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Ciliatenerve Knotweed Root-induced Acute Renal Failure: A Report of Two Cases

目的　分析朱砂莲中毒导致急性肾功能衰竭临床表现、肾脏病理学及相关文献复习。 方法　2007年3月－9月收治朱砂莲中毒急性肾功能衰竭2例，分析临床表现及肾脏病理损害。 结果　朱砂莲急性中毒易致急性肾功能衰竭，危及生命；其主要损害肾小管间质，表现为急性肾小管重度损伤，无炎性细胞浸润，而肾小球几乎无病变。 结论　朱砂莲为我国常使用中药，主要成分为马兜铃酸，易致马兜铃酸肾病，须提高对该病认识，规范使用中草药，避免药物性所致肾损害。Objective　To analyze the clinical and pathological manifestations of kidney in patients with ciliatenerve knotweed root-induced acute renal failure. Methods　Two patients who were admitted into our hospital for acute renal failure caused by over-dose ciliatenerve knotweed root from March to September in 2007 were included in this study. We analyzed the clinical and pathological manifestations of their kidneys. Results　Over-dose ciliatenerve knotweed root could induce acute renal failure, even threaten life. The pathology of kidney is characterized by severe tubular injury,rather than glomerulus damage, without cell infiltration. Conclusions　Ciliatenerve knotweed root is one of the frequently-used traditional Chinese medicines in our country, which can easily result in aristolochinc acid nephropathy. We should recognize the importance of this disease and avoid using nephrotoxic drugs.

Effect of Continuous Renal Replacement Therapy on Patients with Acute Renal Failure in ICU

目的 探讨连续肾脏替代疗法（CRRT）对ICU急性肾功能衰竭（ARF）患者的血浆细胞因子、肾功能指标及其预后的影响。方法 选取我科2002年6月至2003年11月符合ARF的ICU患者38例，其中治疗组20例采用CRRT治疗，对照组18例采用肾脏非替代治疗（保守治疗）。两组患者于治疗前、后分别抽取静脉血标本作血浆细胞因子和肾功能指标的检测，并统计两组患者的临床死亡病例数。 结果 与对照组比较，治疗组的血浆肿瘤坏死因子、白细胞介素-6、白细胞介素-8及血肌酐和血尿素氮水平有显著改善（P＜0.05），而临床死亡率改变不明显（Pgt;0.05）。结论 CRRT能有效清除ICU的ARF患者的炎性细胞因子，改善肾功能指标，但其最终预后仍然很差。对于ICU的ARF患者，应该强调预防的重要性。

NUTRITIONAL TREATMENT OF ACUTE RENAL FAIUSR AFER BILIARY (TRACT) SURGERY (A REPORT OF 7 CASES)

Experienc of nurtitional treatment to 7 patients with acute renal failure (ARF) and nitrogemia after biliarty (tract) surgery is reported in this article. Nittrogen source inn all cases was obtained from "Renal Amine" and "7% Vamin" etc,which are composed of 8 essential amino acids (EAA), and the nergery sources are mainly supplyed by Intralipid (20 or 10%) and suitable amount of glucose. The nutritional admicture of "all in one" were employed as parenteral nutrition (PN). Satisfactary curative effecs in these patients were obtained. The suthors consider that (a) the nutritional treatment of different casuses of ARF should be providing enough energy and more EAA requirments than in normal need to synthesizw non-essential amino acide (NEAA) and protein from excessive blood urea nitrogen (BUN) for redcuing pritein breakdown and nitrogemia, and (b) 20% Intralipid is an effective low-volume, highly calories nutritional agent specially in ARF patients with restiction of waterr.

