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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.

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。

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

A Randomized Controlled Trial of Reduced Glutathione in the Treatment of Acute Renal Failure

Objective　To evaluate the effectiveness and safety of reduced glutathione in the treatment of acute renal failure. Methods　Twenty-three patients with acute renal failure were divided into the treatment group (n=10) and the control group (n=13) by simple randomisation. Patients in the treatment group received intravenous reduced glutathione 1200 mg daily. Patients in the control group were not treated with reduced glutathione. The therapeutic course for both groups was 4 weeks. Serum creatinine and urea nitrogen were determined before treatment as well as at the end of each of the 4 weeks. Proximal and distal renal tubular functions were evaluated at the end of the treatment. The time when clinical symptoms were improved was recorded and adverse drug reactions were monitored. Results　The durations of nausea and vomiting as well as the oliguria stage were shorter in the treatment group than in the control group. The serum creatinine level in the treatment group decreased more markedly than that in the control group. At the end of the treatment, the renal tubular function was better in the treatment group than in the control group. Conclusion　Reduced glutathione contributes to the early recovery of renal function in patients with acute renal failure. However, more high-quality and large-scale randomized controlled trials are needed.

急性生理改变与慢性健康评估综合评分系统在预测急性肾功能衰竭患者预后中的应用

目的　探讨急性生理改变与慢性健康评估综合评分系统（APACHEⅡ）在预测急性肾功能衰竭患者预后中的应用。 方法　对2007年1月－2009年10月重症医学科（ICU）诊断为急性肾功能衰竭的50例患者行APACHEⅡ评分，并就APACHEⅡ评分值与病死率、死亡风险间的关系进行分析。 结果　6～16分段病死率21.9%，死亡风险8.43 ± 9.15；17～26分段病死率65.0%，死亡风险22.64 ± 16.32；27～36分段病死率70.6%，死亡风险48.93 ± 26.53；37～46分段病死率100.0%，死亡风险77.42 ± 23.18；其中17～36分段占74.0%，随着APACHEⅡ评分升高， 死亡风险及病死率随之升高，并且呈正相关。 结论　APACHEⅡ是一种较好的疾病严重度分类系统，对于判断急性肾功能衰竭患者预后有较重要的价值。

急性肾功能衰竭预后相关因素分析

【摘要】目的 探讨急性肾功能衰竭(ARF)的年龄分布、病因、临床类型、治疗对策和预后。 方法 2003年1月-2009年10月住院ARF患者266例,将临床资料进行回顾性分析。 结果 ＜15岁者4例,无死亡；15～39岁66例,死亡2例；40～59岁91例,死亡13例；＞60岁者105例,死亡33例。肾前性113例,死亡36例,肾实质性139例,死亡12例,肾后性14例,无死亡。少尿型101例,死亡22例；非少尿型165例,死亡26例。接受血液净化治疗107例,死亡18例；激素或免疫抑制剂治疗者67例,死亡9例；对症治疗92例,死亡21例。 结论 随年龄增加ARF患病率增加,病死率亦增加； 肾实质性ARF居首位,其次为肾前性；少尿型病死率高于非少尿型,血液净化可降低病死率,明确病理类型,及时激素或免疫抑制剂治疗,可改善预后。