When women during pregnancy and lactation are also complicated with certain diseases, and need to take glucocorticoids and immunosuppressive agents, the doctors should consider not only the efficacy of the drugs, but also the safety of the drugs to the mother, the fetus, and the infant to be fed.Which glucocorticoids and immunosuppressive agents can be safely used during pregnancy and lactation?Which drugs can pass through the placenta to affect the growth and development of the fetus, or to be teratogenic? Which drugs can be secreted into the milk through the breast, acting on newborns or infants?This article gave a more detailed introduction to all of the above topics.

Objective To investigate the clinical features of elderly patients with stage 3-4 chronic kidney disease （CKD） and to analyze the risk factors of the kidney function progression.Methods This was a cross-sectional study. The clinical data of elderly patients （≥60 years）with stable clinical manifestation in Beijing Hospital from January, 2014 to December, 2015 were collected. Based

BackgroundPersistent proteinuria is an important factor contributing to the progression of diabetic nephropathy. The present randomized double-blind placebo-controlled multicenter clinical study evaluated the efficacy and safety of telmisartan combined with the antioxidant probucol in reducing urinary protein levels in patients with type 2 diabetes (T2D).MethodsPatients with T2D and 24-h proteinuria 0.5-3 g were enrolled in the study and randomly assigned to one of two groups: a telmisartan or a probucol + telmisartan group. Both groups were given telmisartan 80 mg q.d. for 48 weeks. The probucol + telmisartan group was given probucol 500 mg b.i.d. for the first 24 weeks, with the dosage then reduced to 250 mg b.i.d. for the remaining 24 weeks. The telmisartan group was given probucol placebo.ResultsIn all, 160 patients were enrolled in the present study. The 24-h proteinuria levels were significantly reduced in the probucol + telmisartan compared with telmisartan group. For patients with baseline 24-h proteinuria levels <1.0 g, both treatments resulted in significant reductions in 24-h proteinuria levels after 48 weeks treatment. However, in patients with baseline 24-h proteinuria levels 1.0 g, 24-h proteinuria levels after 48 weeks treatment were only reduced in the probucol + telmisartan group. There was no significant difference between the two groups for either adverse cardiovascular or other events.ConclusionsIn patients with diabetic nephropathy, probucol combined with telmisartan more effectively reduces urinary protein levels than telmisartan alone.

目的 探讨超纯透析液对维持性血液透析(maintenance bemodialysis,MHD)糖尿病患者的影响.方法 将50例透析龄超过1年的MHD患者根据是否合并糖尿病分为2组(肾炎组,糖尿病肾病组),进行为期6个月的随访,主要监测使用超纯透析液6个月后患者的微生物指标,营养相关指标,炎症指标,包括透析液微生物学质量、β2-微球蛋白(β 2-microglobulin,β2-MG)、血生化指标、C-反应蛋白(C-reactive protein,CRP)、透析充分性和蛋白分解代谢率(protein catabolic rate,PCR)等.结果 本研究共入选肾炎组25例,糖尿病肾病组25例,改用超纯透析液6个月后,细菌和内毒素水平明显改善(t=3.465,P=0.000);患者的血红蛋白(hemoglobin,Hb)、白蛋白(albumin,Alb)明显升高(t=-1.275,P=0.001);PCR水平有所增加(t=-3.332,P=0.000),但是透析充分性无明显变化(t=0.155,P=0.879);CRP水平变化无统计学意义(t=0.022,P=0.881),β 2-MG水平降低(t=3.574,P=0.001).肾炎组改进后的CRP水平明显低于糖尿病肾病组(t=-1.757,p=0.000),但其他各项指标在两组中无明显变化(P＞0.05).多因素分析发现,糖尿病(0R=1.566,95％ CI:1.086～2.257,P=0.016)、干体质量(OR=1.007,95％ CI:1.002～1.013,P=0.009)与CRP变化有关. 结论 改用超纯透析液后,透析液的微生物学质量提高,肾炎及糖尿病肾病患者的营养状态改善,而且肾炎患者的炎症状态改善更加明显.

BACKGROUND To identify the relationship between predialysis pulse wave velocity (PWV), postdialysis PWV during 1 hemodialysis (HD) session, and deaths in maintenance HD patients. METHODS 43 patients were recruited. PWV was measured before and after one HD session and dialysis- related data were recorded. Clinical data such as blood pressure, blood lipids, and blood glucose, were carefully observed and managed in a 5-year follow-up. The association between all-cause death, predialysis PWV, postdialysis PWV, change of PWV (ΔPWV), and other related variables were analyzed. RESULTS After 5 years, 17 patients (39.5%) died. Univariate Cox regression analysis showed that all-cause death of the patients significantly correlated with age, postdialysis PWV, and ΔPWV. Multivariate Cox regression analysis revealed that postdialysis PWV was an independent predictor for all-cause death in these patients (HR: 1.377, 95% CI: 1.146 - 1.656, p = 0.001). CONCLUSION Elevated postdialysis PWV significantly correlated with and was an independent predictor for all-cause death in maintenance HD patients.

