Kidney tubular damage caused by ischemia-reperfusion injury is considered the major cause of delayed graft function (DGF) after renal transplantation. It is not clear whether early generated de novo donor specific antibodies (DSA) play a role in DGF. Here, we report 2 cases of renal transplant with DGF, which seems to be associated with de novo DSA. When the early produced de novo DSA are not potent enough to mediate acute rejection, they may cause mild intra-graft injury, which has a significant impact on the degree of DGF and its recovery. Antibody-targeted therapy seems to be beneficial to the recovery of patients with DGF.

目的 探讨两种穿刺方法对维持性血液透析患者内瘘并发症发生率和疼痛的影响.方法 选择维持性血液透析患者78例,将其中的58例随机分为观察组和对照组各29例.观察组采用顺血流方向针尖斜面向下穿刺方法,对照组采用顺血流方向针尖斜面向上穿刺方法,比较两组血管瘤、血栓、内瘘狭窄发生率.将剩余的20例患者实施自身对照研究,分别采用顺血流方向针尖斜面向下和顺血流方向针尖斜面向上穿刺各20次,采用数字疼痛强度量表记录患者疼痛感受.结果 观察组内瘘狭窄发生率显著低于对照组(P＜0.05);顺血流方向针尖斜面向下穿刺疼痛程度显著低于顺血流方向针尖斜面向上穿刺(P＜0.01);两种穿刺方式的再循环率均为零,对患者透析质量无影响.结论 对维持性血液透析患者采用顺血流方向针尖斜面向下穿刺动静脉内瘘,可有效保护动静脉内瘘,减少并发症发生,缓解穿刺时疼痛,不影响透析质量.

自体动静脉内瘘（arteriovenous fistula）是慢性肾衰竭维持性血液透析病人重要的血管通路,有效的血管通路是保证透析效果的重要因素。自体动静脉内瘘是将体表较浅的静脉在皮下直接与自体动脉吻合形成血管通路。由于其具有维持时间长及感染、出血、栓塞等并发症少的优点,而在临床上应用的最为广

Objective To recognize the characteristics of acute antibody-mediated rejection (AAMR) after kidney transplantation and to investigate the factors influecing the prognosis of AAMR after treatment.Method Three patients with negative cytotoxic cross-match developed early AAMR after kidney transplantation from Jan.2011 to Aug.2012.Pretransplant panel-reactive antibodies (PRA) were strong positive in 1 patient against class Ⅱ and negative in 2 patients who had positive PRA previously.All 3 patients had marked increase of PRA within 1 week post-transplantation and the renal allograft function deteriorated rapidly.After the diagnosis,plasmapheresis (PP)/intravenous immunoglobulin (IVIG) or combined with Bortezomib was used to treat AAMR.Result One patient underwent nephrectomy because of severe hemorrhage in the allograft at the time of diagnosis.One patient treated with PP/IVIG 4 times achieved a full recovery of renal function at postoperative day (POD) 50,while the rest failed to respond to PP/IVIG/Bortezomib treatments 5 times and the allograft had to be removed at POD 24 due to extensive hemorrhage and ischemic necrosis.Conclusion HLA sensitized patients are at high risk of AAMR after kidney transplantation,even with a negative pretransplant PRA.Immediate HLA antibody screening and allograft biopsy are needed to identify AAMR when the allograft represents non-function or early impaired function.PP/IVIG may be effective to treat AAMR,and the prognosis of AAMR depends on the time of when the treatment is started and the severity of antibody-mediated injury in the grafts.

由于移植肾功能的慢性减退,半数受者的移植肾存活时间不超过10年,因此近年来肾移植后恢复血液透析和等待再次移植的病例数明显增加.这些受者往往因前次移植而产生不同程度的致敏,其中高致敏者[群体反应性抗体(PRA)≥80％]不仅因广泛和高水平的抗HLA抗体而难以找到合适的供者,而且再次移植后更易发生排斥反应。

