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 探讨原发性IgA肾病临床特征与病理间的关系。 方法 回顾性分析2006年1月-2008年6月经肾活检诊断为原发性IgA肾病患者109例的临床病理资料。 结果 血尿的发生及血尿的程度与肾活检病理Lee分级无关，而尿蛋白定量、症状性高血压、肾功能受损与病理学分级呈正相关，且与肾小球硬化、间质病变等病理特征呈正相关。 结论 大量蛋白尿、症状性高血压等是IgA肾病预后不良的重要因素，需要积极干预。
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。
目的 总结反复黏膜感染的IgA肾病的临床病理特点。 方法 采用单中心流行病学调查及回顾性研究，收集2006年1月－2009年12月253例经肾活检确诊为IgA肾病的住院患者的临床病理资料，对114例反复黏膜感染的IgA肾病患者（A组）及139例偶发或从未发生黏膜感染的IgA肾病患者（B组）的临床病理指标进行比较。 结果 A组患者年龄较B组小（t=2.913，P=0.004），临床表现无明显症状者比例较B组多，临床分型以反复发作肉眼血尿型为多，病理分级较B组轻（Z=?2.042，P=0.041），IgA+IgM+C3沉积率高（P＜0.001）；B组IgA+IgG+C3沉积率高（P＜0.001），纤维连接蛋白沉积率高（P＜0.001）。 结论 反复黏膜感染的IgA肾病组患者年龄小，反复发作肉眼血尿型多，临床表现及病理分级较轻；两组FN沉积及免疫球蛋白沉积的主要类型不同，提示两组发病机制可能有所不同。
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.
目的 探讨血清中胱抑素C（Cys-C）在糖尿病、高血压为主要原发疾病的慢性肾病患者进行早期筛查和监测的临床意义。 方法 收集2007年7月－2009年3月由糖尿病、高血压引起慢性肾病患者的血清，采用微粒子增强免疫透射比浊分析法测定由89例糖尿病、76例高血压引起慢性肾病患者血清Cys-C浓度，同时测定其血清尿素氮（BUN）、肌酐（Scr）、尿白蛋白排泄率（UAER），根据UAER的量分组统计，分析血清Cys-C与其他传统肾功能指标的相关性。 结果 由于高血压、糖尿病等慢性疾病引起早期肾病时，患者血清Cys-C、UAER与正常对照组间差异有统计学意义（P＜0.01），而传统的肾功指标BUN、Scr与正常对照组差异无统计学意义（P＞0.05）,在中晚期肾病患者中Cys-C浓度与UAER 、BUN、Scr呈显著正相关（r=0.936，0.692，0.653；P＜0.01)。 结论 与BUN、Scr相比，血清Cys-C是一个更准确、更敏感反映早期肾病的指标，是糖尿病/高血压患者早期发现肾病并发症的一项重要监测指标，具有临床意义。