Background:The efficacy and safety of telmisartan combined with clopidogrel, leflunomide, or both drugs for immunoglobulin A nephropathy (IgAN) are unclear. This study was designed to evaluate the efficacy and safety of telmisartan combined with clopidogrel, leflunomide, or both drugs for IgAN. Methods:It is a multicenter, prospective, double-dummy randomized controlled trial. Primary IgAN patients were recruited in 13 renal units across Beijing, China, from July 2010 to June 2012. After a 4-week telmisartan (80 mg/d) wash-in, 400 patients continuing on 80 mg/d telmisartan were randomly assigned to additionally receive placebo (Group A), 50 mg/d clopidogrel (Group B), 20 mg/d leflunomide (Group C), or 50 mg/d clopidogrel and 20 mg/d leflunomide (Group D). The 24-week intervention was completed by 360 patients. The primary endpoint was change in 24-h proteinuria at 24 weeks. A linear mixed-effect model was used to analyze the changes at 4, 12, and 24 weeks. Generalized estimating equations were used to evaluate changes in hematuria grade. This trial was registered at the Chinese Clinical Trial Registry. Results:The effects of telmisartan combined with leflunomide on changes in proteinuria (0.36 [95% confidence interval (CI) 0.18–0.55] g/d, P < 0.001), in serum uric acid (76.96 [95% CI 57.44–96.49] &mgr;mol/L, P < 0.001), in serum creatinine (9.49 [95% CI 6.54–12.44] &mgr;mol/L, P < 0.001), and in estimated glomerular filtration rate (−6.72 [95% CI −9.46 to −3.98] ml[BULLET OPERATOR]min−1[BULLET OPERATOR]1.73 m−2, P < 0.001) were statistically significant, whereas they were not statistically significant on changes in systolic and diastolic blood pressure and weight (P > 0.05). Telmisartan combined with clopidogrel had no statistical effect on any outcome, and there was no interaction between the interventions. No obvious adverse reactions were observed. Conclusions:Telmisartan combined with leflunomide, not clopidogrel, is safe and effective for decreasing proteinuria in certain IgAN patients. Trial Registration:chictr.org.cn, ChiCTR-TRC-10000776; http://www.chictr.org.cn/showproj.aspx?proj=8760.

Objective To assess the clinical efficacy of renal artery stent treatment for severe atherosclerotic renalarterystenosis(ARAS).Methods 106patientswithatherosclerosisunderwentpercutaneoustransluminalrenal angioplasty and stenting( PTRAS) were rolled in,which included 60 male and 47 female patients with renal artery ste-nosis >50%in diameter.The followed-up time was 12 months.The level of patient's blood pressure,serum creatinine and estimated—glomerular filtration rate( eGFR) were detected.Results During 12 months of follow up,both systol-ic and diastolic blood pressure level were significantly decreased(P<0.05),and less antihypertensive medication was taken(P<0.05).EGFR remained stable in the process of follow-up.(P<0.05).Conclusion PTRAS is effective for the treatment of hypertension and keep the renal function stabilize in ARAS patients.

Objective To evaluate the clinical effects of renal artery stent revascularization on renal function in elderly patients with atherosclerotic renal artery stenosis (ARAS) and investigate the relationship between renal artery stenosis (RAS) and renal function in patients with renal artery stenosis.Methods Renal angiography has demonstrated atherosclerotic RAS in the 26 patients.All patients underwent nephro-dynamic imaging before and 3 months after operation.Using single kidney glomerular filtration rate (SKGFR) for assessing renal function,the relationship between renal artery stenosis (RAS) and renal function was appraised and the effect of renal artery stent revascularization on renal function was evaluated.Results The SKGFR was lower in the affected kidney with atherosclerotic renal artery stenosis than in healthy kidney[(18.0 ± 9.2) ml/min vs.(22.9 ± 11.1) ml/ min t =2.118,P＜0.05].The renal function in the affected kidney was improved 3 months after operation than before operation,but it had no significant difference (P＞0.05).Conclusions The renal function is damaged in effected kidney in patients with atherosclerotic renal artery stenosis,and it is not significantly improved after renal artery stent revascularization.