Objective To investigate the correlation between inflammation status and uremic pruritus in maintenance hemodialysis (MHD) patients. Methods Thirty-nine MHD patients and twelve healthy controls were recruited to the study. We inquired of MHD patients about the severity of their pruritus by visual analog scale (VAS). Blood samples were taken before and after hemodialysis during the inquiry day. Inflammatory factors including interleukin (IL) -2, IL-6, IL-10, tumor necrosis factor (TNF) were measured by Cytometric Bead Array. Results Preand after-dialysis levels of IL-2, IL-6, IL-10 and TNF and pre-dialysis level of hsCRP were significantly higher in MHD patients than in healthy controls, and these levels had no significant correlation with age or sex. Spearman rank correlation analysis and linear regression analysis showed that pre-dialysis IL-2 level was positively correlated with VAS score (β=0.586, t=4.399, F=19.354, P< 0.01). Based on VAS score, MHD patients could be divided into 3 groups, no pruritus group (VAS=0.38%), mild to moderate pruritus group [VAS=1～5(41%)], and severe pruritus group [(VAS> 5(21%)]. Preand after-dialysis IL-2 levels were significantly higher in severe pruritus group than in no pruritus group. Conclusion A higher prevalence of uremic pruritus was found in MHD patients. Inflammation plays an important role in the pathogenesis of uremic pruritus. IL-2 closely relates to uremic pruritus in MHD patients.

Objective To explore the effect of two puncture methods on the puncture difficulty,puncture ease and puncture-related pain of hemodialysis patients so as to provide theoretical proof for the clinical application of button-hole method.Methods Totals of 33 cases were divided into baseline stage and follow-up stage.In baseline stage,rope-ladder puncture method was applied,and in follow-up stage,button-hole puncture method was used.Repeated puncture times,puncture stress,puncture-related pain,compression time after needle removal,infiltration occurrence after needle removal,infection occurrence,aneurysm formation,thrombosis formation were recorded.Results Compared with rope-ladder puncture,button-hole method decreased puncture difficulty and reduced the repeated puncture times.And the incidence of bad sticks was significantly decreased from (0.8 ± 1.4) to (0.3 ± 0.6),with significant difference (t ＝ 1.89,P =0.043 8).Button-hole method reduced the puncture stress,and the VAS score was reduced from (2.9 ± 2.4) to (1.3 ±1.2),with significant difference (t =3.42,P =0.001 0).Button-hole method abated the puncture-related pain,but no significant difference was found between them [(1.6 ± 2.0) vs (2.3 ± 2.2)],with no difference (t =1.35,P =0.181 0).Button-hole method protected the fistula appearance efficiently,and not increased the infection occurrence,aneurysm formation and thrombosis formation.Conclusions For a patient with a limited space to puncture,or with frequent puncture,or with severe puncture stress,button-hole method is good method,because it can decrease puncture difficulty and reduce repeated puncture times,reduce the puncture stress and protect the fistula appearance efficiently.

Objective To investigate actual blood flow rates of different permanent dual-lumen catheters in hemodialysis,to identify recirculation rates under different blood flow rates and connection methods,and to provide information for clinical application of permanent dual-lumen catheters. Methods Fifty six patients who needed permanent dual-lumen catheters for hemodialysis were divided into two groups according to catheter types: 30 patients in Permcath group and 26 patients in Tal Palindrome TM group.The actual blood flow rates were monitored by transonic HD02 hemodialysis monitor,and the recirculation rates were measured under both normal and reverse connections when blood flow rates of dialyzer were set at 150,200,250,300,and 350 mL/min. Results No matter what connections we applied,the actual blood flow rates of both catheters could achieve requirements of pre-set pump flow rates;no statistical differences were found in the actual flow rates between normal connection and reverse connection at diffe-rent pre-set pump flow rates(P>0.05 for all).There was hardly any recirculation when dialyzer blood flow rates ranged from 150 mL/min to 350 mL/min under normal connection.Under reverse connection at different pre-set pump flow rates,there were no significant differences in recirculation rates within group(P>0.05 for both),while recirculation rates of the Permcath group were significantly higher than those of the Tal Palindrome TM group(P<0.01 for all). Conclusion Blood flow rates in hemodialysis by using these two permanent dual-lumen catheters can meet requirements of pre-set pump flow rates,and no recirculation appears in both catheters under normal connection.Recirculation rates are lower in Tal Palindrome TM catheter under reverse connection,and recirculation would not increase along with the increment of blood flow rates.We recommend reverse connection of catheters should be avoided,and in order to guarantee hemodialysis effect blood flow rates should be increased if reverse connection is needed.

