目的:探讨住院患者急性肾功能衰竭(ARF)的临床病因方法:回顾性分析139例ARF患者的临床资料,探讨其病因、肾衰类型及危险因素。结果:139例ARF患者中,肾前性90例,肾性37例,肾后性12例。其中,60岁以上的老年人73例,占52.5%。引起ARF的根本病因中,感染、心衰及创伤为引起ARF的主要病因。结论:注意有效血容量不足的症状及体征、及时扩容及控制感染可以减少ARF的发生。同时,60岁以上老年人仍是高危人群,应重在预防。
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。
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.
【摘要】 目的 总结急性肾功能衰竭（acute renal failure， ARF）的病因特点、治疗情况与预后的关系。 方法 回顾性分析2007年8月-2008年4月77例ARF的临床资料，总结各种因素与患者预后的关系。 结果 肾性因素是最主要的致病病因，占77.92%，其中以药物和中毒居多。老年患者、少尿型患者或合并多脏器功能衰竭患者病死率较高，分别为25.93%，29.55%，83.33%。 结论 ARF应早期诊断，积极给予综合治疗，包括肾脏替代治疗，老年ARF患者易出现多脏器功能衰竭、合并感染等，应放宽透析指征，并注意去除高危因素以提高存活率。【Abstract】 Objective To explore the clinical features, treatment, and prognosis of acute renal failure (ARF). Methods The clinical data of 77 patients with ARF from Auguest 2007 to April 2008 were retrospectively analyzed. Results Renal factor was the most important cause of ARF, accounting for 77.92%. The mortalities of elderly patients, oliguric patients and with multiple organ failure were 25.93%, 29.55%, and 83.33%, respectively. Conclusion Patients with ARF should be diagnosed as early as possible and given comprehensive treatments, including renal replacement therapy; the elderly patients with multiple organ failure and infection should be relaxed dialysis indications. We should pay attention to the removal of risk factors to improve the survival rate.
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, 610, 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 highrisk patients.
ObjectiveTo explore the value of Aquaporin-3 (AQP-3) on the detection of early renal function damage by investigating the expressions of renal AQP-3 mRNA and protein of rats with obstructive jaundice (OJ). MethodsForty mature male Wistar rats were divided into two groups randomly: experimental group (n=20) in which the model of OJ rats was established, and control group (n=20, sham operation group). The levels of serum total bilirubin (TBIL), direct bilirubin (DBIL), creatinine (Cr)， and blood urea nitrogen (BUN) were detected by fullautomatic biochemical analyzer on 7 d and 14 d after operation. The expressions of renal AQP-3 mRNA and protein of rats were detected by RT-PCR and Western blotting, respectively. ResultsThe levels of serum TBIL and DBIL were significantly higher on 14 d than those on 7 d after operation in experimental group (P=0.000), which were significantly higher than those at corresponding time point in control group (P=0.000), while the difference within control group was not significant (P=0.154). Thus, the OJ models of rats were established successfully. The difference of serum Cr levels of rats between inter-and intragroup were not significant (Pgt;0.05). Serum BUN level on 14 d after operation in experimental group was significantly higher than those on 7 d after operation in experimental group and on 14 d after operation in control group (P=0.001), although serum Cr levels were not different between 7 d and 14 d after operation in control group (P=0.288). The expressions of AQP-3 protein of rats on 7 d and 14 d after operation in experimental group were significantly lower than those at corresponding time point in control group (P=0.033, P=0.000), meanwhile on 14 d after operation in experimental group was significantly lower than those on 7 d after operation in experimental group (P=0.000). The expressions of AQP-3 mRNA of rats on 7 d and 14 d after operation in experimental group were significantly higher than those at corresponding time point in control group (P=0.000), but the difference at different time point in two groups was not significant (P=0.139, P=0.059). ConclusionsThe changes of renal AQP-3 protein and mRNA expressions are prior to the changes of serum Cr and BUN levels of rats suffered from OJ complicated renal function damage, which are promised to improve the early diagnosis rate of renal function damage in rats with OJ.