成人心内直视手术后急性肾功能衰竭的治疗

目的　探讨体外循环心脏手术后发生急性肾功能衰竭的治疗方法及疗效。 方法　回顾性分析2011年1月至2012年7月福建医科大学附属协和医院33例行体外循环心脏手术后发生急性肾功能衰竭患者的临床资料，其中男21例，女12例；年龄25～67 （45.21±7.27） 岁。28例采用床旁连续肾脏替代疗法治疗，5例采用腹膜透析联合间歇床旁连续肾脏替代疗法治疗。对比分析经两种治疗方法患者治疗前、后的尿量、尿素氮、血肌酐、血钾和平均动脉压的变化。 结果　33例患者经床旁连续肾脏替代疗法或腹膜透析联合间歇床旁连续肾脏替代疗法治疗后血钾、血肌酐和尿素氮较治疗前明显降低，平均动脉压治疗6 h后较治疗前升高（P＜0.05）。围术期死亡9例，死亡率为27.27%，主要死亡原因为多器官功能衰竭、重症肺部感染合并气道出血、恶性心律失常和消化道出血等。24例患者于治疗后5～14 d尿量恢复正常，肾功能指标正常。随访24例，随访3个月，复查肾功能各项指标均正常。 结论　床旁连续肾脏替代疗法治疗心脏手术后急性肾功能衰竭可获得满意的治疗效果，但应监测电解质及出凝血情况。对有出血倾向及血小板减少症患者采用腹膜透析联合间歇床旁连续肾脏替代治疗，也可获得良好的疗效。

Application of the Clinical Score Developed by Cleveland University to Predict Acute Renal Failure after Cardiac Surgery in Chinese Patients

Abstract: Objective To investigate the application value of the Clinical Score developed by Cleveland University in predicting the occurrence ratio of acute renal failure in Chinese patients after cardiac surgery. Methods A total of 456 adult patients , 230 males and 226 females , with cardiac surgery during August 2008 to July 2009 were included in our study. Their age ranged from 18 to 88 years with an average age of 56.7 years. Before the surgery, Clinical Score was used to predict acute renal failure after cardiac surgery. Based on the score of ≤5, 610, or ≥11, the patients were divided into group Ⅰ (n=401), group Ⅱ (n=42) and group Ⅲ (n=13). The occurrence rate of acute kidney injury (AKI), continuous renal replacement therapy in hospital, multiple organ failure, mortality and other clinical indexes were compared among the 3 groups. Results Occurrence ratio of AKI of group Ⅰ, Ⅱ, Ⅲ was respectively 2.74%, 28.57% and 76.92% (χ2=73.004, P=0.000). Continuous renal replacement therapy rate was respectively 0.50%, 9.52%, and 38.46% (χ2=36.939, P=0.000). Multiple organ failure rate was respectively 0.50%, 4.76%, and 23.08% (χ2=19.694, P=0.000). Mortality rate was respectively 0.25%, 2.38%, and 15.38% (χ2=14.061, P=0.001). There were significant differences among the three groups. Conclusion The Clinical Score to Predict Acute Renal Failure developed by Cleveland University can effectively predict the occurrence rate of acute renal failure in the Chinese patients after cardiac surgery before the operation. Therefore, corresponding preventive methods can be taken for highrisk patients.

体外循环心脏手术后急性肾功能衰竭的肾脏替代治疗

目的 探讨体外循环（CPB）心脏手术后急性肾功能衰竭(ARF)的发生原因及肾脏替代治疗的方法，总结其治疗经验。 方法 回顾性分析我院2004年2月至2008年2月14例体外循环心脏手术后发生急性肾功能衰竭患者的临床资料，所有患者除常规治疗外，分别给予持续血液滤过1例、血液透析5例、腹膜透析7例。 结果 14例患者中死亡7例，其中5例死于多器官功能衰竭，1例死于低心排血量综合征，1例死于腹膜透析并发败血症。余7例经肾脏替代治疗8～39 d肾功能恢复，治愈出院。生存的7例患者随访1～48个月，肾功能无明显异常，尿素氮4.16±3.19 mmol/L(2.96±8.18 mmol/L)，肌酐56±16 μmol/L(55~89 μmol/L)。 结论 急性肾功能衰竭是体外循环心脏手术后严重并发症之一，死亡率较高。采取适当的预防措施可减少该并发症的发生，血液滤过、血液透析及腹膜透析是有效的肾脏替代治疗方法。

