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The Effect of Simvastatin in Patient with Chronic Renal Insufficiency MOU Hong,CHEN Tong,HE Long

目的：研究羟甲戊二酰辅酶A还原酶抑制剂辛伐他汀治疗慢性肾功能不全的临床疗效。方法：选择慢性肾功能衰竭患者共40例，随机分成两组，在原有基础治疗上治疗组20例患者予以辛伐他汀治疗，对照组20例单纯以基础治疗，在24周时监测TC、TG、24 h尿蛋白、Scr、BUN、C-反应蛋白的值。结果：与治疗前相比，两组TC、TG、24 h尿蛋白、Scr、BUN、C-反应蛋白均明显下降，与对照组相比，治疗组血脂有显著下降（P＜0.01）而且24h尿蛋白、Scr、BUN、C-反应蛋白均明显下降(P＜0.05)。结论：辛伐他汀能降低蛋白尿，延缓慢性肾功能不全的进展

Hepatic and Renal Insufficiency Induced by Intravenous Injection with Amiodarone: A Case Report and Literature Review

【摘要】　目的　报道1例静脉滴注胺碘酮致肝肾功能不全患者。　方法　2010年10月收治1例扩张性心肌病患者，治疗过程中使用胺碘酮注射液，导致严重的肝肾功能不全。系统查阅中国期刊全文数据库及外文数据库Pubmed、Embase建库至2011年8月关于胺碘酮致肝肾功能不全的相关文献，进行静脉胺碘酮致肝肾功能不全的可能性评估，探索胺碘酮静脉滴注致肝功能不全的的作用机制。　结果　根据查阅文献结果分析，此患者静脉注射胺碘酮致肝功不全的可能性高，Naranjo概率评分分别为7分。　结论　提出临床医师和临床药师应进行胺碘酮静脉的药学监护，高度的重视胺碘酮相关的不良反应，从而及时识别和防治胺碘酮所致肝肾功能不全，减少其不良预后。【Abstract】　Objective　To report a case of hepatic and renal insufficiency induced by intravenous injection with amiodarone, and to evaluate the possibility of the adverse drug reaction.　Methods　A patient with dilated cardiomyopathy was admitted in October, 2010. During the procedure, the use of amiodarone hydrochloride injection made the patient suffer from liver and kidney dysfunction. We retrieved the literatures about liver and kidney toxicity of amiodarone from CNKI, Pubmed, and Embase (from the establishment of the databases to November 2011). We also ssessed the possibility of the adverse drug reaction, discussed the mechanism of amiodarone-induced hepatic insufficiency.　Results　According to the literature, There was a great possibility of hepatic insufficiency induced by amiodarone, and the total score of the Naranjo probability score was 7.　Conclusion　It is important to pay more attention to the pharmaceutical care of amidarone to timely recognize and effectively prevent or treat hepatic and renal insufficiency induced by intravenous injection with amiodarone.

急性肾功能不全伴重症肺炎并腹膜炎及精神抑郁分裂症护理一例

Clinic Observation of Efficacy of Hypericum Japonicum Thunb on Treatment of 23 Patients with Chronic Renal Insufficiency

摘要:目的: 观察地耳草颗粒对慢性肾功能不全的治疗效果。 方法 :观察23例患者治疗前后血肌酐、尿素氮、 血浆白蛋白、血色素的变化。 结果 :地耳草颗粒可明显降低患者血肌酐、尿素氮水平;并提高患者血浆白蛋白和血色素水平。 结论 :地耳草颗粒对慢性肾功能不全有一定的治疗效果。Abstract: Objective: To observe the clinic efficacy of Hypericum japonicum Thunb on treatment of 23 patients with chronic renal insufficiency diseases. Methods : Observe the change of Bun, Scr, Hb, Alb level after the treatment by Hypericum japonicum Thunb. Results : the Bun and Scr declined, Hb and Alb level raised after the treatment. Conclusion : Hypericum japonicum Thunb has some therapeutic effects on chronic renal insufficiency diseases.

Clinical Study of Yihuo Qingxia Method in Treating Severe Acute Pancreatitis with Renal Insufficiency at Early Stage

目的:探讨早期采用益活清下法治疗重症急性胰腺炎(severe acute pancreatitis,SAP)并肾功能不全的疗效。方法:35 例符合病例选择标准并接受益活清下法治疗的SAP并发肾功能不全患者,按发病后入院时间分为早期组(3d 内入院接受治疗,24例)和晚期组(3～7 d 内入院接受治疗,11例),比较治疗过程中两组患者各并发症的持续时间、病程、手术中转率及病死率。结果:两组入院48小时Ranson 评分、急性生理和慢性健康评价指标Ⅱ(APACHE Ⅱ )评分及CT 评分比较差异无显著性(Pgt; 0.05);早期组急性呼吸窘迫综合征、肾功能不全的持续时间低于晚期组(Plt; 0.05);早期组和晚期组中转手术率分别12.5%(3/24例)和 18.18%(2/11例),差异无统计学意义(Pgt; 0.05);病死率早期组和晚期组分别为 8.33%(2/24例)和9.09%(1/11例),差异无统计学意义(Pgt; 0.05);早期组和晚期组住院病程分别为(20.40±18.25)d 和(34.92±12.62)d,两组比较有统计学意义(Plt; 0.05)。结论:早期使用益活清下法对SAP合并肾功能不全可以取得更好疗效。

