肾脏病学与治疗学杂志

?????????????????????????????????????????

?????????????????????/??????????????????????????????????????????????????????????????????????????????????????????????? 3cc ???????????????????????????????

???????±SD????? 61.25 ?±8.86 ??50 ? 90 ?????????? 44 ??29.3%?n=150??????? 61 ? 65 ????57 ??38.0%??????????????????????????129.29 ± 1.94?mmol/L ??132.05 ± 2.41?mmol/L?P>0.0001??????????????????149.8 ± 0.3?mmol/L ??147.2 ± 1.1?mmol/L?P>0.02?????????????????2.82±0.5?mmol/L??3.8±1.6?mmol/L?P>0.03?????????????????110±12.5?mmol/L??106±9.5?mmol/L?P>0.04?????????????????80.0±10.6?mmol/L??95.0±11.2?mmol/L?P>0.0001?????????????????130±7.6?mmol/L??110±9.6?mmol/L?P>0.05???????????????HCO3?????20.0±1.4?mmol/L??29.0±2.1?mmol/L?P>0.002?????????????????38.1±2.5?mmol/L??31.02±3.6?mmol/L?P>0.006??

????????????????????????????????????????????????????????

A 43-year-old male was admitted to our hospital because of renal failure and arterial hypertension. He was followed from the age of 15 years for psychosis and had no familial history of disease. Investigations revealed sensorineural deafness, a microcytic hypochromic anemia with normal ferritin leading to the diagnosis of β thalassemia minor and nephrotic syndrome. Examination of the renal biopsy specimen demonstrated severe Ig A nephropathy. No classic cause of IgA nephropathy was found. Review of literature showed two previous reported cases of Ig A nephropathy associated with β thalassemia minor but without deafness or psychosis. We wonder through this case if an explanation to this association may be made by a genetic defect.

Kidneys are one of the vital organs of body which carry out several important roles in regulating the normal body functions. Its major role is formation of Baul (urine) and execute water and salt balance, and release of hormone. Excess use of antibiotics (chiefly aminoglycosides), NSAIDS and anti-tubercular drugs damage the kidneys. Renal failure is the condition where withholding of metabolic products in response to weakening of function. In recent time its management is by dialysis, kidney transplantation or chemotherapy. This type of treatment is costly and not affordable by everyone. For this solution there are many drugs describe in Unani literature from Mawalide Salasa origin like; plant, mineral and animals that have negligible side effects and easily available their native. The present review attempted to clarify the role of the drug repertoire of the Unani Medicine which are used for the management of amraze kuliya/zofe kuliya scientifically proved useful in treating renal disorders

Acute kidney injury (AKI) previously known as acute renal failure is a common clinical syndrome, with multiple etiologies and a complex array of clinical and biochemical changes. AKI affecting all age groups with increasing incidence in hospitalized patients and associated with significant morbidity and mortality. It is until 2004, when the Acute Dialysis Quality Initiative (ADQI) group proposed RIFLE (risk, injury, and failure, loss of function and end-stage renal failure) as consensus criteria for AKI definition and staging. Subsequent refinements and modifications had been proposed to increase specificity and sensitivity of diagnosis and prognosis, including pRIFLE (for children), AKIN and KDIGO. This review focuses on the recent advances in AKI definitions and classifications and highlights area of limitations and controversies.

Cardiorenal syndrome is an umbrella term referring to all conditions where an acute or chronic dysfunction of heart or kidney may cause acute or chronic dysfunction of other organ. The purpose of this review is to give a brief overlook of this important clinical syndrome.

Over the past 40 years, practice of meditation has increased considerably in the West, and has been used as a complementary therapy for a variety of diseases. Today, it is the third most commonly used complementary alternative therapy in American children and adults. Several studies have shown its beneficial effect on conditions such as depression, anxiety, panic attacks, eating disorders, post-traumatic stress, hypertension and cardiovascular disease. Stress affects the quality of life, not only in patients with chronic kidney disease (CKD) on hemodialysis, but also on their caregivers. A growing number of CKD patients depend on non-professional health caregivers, such as family and friends. However, the needs of caregivers are often neglected and under-prioritized. Considering the heavy burden caregivers of patients with chronic disease need to carry and the lack of intervention studies, the purpose of this study was to evaluate the benefits of the practice of meditation on the level of anxiety and depression in caregivers of children with CKD undergoing hemodialysis.

Background & objectives: Our review discuss the relation between hypertension and the renal system ,and show the cyclic effect of both hypertension and chronic kidney damage on each other, our objectives are to control the high blood pressure with minimal renal affection due to side effects of medications.

Materials & methods: many studies and trials compare between different antihypertensive drugs and their effects on kidneys which may decrease their efficiency.

Results: Angiotensin converting enzyme inhibitor (ACE-Is), angiotensin II receptor blocker (ARBs), Beta-blockers and calcium channel blockers are identified to be the second line of treatment of hypertension according to a network meta-analysis conducted in 2003, ACE-Is were found to show a significant effect in slowing the progression of nephrosclerosis and slower declining of GFR more than β-blocker or calcium channel blocker.

Conclusion: Kidney is indispensable organ in the body that we must protect it from the irreversible macroscopic and microscopic changes pathological as : macroscopic (small size, finely granular surface, adherent and difficulty stripped capsule, fibrotic, atrophic, not demarcated cortex on cut section, thick prominent arterioles and increased peripelvic fat) and microscopic (afferent and efferent arterioles show benign arteriosclerosis, gradual ischemic atrophy and fibrosis of the glomeruli, atrophy of non-functioning tubules related to atrophic glomeruli, may undergo compensatory cystic dilatation of tubule related to functioning glomeruli). ACE-Is is considered the drug of choice in hypertensive patients complicated with chronic kidney disease, In hypertensive patients that are refractory to medical treatment, renal sympathetic denervation is a safe alternative.

Anti-glomerular basement membrane (GBM) disease is characterized by autoantibodies directed against the anti-GBM antigen, which is part of the non-collagenous domain of the alpha 3(IV) collagen chain. These antibodies bind to the GBM and most patients show rapid progressive form of glomerulonephritis. The alveolar basement membrane also contain the anti-GBM antigen, and some patients pulmonary haemorrhage

Objective: To evaluate once-monthly continuous erythropoiesis receptor activator (C.E.R.A.) in patients with chronic kidney disease (CKD) for two years under standard conditions.

Methods: In a non-interventional study, C.E.R.A. was administered according to local practice in patients with dialysis dependent or non-dialysis dependent CKD.

Results: 206 patients were evaluable to month 24. In the dialysis dependent and non-dialysis dependent patients who had received ESA therapy prior to study entry, Hb remained stable from baseline to the end of the study: mean (SD) change was -0.3 (1.5) g/dL (n=148) and 0.3 (1.6) g/dL (n=33), respectively. The mean (SD) dose of C.E.R.A. was 114 (78) μg in dialysis dependent patients and 97 (71) μg in non-dialysis dependent patients at baseline, remaining virtually unchanged during the study (109 (76) μg and 99 (68) μg). During the two-year study, dialysis dependent and non-dialysis dependent patients received a mean of 6.1 and 4.3 dose changes, respectively. Discontinuation due to adverse events was rare (2.9%).

Conclusions: Once-monthly C.E.R.A. is effective and convenient in dialysis dependent and non-dialysis dependent patients with renal anemia under routine conditions for at least two years, and requires few dose changes. C.E.R.A. was well-tolerated with a good safety profile over the two-year study period.