腹膜透析治疗小儿心脏手术后并发急性肾功能衰竭

目的 总结腹膜透析（PD）治疗小儿心脏手术后并发急性肾功能衰竭(ARF)的临床经验。 方法 27例ARF患者，年龄3个月～12岁（4.20±3.58岁）；体重4.2～30.0 kg（12.35±7.65 kg）。因心脏手术后发生ARF进行PD。动态监测血气分析、电解质、血清肌酐(Cr)、尿素氮（BUN）、平均动脉压（MAP）和中心静脉压（CVP）的变化。 结果 PD后 5d Cr、BUN与PD前比较明显下降（Plt;0.01），血钾、血钠、碳酸氢根（HCO3-）恢复正常。术后死亡8例（29.6%），死于低心排血量3例，感染并发多器官功能衰竭3例，恶性心律失常1例，肺动脉高压危象1例。发生并发症9例（33.3%），其中管周漏液3例，腹膜炎3例，透析管堵塞3例（其中感染堵塞1例、大网膜堵塞2例）。 结论 小儿心脏手术后ARF早期行PD疗效肯定、安全，操作方便，可降低死亡率。

Prevention and Treatment of Acute Renal Failure after Cardiac Surgery

Acute renal failure(ARF) is a serious complication after cardiac surgery. It is an important influential factor of increasing mortality, extending mechanical ventilation time and intensive care unit time, resulting in cognition functional impairment and respiratory function failure et al, and increasing cost of hospitalization. Extracorporeal circulation, intra-aortic balloon pump, renal inadequacy before surgery, diabetes and peripheral vascular disease are all risk factors of ARF after operation. These factors can lead to ARF by constriction of capacitance vessel, filling defect of renal and ischemia-reperfusion injury et al. Appropriate drug treatment, haemodialysis and hemofiltration could protect renal function and improve prognosis of ARF.

高容量血液滤过治疗心脏手术后急性肾功能衰竭

Evidence-Based Treatment Practice for A Hepatitis B Related Nephritis Patient with Renal Failure

Objective　By means of evidence-based clinical practice, to find more effective treatment for a hepatitis B related nephritis patient with renal failure. Methods　The following databases as Up to Date (May 2011), The Cochrane Library (Issue 5, 2011), PubMed (1978 to 2011) and CNKI (1978 to 2011) were searched to identify systematic reviews and randomized controlled trials (RCTs) of treating hepatitis B related nephritis with glucocorticoid, immunosuppressor or antiviral therapies, and the quality of collected clinical evidence was evaluated by using GRADEpro software. Results　The glucocorticoid or combined immunosuppressors was not recommended for existing adverse effects and not acting on the remission of hepatitis B related nephritis and reduction of proteinuria. However, the antiviral therapy used alone was recommended for acting on the remission of hepatitis B related nephritis and the reduction of proteinuria. In view of adverse effects and expensive price of interferon, the nucleoside analogue antiviral agent was suggested. Considering the renal toxicity of adefovir and tenofovir, and possible drug-resistance of lamivudine, the entecavir (0.5 mg qd) was finally selected with patient’s agreement, and the supporting therapies such as lowering blood pressure, and protecting the kidney and liver were adopted continually. After one month treatment, 24-hour urinary protein got reduced, serum albumin got increased, kidney function got stable, and hepatitis B virus DNA quantity got reduced. Conclusion　For treating hepatitis B related nephritis with kidney failure, entacavir can reduce 24-hour urinary protein, raise serum albumin, stabilize kidney function and reduce hepatitis B virus DNA in a short term, but its long-term efficacy still requires further studies.