无环鸟苷致多发性骨髓瘤合并肾功能不全患者精神障碍一例

经皮肾镜取石术后肾出血并肾功能不全一例

Detection and analysis of gene mutation in a case of child’s renal coloboma syndrome

ObjectiveTo analyze and identify the pathogenic mutation that caused a case of child’s renal coloboma syndrome (RCS).MethodsA child with congenital cataract in the right eye and optic disc defect in the left eye and his parents with normal phenotype were included in the study. The blood of the child and his parents were captured to extract DNA and make molecular test. The possible variants were screened through NGS sequencing using the ophthalmology gene panel on illumina NextSeq 500 platform, and proved the selected PAX2 mutation by Sanger sequencing. Pathogenicity report was retrieved through PubMed and related database. Pathogenicity analysis of the candidate mutated site has careful consideration of the patient’s clinical presentations and sequencing result base on Standards and Guidelines for the Interpretation of Sequence Variants revised by ACMG. According to the results of gene diagnosis, the child was executed related clinical examinations on kidney.ResultsThe sequence result showed that a heterozygous mutation in PAX2, c.70dupG (p.V26Gfs*28), which lead to truncated protein product that terminated after 28 amino acids of the mutated site. Both of his normal parents were not carriers of the heterozygous mutation. Sanger sequencing results of the child and his parents were consistent with the NGS sequencing. The autosomal dominant disease phenotype was inferred to be caused by the heterozygous mutation of c.70dupG (p.V26Gfs*28) of PAX2 gene. Renal color Doppler ultrasound results showed the child with small renal cysts on the left and mildly separated collecting system. Renal function tests showed the child with α1 microglobulin index increased.ConclusionThe heterozygous mutation c.70dupG (p.V26Gfs*28) in PAX2 is the genetic pathogenic cause for the patient with RCS.

Application of Continuous Renal Replacement Therapy in Patients with Acute Renal Insufficiency after Heart Transplantation

Objective To summarize and analyze the clinical outcomes and experiences of continuous renal replacement therapy(CRRT) in patients with acute renal insufficiency after heart transplantation. Methods There were 39 patients received orthotopic heart transplantation from September 2007 to September 2008 in Fu Wai hospital. Seven cases required the use of PRISMA CRRT machine (Gambro Healthcare,Inc.) because of acute renal insufficiency after heart transplantation, and received continuous venovenous hemodiafiltration(CVVHDF) treatment via M100 blood filter (hemofilters). Activated coagulation time (ACT) was maintained in 160200 s. Results Six survivals with New York Heart Association (NYHA)Ⅰdischarged ，1 case died of multiple system organ failure (MSOF) and severe infection. The time of CRRT was 48658 h, with an average of 252 h. Seven patients were oliguric or anuric during CRRT, but hemodynamics and internal environment were stable. After stopping CRRT, the creatinine level rose to 267.1±68.5 μmol/L， then the creatinine level decreased to normal range with urine increasing gradually. Postoperative glomerular filtration rate (GFR) was 56.5±19.0 ml/min， and there was no statistical significance compared with preoperative GFR（Pgt;0.05）. Six survivals were followed up for 513(9.7±3.8)months，and their creatinine level was in normal range(90.6±26.7 μmol/L). There was no statistical significance compared with the creatinine level at discharge (83.2±26.5 μmol/L, Pgt;0.05）. Conclusion The prognostic outcomes of patients with acute renal insufficiency after heart ransplantation are excellent after using CRRT. No significant renal dysfunction is found.

合并慢性肾功能不全患者的冠状动脉旁路移植术

目的 总结合并慢性肾功能不全的冠心病患者行冠状动脉旁路移植术（CABG）的临床经验。方法 1997年4月至2004年11月，对18例合并慢性肾功能不全[术前血清肌酐（Cr）129～497μmol／L（216.0±98.3μmol／L）]的冠心病患者行CABG，其中体外循环CABG和非体外循环CABG各9例。结果 术后住院死亡3例，其中大面积脑梗死、肾功能衰竭1例；肾脏和呼吸功能衰竭1例；肺部感染、呼吸功能衰竭1例。4例患者采用腹膜或血液透析。随访11例，失访4例，随访时间2～22个月（7.6±7.3个月），随访期间无明显的心绞痛发作5例，心绞痛较术前明显减轻5例，有较剧烈的胸痛发作1例。血清Cr较术前变化不明显4例（变化〈50μmol／L），较术前明显增高（Cr增高〉100μmol／L）5例。长期腹膜透析1例，脑出血1例，死亡2例（脑梗死、肺部感染）；抗凝治疗发生并发症1例。结论 对合并肾功能不全的冠心病患者积极改善肾功能，通过适当的围术期处理，行CABG后的近期结果是可以接受的。