Objective To evaluate the feasibility and safety of heparin-free anticoagulation in continuous venovenous hemofiltration(CVVH) for patients at high risk of hemorrhage.Methods Using self-control method,40 cases of high bleeding tendency patients with CVVH treatments were divided into two groups.In the experimental group(odd day),68 sessions were treated with modified heparin-free anticoagulation,while 68 sessions in control group(even day) with traditional heparin-free anticoagulation without heparinization.Comparisons were conducted on effective treatment time,priming volume of saline solution,actual ultrafiltration volume,the difference of some clinical parameters between pre and post treatments,filter and venous chamber coagulation between the two groups.Results There were statistic differences on effective treatment time,priming volume of saline solution,actual ultrafiltration volume,the differences of some clinical parameters between pre and post treatments and filter and venous chamber coagulation(P0.01).Conclusion It is safe and effective for high bleeding tendency patients with CVVH treatment when we take the improved method and implement the routine nursing cooperatively.Furthermore,it can increase the effective treatment time,decrease the priming volume of saline solution,raise the actual ultrafiltration volume,reduce the possibility of filter and venous chamber coagulation and relieve the nurse' workload and also be cost-saving.

目的探讨双重血浆滤过(DFPP)治疗难治性重症肌无力患者的护理方法。方法对29例难治性重症肌无力患者进行DFPP治疗119次,平均4.1次,总结其临床资料及护理方法,包括治疗前、后1个疗程空腹血标本AChR-Ab水平;治疗前、后第1天及治疗后第7天的临床绝对评分,并根据临床相对积分法判断临床效果;治疗前做好心理护理,选择合适的血管通路,充分抗凝;治疗中严密监测并记录生命体征的变化和仪器显示的各种参数;治疗后健康指导等。结果痊愈10例,显效14例,好转4例,无效1例,总有效率82.8%;治疗前、后AChR-Ab水平有显著差异(P<0.01)。119次治疗过程中发生不良反应5次(4.2%)。结论DFPP能有效降低重症肌无力患者体内AChR-Ab水平,缓解临床症状,合理的护理干预措施可使治疗安全有效。

Objective To examine the association of arteriovenous fistula (AVF) blood flow (Qa) dynamics with inflammation state and its effect on cardiovascular diseases (CVD) in maintenance hemodialysis (MHD) patients.Methods Thirty MHD patients with AVF and twelve healthy people were enrolled in the study.Qa and cardiac output (CO) were measured by Transonic Hemodialysis Monitor HD 02.In MHD patients,pre-dialysis blood samples were taken before Qa monitoring.High-sensitivity C-reactive protein (hsCRP) was measured by immunoturbidimetry (Kyoma,Japan).Inflammatory factors IL-2,IL-6,IL-10,TNF were measured by Cytometric Bead Array (BDTM).Cardiovascular diseases morbidity was monitored prospectively within nineteen months follow-up period.Results There were no significant differences in age and sex between MHD patients and healthy people.The serum IL-6,IL-10,TNF and hsCRP were significantly higher in MHD patients than those in healthy controls [2.38 (1.86-4.69) vs 1.14 (0.27-1.18) ng/L,P＜0.01; 1.47 (1.19-2.10) vs 1.04 (0.00-1.23) ng/L,P＜0.01; 1.33 (1.05-1.56) vs 0.54 (0.00-1.24) ng/L,P＜0.05; 4.90 (1.58-7.45) vs 1.50 (0.63-1.90) mg/L,P=0.01].During the follow-up period,6 patients (20.0％) developed at least one episode of cardiovascular event.Qa,serum IL-6 and hsCRP levels were significantly higher in patients with CVD as compared to those without CVD [(1120±192) vs (893±189) ml/min,P＜0.05; 4.86 (2.96-7.85) vs 2.20 (1.80-3.10) ng/L,P＜ 0.01;11.75 (3.83-31.53) vs 4.45 (1.05-6.68) mg/L,P＜0.05].Binary Logistic regression analysis demonstrated that serum IL-6 was an independent and stronger risk factor for CVD morbidity [HR=1.943,95％CI (1.110-3.402),P=0.02].Spearman rank correlation analysis and liner regression analysis showed that Qa was positively correlated with serum IL-6 (β=0.492,P＜0.01).Path analysis suggested that Qa contributed to CVD mortality via the increase of serum IL-6.Conclusions AVF blood flow monitoring is important for MHD patients.IL-6 is an independent risk factor of CVD in MHD patients.AVF blood flow increases cardiovascular diseases morbidity in MHD patients via its promotion of IL-6 production.