目的 研究血液透析(Hemodialysis,HD)患者血浆非对称性二甲基精氨酸(Asymmetric dimethylarginine,ADMA)与透析中血压变化的关系.方法 经生物电阻抗检测干体质量达标且符合入选标准的维持性血液透析(Maintenance Hemodialysis,MHD)患者31名进入研究,根据血液透析过程中血压波动情况分为年龄相匹配的3组:透析中高血压组(n=11)、低血压组(n=12)和血压平稳组(n=8).用酶联免疫吸附(Enzyme linked immunosorbent assay,ELISA)法检测患者透析前、后血浆ADMA水平,探讨ADMA与透析中血压变化的关系,并进行组间矿物质骨代谢指标、电解质、营养指标、炎性标记物、血脂水平、脉压差和降压治疗等的比较.结果 31例MHD患者透析前血ADMA均值为3.37±1.48 u mol/L,透析后降至1.71±0.80 μmol/L(P＜0.001),均显著高于国外正常参考值.透析中低血压组透析前、后血ADMA值(4.38±1.56 μmol/L,2.25±0.83 μmol/L)均高于透析中高血压组和血压平稳组,差异有统计学意义(2.70±1.18 μmol/L,1.32±0.60 μmol/L和2.78±0.88μmol/L,1.43±0.56μmol/L;P=0.006和0.006).透析中高血压组患者透析中的平均脉压差高于透析中低血压组和血压平稳组(62.41±11.57mmHg,48.80±12.88 mmHg和44.56±8.30 mmHg,P=0.004).高血压组碱性磷酸酶(ALP)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)和高敏C-反应蛋白(high-sensitivity c-reactive protein,Hs-CRP)均高于血压平稳组(P值分别为0.036、0.039、0.046、0.046),低血压组同样指标也高于血压平稳组(P值分别为0.046、0.035、0.040、0.004),上述指标在高血压组和低血压组间差异无统计学意义(P＞0.05).结论 在干体质量达标的MHD患者中,血ADMA水平显著高于正常,透析过程中的血压波动与内皮功能不良、血管僵硬、微炎症状态等密切相关.

目的 了解维持性血液透析(maintenance hemodialysis,MHD)患者颈动脉粥样硬化情况,分析该人群颈动脉内中膜厚度(carotid intima-media thickness,CIMT)与血清高敏C反应蛋白(HsCRP)、成纤维细胞生长因子23(fibroblast growth factor 23,FGF23)及Klotho蛋白水平之间的相关性.方法 选取2012年1月至6月期间在卫生部北京医院血液净化中心MHD患者共88例,根据颈动脉彩色多普勒超声检查结果分为CIMT增厚组和CIMT正常组.对CIMT增厚可能的危险因素进行分析,采用非条件Logistic回归分析进行CIMT影响因素的多因素分析.结果 88例MHD患者中CIMT增厚者共53例(60.2％),CIMT正常者共35例(39.8％),2组CIMT中位数分别为1.5mm和1.0mm,有统计学意义(P=0.000).其中CIMT增厚组粥样硬化斑块发生率明显高于CIMT正常组(92.5％比65.7％,P=0.001).CIMT增厚组平均年龄为66.64±10.61岁,CIMT正常组平均年龄为58.63±11.78岁,有统计学意义(t=3.320,P=0.001);CIMT增厚组糖尿病患病率为37.7％,CIMT正常组糖尿病患病率为17.1％,有统计学意义(x2=4.294,P=0.038);CIMT增厚组与正常组FGF23中位数分别为127.82 ng/L和86.74 ng/L有统计学意义(Z=-3.713,P=0.000);2组HsCRP中位数分别为5.34mg/L和2.19mg/L,有统计学意义(Z=-3.547,P=0.000).CIMT增厚组与正常组Klotho蛋白中位数分别为42.48 U/L和41.21U/L,2组无统计学意义(Z=-0.085,P=0.932).非条件Logistic回归分析显示年龄、FGF23和HsCRP是CIMT增厚的独立危险因素.结论 MHD患者伴CIMT增厚者易形成动脉粥样硬化斑块.血清HsCRP、FGF23和年龄是MHD患者CIMT增厚的独立危险因素.

