肾脏病学与治疗学杂志

Introduction: The AKI appears in 5-25% of patients in ICU, of which 6% will require RRT. If the AKI is associated with MODS mortality will be 50% and if RRT is required this will be 80%. Sepsis and Acute tubular perfusion are causes of AKI. The CRRT is an option for hemodynamically unstable patients and those who cannot handle the volume or metabolic disorders. The hemodialysis (HD) in critical patients is a common practice; however, the use of continuous therapy with hemodiafiltration modality requires special characteristics. Objective: To describe the experience using PRISMA monitor in our center. Material & Methods: Retrospective, descriptive, observational study. All patients were given CRRT with PRISMA at our center from March 2013 to November 2014. Data analysis was performed using Excel and SPSS programs. There is no conflict of interest and was conducted according to the ethics committee of our hospital. Results: CRRT was applied in an active way to 18 patients, 15 males (83%) and 3 females (17%), the average age was 43.9 years (Min. 17 Max. 78). 14 presented AKIN III, 4 where known with CKD. The most common cause of AKI was septic shock (83.3%). The oliguric AKI was the most common form of presentation in 86% of the patients. The average days of stay in ICU was 17.5 (SD 16.5). The average days of arrival and development of AKI is 2.6 days (SD 2.9). APACHE II and SOFA admission average was 30.5 (SD 6.5) and 13.6 (of 3.9) respectively. It was possible to stop CRRT in 5 of 18 patients (27.7 %), 2 patients continued with HD. There was a patient with combined therapy PRISMAMARS. Only 3 out of 18 patients (20%) survived the hospital stay. In the comparative analysis of the groups: Survivors versus non survivors, there were no statistically significant differences in the SOFA and APACHE II scores or in the days of stay in the ICU with IC of 95%. As for the prescription, blood flow measured in ml/min, extraction measured in ml/hr, the dialysate, the reinjection and total UF, showed no statistically significant differences with IC of 95%. Discussion & Conclusions: According to the results, our experience is similar to that reported in the literature with high mortality in patients with AKI and MODS, despite improvement in renal function. With the methodology used and the present number of patients, it´s not possible to point out a good or bad prediction factor on the clinical characteristics of the patients or the therapeutic prescription.

With the introduction of combination antiretroviral therapy (cART), prognosis of HIV infection has been improved and kidney transplantation (KT) in HIV positive patients became possible. We reviewed the demographic, clinical, laboratorial and therapeutic data of all the HIV-infected patients who underwent KT prior between 2009 (first KT in Portugal in a HIV-infected patient) and May 2014. Case accrual was through all Portuguese KT centers where a KT in a HIV-infected patient was performed. Patients were transplanted following the American and Spanish guideline recommendations that included maintenance on cART, undetectable plasma HIV RNA copies and absolute CD4 counts of ≥200 cells/μl in the last 6 months. Fourteen KT were performed on men, 3 KT on women. The mean age of patients at the time of transplantation was 49.9±11.7 years. HIV status was known for 12±5 years. Eight patients had AIDS in the past and all patients received grafts from deceased donors. Twelve patients (64.7%) received induction therapy with basiliximab and two patients had early graft loss. In 2 patients humoral rejection was diagnosed and in 3 patients, cellular rejection. Two patients died and one additional patient had early graft loss. KT is a possible but challenging, renal replacement therapy in selected HIV patients. Even in those with AIDS criteria in the past, when the disease is controlled and after the reconstitution of the immune system with cART, KT can be performed. Nevertheless, the risk-benefit ratio for each patient needs to be taken in consideration.

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???????????????O2 ≥95%??????????????????? (IR) ?????????????? IR ????????????? (ROS)????????????? (HSP) 32 ? 70 ???????? (HO) ????????? 52 ????? 7 ??(A) IR?(B) HO + IR?(C) ??????? (MPG) + HO + IR?(D) MPG + IR?(E) HO + ????(F) MPG + ???? (G) ??????????B?C ? E ??????? 6 ????????????? 4 ??????? 40 ??????????A?D?F ? G ????????????????????????? 24 ?????????????? (Cr)????? (BUN) ?????? (CLCr) ?????????????????? (CAT) ???????? (SOD) ???????? (GSH) ???? (MDA) ???????????????? MPG??? ROS ?????? ROS ???????? HSP32 ? 70 mRNA ?????????IR??A?????????IR??B???Cr?BUN???CLCr???P≤0.016????????B??????MPG??C???Cr?BUN???CLCr???P≤0.004???IR?A????????IR??CAT???GSH?????P≤0.007????B??????MPG????GSH??????D??CAT?????P<0.001????????????????????SOD???????? IR ? A ?????????????? MPG ?????? MDA ???????????????????? HSP32 ? 70 mRNA ???????????????????????????????????????????????? IR ????????????????????????????????? HSP ?????????????????????????????????

? PHAII ?????????????????????????????????????????????????????????????????????????????????????? K+ ?? 9 mmol/l??????????????????????????????????????75% ???????????????????????????????????????????????? 30 ????????????? (DCT) ? Na+-Cl- ????? (NCC) ? Na+ ? Cl- ?????????? PHAII ????????? 36% ??????????????????? (a) ?????? K+ ?? (ROMK)?? (b) ????? (Cl-) ??? (Cl- ??)????? K+ ??????????????? Na+ ?? (ENaC) ? Na+?? (c) ???????? ENaC ?? Na+ ??????????? K= ???2000 ??????????????????-???????????? WNK1?????????????????????? (=K)????????? WNK 2?3 ? 4??????WNK 1 ? 4?WNK 1 ? 4?????????????????????????????????? NCC????? WNK ????????? PHAII????? WNK1 ? WNK4 ????? 13% ? PHAII??????????? E3 ??????????????????????????????? cullin 3 ? kelch-like3??????CUL3 ? KLHL3??? 79% ? PHAII?PHAII ????????????? CUL3??? KLHL3??? KLHL3?WNK4 ? WNK1? CUL3 ? KLHL3 ?? WNK4 ???????????WNK4 ?????? ROMK ???????????????????? (a) ?????? WNK4 ?????????? Cl- ????????? (b) ????? NCC ???????????? Na+ ? ENaC ??????? (c) ???????????Na+ ? ENaC ???????????????????????? ENaC ????? Na+ ???????????????????????????? (c) ?????????? PHAII ????????????????? NCC?????????????????????????????????????????? K+ ?????????dDAVP ????? PHAII ????????????????????????? Na+ ????????????????? K+????????????? K+ ??????????????? K+ ?????????