目的探讨血浆置换(PE)联合连续性血液净化(CBP)治疗小儿重症溶血性尿毒症综合征的疗效及护理方法。方法对11例重症溶血性尿毒症综合征患儿进行PE联合CBP治疗53例次,平均4.7(3～7)次/例。治疗前准确进行护理评估;治疗中密切监护,建立及维护好血管通路,积极防治并发症。结果 8例好转或治愈,2例死亡,1例放弃治疗出院失访。结论 PE联合CBP治疗小儿重症溶血性尿毒症综合征疗效好,密切观察病情及合理的护理措施能保证治疗的安全及有效。

目的 探讨改良式吸附法无肝素联合盐水冲洗法在高危出血倾向患者血液透析(HD)应用中的可行性和安全性.方法 将48例具有高危出血倾向行无肝素血液透析(HFHD)治疗的患者随机分为观察组和对照组,对照组采用传统无肝素法治疗78例次,观察组采用改良式无肝素法治疗78例次.比较两组患者治疗前后血红蛋白(Hb)、凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、血小板计数(PLT)、血浆纤维蛋白原(Fbg)的变化,观察两组患者有效治疗时间、生理盐水冲洗量、净超滤量、体外循环凝血及治疗后出血并发症情况.结果 两组治疗前后Hb、PT、APTT检测结果组内比较差异无统计学意义(均P＞0.05)；对照组治疗前PLT、Fbg分别为(88.66±40.57) ×109/L,(3.28±1.24)g/L,治疗后分别为(70.16±38.64)×109/L,(2.65±1.27)g/L,前后比较差异均有统计学意义(t=2.916,3.135；P＜0.01)；观察组治疗前PLT、Fbg分别为(88.59±40.76)×109/L,(3.26±1.26) g/L,治疗后分别为(70.18±37.94)× 109/L,(2.67±1.25)g/L,前后比较差异有统计学意义(t=2.920,2.936;P ＜0.01).两组间Hb、PT、APTT、PLT、Fbg比较差异无统计学意义(均P＞0.05).两组有效治疗时间、生理盐水冲洗量、净超滤量、透析器和静脉壶凝血情况比较,差异均有统计学意义(P＜0.01).两组无一例诱发或加重出血.结论 对高危出血倾向患者行HFHD治疗,采用改良式吸附法无肝素联合盐水冲洗的方法,不但能起到安全有效的抗凝效果,还可延长有效治疗时间、减少生理盐水冲洗量、增加净超滤量、降低透析器和静脉壶凝血发生率、减轻护理工作量、节约成本；科学有效的护理配合是治疗成功的保证。

Objective Explore the complications related to long-term deep venous catheterization and nursing care. Methods 109 cases with long-term deep venous catheterization from october 2002 to October 2009 were analyzed retrospectively. Incidence and treatment of complication related to long-term deep venous catheterization,time of catheter use and causes of catheter withdrawal were observed and recorded. Results The average time of catheter use was ( 19. 8 ± 10. 7) months. 57 cases had catheter withdrawal (52. 3% ), with average time of catheter use of (9.8 ±7.5) months. 22 out of 109 cases (20.2%) had infection related to catheterization, including 17 cases of bacteria infection and 5 cases of fungi infection. 11 cases had catheter thrombosis ( 10. 1% ), 4 cases had catheter malposition(3.7% ) and 3 cases had cuff falling out (2. 8% ). Conclusions Infection related to catheterization,catheter thrombosis and catheter malposition are the most common complications. Proficient skill of catheterization and intensive nursing care could decrease the incidence of complications related to catheterization and increase the time of catheter use.

Objective To explore the effect of food intake at different time on blood pressure in the process of hemodialysis.Methods Totally,289 hemodialysis sessions were collected from 39 maintenance hemodialysis patients who had hypotension frequently du-ring hemodialysis.These hemodialysis sessions were divided into three groups:group I included 109 sessions,and the food intake were prohibited in the process of hemodialysis;group Ⅱ had 88 sessions,in which patients took food at 1.5-2.0 hours of hemo-dialysis.The remaining 92 sessions were collected in group Ⅲ,and these patients took food at 3.5 hours of hemodialysis.The food taken weighted no more than 500 g.Results The difference of mean arterial pressure(MAP)before and after food intake,the changes of relative blood volume(ΔRBV),and total volume of ultrafiltration(UF),the minimal MAP,rates of hypotension and symptomatic hypotension had significant differences among the 3 groups(P<0.01 for all).Compared with the other two groups,the differences in the above mention parameters in group Ⅲ were most significant(P<0.0125).The proportion of unexpected termination of dialysis among the 3 groups had no significant differences(P>0.05).Conclusion For hypotension-prone patients,food intake at 1.5-2.0 h of hemodialysis can be helpful to avoid hypotension.

