptoms noted were weight gain, edema, dyspnea, oliguria and red or smoky urine. The most prominent physical signs were elevated blood pressure, edema, abnormalities in the chest and fever of over 100° F. Fifteen patients showed roentgen evidence of pulmonary vascular congestion, pleural effusion, cardiomegaly, pneumonia or a combination of these abnormalities. All the patients had proteinuria and red blood cells in the urine, and half of them had red blood cell casts. Azotemia, when present, subsided in 9.4 days. The average diastolic pressure was 105 mm. of mercury and the mean fall was 26 mm. in 23.5 days. At six months, nine of the 13 patients still being observed continued to show proteinuria or microscopic hematuria (seven showed both). A late follow-up of ten patients showed one to have significant hypertension and one to have early functional impairment and inconstant proteinuria. In these cases the average blood pressure was 140/91 mm. as compared with 119/74 mm. at the time of discharge.Sporadic glomerulonephritis in adults presents essentially the same pattern as it does in children. Urinary abnormalities may persist for months or even years, and neither the present series nor those reported by others clearly reveal the ultimate prognosis.