目的 对于终末期肾脏病患者,在何时开始透析治疗仍然是一个未能得到共识的热门问题.本课题旨在研究北京市的终末期肾脏病患者的透析时机是如何变迁的. 方法 所有资料均来自北京市血液净化质量控制中心的2012年度报告.入选条件:①开始透析时间在2007年1月1日～2012年12月31日的所有终末期肾脏病患者;②开始透析前90天内或进入透析后90天内有血肌酐的化验结果.根据进入透析时的血肌酐水平,通过CKD-EPI公式计算得到eGFR,并以此评估透析时机.根据eGFR水平将透析时机分为3组,分别为Group 1[eGFR:0～4.9 ml/(min· 1.73m2)]、Group 2[eGFR:5.0～9.9 ml/(min·1.73m2)]和Group 3[eGFR:10 ml/(min·1.73m2)及以上]. 结果 共有7 200例患者符合入选条件,其平均年龄为57.5±16.0岁,男性占56.3％.自2007年至2012年间,分别有341、682、1 137、1 577、1 886、1577例患者开始透析治疗.比较历年的eGFR分组情况,自2007～2010年,Group 3组的患者比例逐渐升高,至最高峰20.7％,之后下降至2012年的15.6％.Group 2组的患者比例在2012年为最高峰,52.8％.无论哪一个年度,均有一半左右的患者进入透析治疗时的eGFR在5～10 ml/(min· 1.73m2)范围;低于5 ml/(min·1.73m2)进入透析的患者比例约为1/3,明显高于美国USRDS的统计结果. 结论 北京市终末期肾病患者人数近些年仍有持续的增长,透析时机比美国USRDS的报道明显偏晚.

OBJECTIVE:To establish the control charts for early warning of diarrhea based on the syndromic surveillance data from enteric clinic in Beijing.METHODS:The outpatient data from enteric clinic of a Grade Three General hospital in Haidian district, Beijing from April 1 to Oct. 31, 2009 and from May 1 to Nov.10, 2010 were collected, according to the moving average method, the baseline calculated, the value of probability α and μα, the early warning value based on the formula "w=Xj+μαSj" calculated and the early warning control charts drew at last.RESULTS:According to the harmfulness, the severity and controllability of diarrheal diseases, the value of probability α was determined as 0.01, then μα (unilateral) as 2, based on the early warning value, the control charts of diarrheal diseases, bacillary dysentery and other infectious diarrhea were established.CONCLUSION:The enteric clinic requires to further collect baseline data to evaluate and continuously adjust the established control charts for the best early warning model in accordance with the enteric clinic.

肾脏病早期,大多没有症状.如果没有注意尿色的异常、尿量的变化,或没有出现明显的水肿、腰痛,往往就不会引起人们的重视.这时,不进行尿液常规检查的话,很难在早期发现是否患有肾脏病.本文就易患肾脏病的情况及应注意的临床细节进行分析. 中老年人容易罹患继发性肾小球病 中老年人容易罹患继发性肾小球病,例如糖尿病肾病、高血压肾损伤、骨髓瘤肾病等.已经患上了糖尿病、高血压、高脂血症、痛风或高尿酸血症的患者,或是长期吸烟者、肥胖者,如果对血糖、血压、血脂等指标控制不好,逐渐出现了微量白蛋白尿或持续蛋白尿,就说明已经进入了慢性肾脏病阶段.

<正>骨-矿物质代谢异常是慢性肾脏病(Chronic kidney disease,CKD)常见并发症之一。近年来,人们发现成纤维细胞生长因子23(Fibroblast growth factor 23,FGF23)在CKD早期就参与了血磷代谢的调节;并被证实与终末期肾脏病(End stage renal disease,ESRD)患者的高死亡率和高心血管事件发生率相关。本文就FGF23在肾脏病领域的研究进展作一综述。1 FGF23分子结构和生理功能FGF23属于FGFs家族中一员,相对分子质量为32 000,基因定位于染色体12p13,共有3个外显子及2个内含子,编码糖蛋白产物含251个氨基酸,首先切除前24个氨基酸信号肽链,随后经GALNT3酶

BACKGROUND:Family members of patients with end stage renal disease were reported to have an increased prevalence of chronic kidney disease (CKD). However, studies differentiated genetic and non-genetic family members are limited. We sought to investigate the prevalence of CKD among fist-degree relatives and spouses of dialysis patients in China.METHODS:Seventeen dialysis facilities from 4 cities of China including 1062 first-degree relatives and 450 spouses of dialysis patients were enrolled. Sex- and age- matched controls were randomly selected from a representative sample of general population in Beijing. CKD was defined as decreased estimated glomerular (eGFR<60 mL/min/1.73 m2) or albuminuria.RESULTS:The prevalence of eGFR less than 60 mL/min/1.73 m2, albuminuria and the overall prevalence of CKD in dialysis spouses were compared with their counterpart controls, which was 3.8% vs. 7.8% (P<0.01), 16.8% vs. 14.6% (P=0.29) and 18.4% vs. 19.8% (P=0.61), respectively. The prevalence of eGFR less than 60 mL/min/1.73 m2, albuminuria and the overall prevalence of CKD in dialysis relatives were also compared with their counterpart controls, which was 1.5% vs. 2.4% (P=0.12), 14.4% vs. 8.4% (P<0.01) and 14.6% vs. 10.5% (P<0.01), respectively. Multivariable Logistic regression analysis indicated that being spouses of dialysis patients is negatively associated with presence of low eGFR, and being relatives of dialysis patients is positively associated with presence of albuminuria.CONCLUSIONS:The association between being family members of dialysis patients and presence of CKD is different between first-degree relatives and spouses. The underlying mechanisms deserve further investigation.