对20例重症肌无力患者给予药物治疗的同时采用二重滤过治疗。治疗前评估患者生命体征及凝血指标,做好心理护理及健康教育,留置股静脉双腔导管建立血管通路;治疗中密切观察及时调整治疗参数,预防低血压;治疗后正确封管,预防交叉感染等。结果患者四肢肌力及吞咽困难明显改善,临床痊愈15例,基本痊愈3例,显效1例,好转1例。提出二重滤过治疗重症肌无力能迅速改善症状,治疗中需密切关注仪器参数变化和患者生命体征,以确保患者安全。

Objective To evaluate the effects and safety of amlodipine combined with bisoprololin for the treatment of renal hypertension. Methods Fifty-one patients with renal hypertension were randomly divided into two groups. 28 Patients in the control group were treated with amlodipine 5.0 mg q12 h,while 23 in the treatment group were treated with amlodipine 5 mg qd and bisoprolol 2.5-5.0 mg qd for eight weeks. Blood pressure,heart rate and renal function were monitored before and after treatment. Results The total antihypertensive effective rates were 67.9% and 82.6% in the control and treatment group,respectively. There were no significant changes in heart rate and renal function before and after treatment in both groups and no obvious adverse events occurred. Conclusion Amlodipine combined with bisoprolol was efficient and safe for the treatment of renal hypertension,and was more effective than amlodipine used alone.

OBJECTIVE:To study the effects of Carthamus tinctorius on oxidative stress of kidney in rats with type 2 diabetes mellitus. METHODS:Type 2 diabetes mellitus rat model was developed successfully by unilateral nephrectomy and giving high lipid and high glucose diet and low dose streptozotocin (STZ). Then the model rats were randomly divided into four groups:control group,model group,low-dose and high-dose Carthamus tinctorius groups. After treatment for 12 weeks,biochemical indicators,urinary albumin excretion rate (UAER),the activities of superoxide dismutase (SOD) and Glutathione peroxidase (GSH-PX) and the content of malonaldehyde (MDA) in the renal tissue,and the mRNA gene expressions of both P22phox and P47phox in renal cortex were measured. RESULTS:Compare with model group,Carthamus tinctorius-treated groups (high-dose and low-dose) showed no significant difference in blood glucose level,but much significant decrease in levels of serum creatinine,urea nitrogen and UARE,significant increase in SOD and GSH-PX activities,much significant decrease in MDA content and significant downregulation of mRNA expressions of both P22phox and P47phox. CONCLUSION:Carthamus tinctorius-treatment can mitigate the oxidative stress of renal cortex to play protective effect on kidney and delay the development of diabetic nephropathy.

This is a case of one patient who was treated with a bortezomib-based desensitization regimen to treat sensitization obtained though a previous transplant lost to chronic rejection. This regimen successfully convert a positive crossmatch to negative, prevented both hyperacute and acute rejections out to 3-months post transplant, and was without any noticeable side effects. This account demonstrates that desensitization by bortezomib combined with plasmapheresis and low-dose IVIG is a possible way to transplant a highly sensitized patient.

Objective To study the effects and mechanism of GABA on tubular interstitial fibrosis in chronic renal failure rats. Methods The model of chronic renal failure was induced by 5/6 nephrectomy in rats.The nephrectomized rats were randomly allocated to the GABA treatment group and model group.The rats with sham operation served as control.BUN and Scr were determined,and renal pathological changes were evaluated at the 60th day after operation.Immunohistochemistry was used to examine the expression of TGF-β1 and TIMP-1 and RT-PCR was applied to test the mRNA expression of TIMP-1. Results Compared with the model group,the renal function in GABA treatment group was ameliorated,the tubular interstitial fibrosis and atrophy were lessened significantly,while the effects on glomeruli were less. Conclusion GABA may have a beneficial effect on renal function in nephrectomized rats by inhibiting fibrosis and atrophy primarily in tubuli and tubular interstitium.