Diabetic kidney disease (DKD) is a major complication of diabetes mellitus. One third of patients with advanced diabetes mellitus can develop to uremia, which seriously endangers people’s health. In recent years, with the improvement of people’s living standards and the increasing incidence of diabetes, it has become the main cause of end stage renal disease in China. Over the past two decades, the understanding of diagnosis and treatment of DKD has been improved, such as putting forward the new concept of normoalbuminuric DKD and developing a variety of new anti-diabetic drugs. However, at present, the basic strategies of DKD treatment are still lifestyle modification, glucose control, blood pressure control and lipid control.
In the management of diabetic nephropathy patients with hemodialysis, diabetes link nurse (DLN) can realize the continuity of nursing management, simplify the communication between multiple disciplines, and play multiple roles such as relieving patients’ psychology, participating in scientific research and clinical management. In this paper, by introducing the origin and development status of DLN in foreign countries, and summarizing the function and clinical contribution of DLN in the management of diabetic nephropathy hemodialysis patients. This article combines the current development status of DLN in China, to arouse the attention of clinical nursing colleagues, and provide some reference for the management of diabetic nephropathy patients with hemodialysis and the training of DLN in China.
Kidney transplantation is an ideal treatment for patients with end-stage renal disease. Circulating alloantibodies against donor human leukocyte antigens and blood group antigens can impair allografts, shorten allograft survival, and limit access to kidney transplantation. Furthermore, the presence of donor specific antibodies is associated with increased incidence of antibody-mediated rejection and decreased graft survival following transplantation. Plasmapheresis, an extracorporeal therapy directed at removing plasma proteins that has been found to minimize the effects of perioperative sensitization in kidney transplantation. Plasmapheresis enables transplantation across the barrier of ABO blood group incompatibility. In addition, it is also an important approach for the treatment of antibody-mediated rejection. Therefore, studying the application of plasmapheresis in perioperative period of kidney transplantation is expected to increase the chance of transplantation and improve the outcomes following transplantation. This article introduces the application of plasmapheresis in the perioperative period of kidney transplantation.
目的:观察采用疏血通注射液联合ACEI/ARB治疗早期糖尿病肾病(DN)的疗效。方法:将78例2型DN患者随机分为对照组(ACEI/ARB)和治疗组(ACEI/ARB+疏血通注射液),疗程4周。比较两组治疗前和治疗后尿微量白蛋白(mAlb),Scr、BUN等指标的变化。结果:(1)治疗后治疗组和对照组尿白蛋白均显著下降(Plt;0.01,Plt;0.05),治疗组比对照组下降更为明显(Plt;0.05)。(2)治疗后两组血浆白蛋白均增加(Plt;0.01),治疗组与对照组治疗后比较无明显差异(Pgt;0.05)。(3)治疗后两组Scr、BUN、TC、TG和血钾均无明显变化。结论:联合应用疏血通注射液能有效减少早期DN患者的蛋白尿,改善肾功能。
ObjectiveTo explore the safety and efficacy of patients with dialysis-dependent end-stage renal disease who underwent coronary artery bypass grafting (CABG). Methods We retrospectively analyzed the data of 40 dialysis-dependent patients who underwent CABG in Beijing Anzhen Hospital between January 1, 2006 and August 20, 2013. There were 27 male and 13 female patients at mean age of 63.52±9.17 years. Of them, 33 patients underwent off-pump CABG were in the off-pump CABG group, while 7 patients underwent on-pump CABG were in the on-pump CABG group. ResultsThe average number of the grafts is 2.27±0.68. In the off-pump CABG group, 1 patient died from perioperative myocardial infarction with mortality of 3.0%.In the on-pump CABG group, the operative mortality was 28.6%, with 1 death because of serious infection and secondary multi-organ failure 15 days after the operation, and another death because of ventricular fibrillation 4 days after the operation. The follow-up rate was 100.00%. Overall mean follow-up time was 4.3±2.1 years. During the follow-up, the overall survival rate at 1 year, 3 years, and 5 years was 92.68%, 89.43%, and 82.04% respectively. ConclusionCABG can be performed in the patients with dialysis-dependent end-stage renal disease who also suffered with severe coronary artery disease, despite higher mortality. Surgeons should carefully select patients for the operation. Through optimal way of revascularization, and reasonable perioperative therapy, especially more actively use of continues renal replacement therapy, good results could be got in those kinds of patients.
ObjectiveTo investigate the protective effect of Roux-en-Y gastric bypass surgery on early damage of renal tissue in type 2 diabetes mellitus rats, and explore the mechanism of the protective effects. MethodsDiabetes mellitus animal models were induced by intraperitoneal injection of streptozotocin (STZ, 35 mg /kg) and a high-fat diet.Diabetic rats were divided into three groups randomly (digital table method): diabetes control group (n=8), sham operation group (n=8), and Roux-en-Y gastric bypass group (n=14).Another 8 normal SD rats as the normal control group.The fasting blood glucose, serum total cholesterol (TC), triglyceride (TG), and free fatty acid (FFA) were measured before operation and in 8 weeks after operation; plasma BUN and Cr were measured respectively before operation and in 4 and 8 weeks after operation in each group rats, 24 h urine microalbumin and urine 8-hydroxydeoxyguanosine were measured respectively before operation and in 8 weeks after operation in each group rats.Renal pathological changes were observed and the indexes of kidney hypertrophy, the mean glomerular area (MGA), and the mean glomerular volume (MGV) were analyzed in 8 weeks after operation.The expressions of fibronectin, typeⅣcollagen (CoⅣ), transforming growth factor-β1 (TGF-β1), intercellular adhesion molecule-1(ICAM-1), nicotinamide adenine dinucleotide phosphate oxidase 4 (NOX4), and Bcl-2 protein in renal tissues were investigated by immunohistochemical staining. ResultsRoux-en-Y gastric bypass surgery could reduce the blood glucose, blood lipid, MGA, MGV, and the index of kidney hypertrophy of diabetic rats significantly (P < 0.05), improved renal pathological morphology and kidney function (P < 0.05), reduced the protein expressions of fibronectin and CoⅣ, decreased the protein expressions of TGF-β1, ICAM-1, and NOX4, and increased the protein expression of Bcl-2. ConclusionRoux-en-Y gastric bypass surgery can improve kidney function and the pathological damage of diabetes rats, its mechanism may be related to inhibition the protein expressions of TGF-β1, ICAM-1, and NOX4, and increase the protein expression of Bcl-2.
目的:观察黄芪注射液治疗糖尿病肾病的临床疗效。 方法:将116例糖尿病肾病患者随机分为治疗组和对照组,治疗组在对照组的基础上同时使用黄芪注射液,观察治疗后4周24小时尿蛋白定量、血肌酐、尿素氮、血尿β2微球蛋白、甘油三酯、总胆固醇、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、血尿酸等变化.结果:治疗组治疗后24小时尿蛋白定量、血尿酸均有不同程度的改善,与治疗前比较Plt;0.05,治疗组与对照组比较Plt;0.05。而血尿β2微球蛋白、血胆固醇无明显变化。结论:黄芪注射液对糖尿病肾病有较好的疗效。