Objective To understand the blood pressure variability (BPV) and the influencing factors through ambulatory blood pressure monitoring during hemodialysis (HD) in the end-stage renal disease (ESRD) patients.Method Eighty-one ESRD patients on maintenancing HD for more than three months were enrolled into the study.The patients were with properly dry body weight.The blood pressure was monitored using dynamic blood pressure monitor around the HD.BPV was estimated with the coefficient of variation (CV) and standard deviation (SD) of the systolic blood pressure (SBP-CV,SBP-SD).Patients were divided into two groups according to the mean of SBP-CV:high SBPV group and low SBPV group.The possible influencing factors such as age,dialysis duration,ultrafitration volume,ultrafiltration/body weight,therapy of antihypertensive,electrolyte,nutrition state,metabolic bone disease indexes,inflammatory state and serum lipid state were analyzed and compared between the two groups.And multivariate stepwise regression analysis was made between the SBP-CV,SBP-SD and the above observational parameters.Results The average SBP-CV of the 81 patients was (8.12± 3.16)％,SBP-SD was (11.22±4.55) mm Hg.The proportion of hypertention and hypotention in high SBPV(SBP-CV≥8.12％) group (20.0％,25.7％) was higher than that in the low SBPV(SBP-CV ＜8.12％) group (8.7％,6.5％)(P =0.009).Serum high-sensitivity c-reactive protein (hs-CRP) and alkaline phosphatase (ALP) were higher in high SBPV group than that in the low SBPV group[(7.19± 5.95) mg/L vs (3.35±2.78) mg/L,P =0.001 and (180.31±96.32) U/L vs (98.00±41.19) U/L,P =0.049].Serum creatinine and potassium were higher in the low SBPV group than that in the high SBPV group [(1015.83±276.20) μmol/L vs (893.63±216.61) μmol/L,P =0.034 and (5.27±0.78) mmol/L vs (4.80± 0.23) mmol/L,P =0.005].SBP-SD was positively correlated with hs-CRP (β =0.499,P ＜ 0.01),SBP-CV was positively correlated with hs-CRP and dialysis vintage (β =0.464 and 0.211,P ＜ 0.01 and P ＜ 0.05) by the multivariate stepwise regression analysis.Conclusions The SBP-CV during HD is 8.12％ in ESRD patients.Hypertention and hypotention are more often in the higher SBPV patients.SBPV is closely related to the serum hs-CRP.

<正>病例患者为42岁育龄期女性,以"皮疹、多关节痛伴尿检异常6年,持续便血10d"入院。患者6年前出现皮疹、多关节痛、口腔溃疡伴发热、乏力,在外院查ANA、ds-DNA、Sm抗体阳性,尿蛋白(++),并行肾穿刺示LN-IV型,诊断为"SLE-LN",给予糖皮质激素、环磷酰胺、吗替麦考酚酯片等药物治疗,病情逐渐缓解。此后患者因自行停药、感染等因素再发3次。2012年

Drugs are a double-edged sword, which can both treat the disease and cause damage to kidney and other organs. The predisposing factors of drug-induced renal injury include lack of effective volume of circulating blood, the original kidney damage, the elderly, and the joint use of nephrotoxic drugs. Early drug-induced renal injury may not show obvious symptoms, signs, or only show abnormal levels of biomarkers such as urinary neutrophil gelatinase-associated lipocalin(NGAL), kidney injury molecule-1(Kim-1), and interleukin-18(IL-18), etc. During the course of medication, regular test of these indicators will help early detection of drug-induced renal injury. To prevent or reduce drug-induced renal injury, we should be familiar with the drug features, adverse drug reactions as well as the patients' physical condition, strictly control the medication indications, and adhere to rational use of drugs.

<正>心血管疾病是慢性肾脏病患者致残和死亡的主要原因,约占透析患者死亡原因的50%,透析患者心血管疾病所致的死亡率是普通人群的10～30倍[1]。终末期肾脏病患者存在多方面心血管疾病的危险因素:①传统的心血管疾病危险因素如年龄、性