慢性肾病、慢性肾功能衰竭全方位审视

慢性肾痛(CKD)、慢性肾功能衰竭(CRF)是全身性疾病在肾脏的表现、特别与血管性免疫性和代谢性疾病相关.肾脏又是一个排泄器官,中西药的过度应用,尤其是具有毒性药物如雷公藤类、抗生素类累积性损伤肾脏.所以,根本性控制在于预防和少用药物.近年来因为应用了肾替代疗法、包括肾移植带来一些社会、经济、生活质量、移植肾来源等问题.本文以全新的理念提出质疑且对其共性治疗重新评估替代疗法,并重视个案分析对某些肾病的病名提出它的概念的非合理性,对其共性治疗的误导应予以反思.最后,建议逐步改变单纯生物医学模式的替代疗法,重视整体全方位地发挥自身潜在调节力量缓解或治愈或延长寿命,这样可以大大地减少CKD、CRF、ESRD的发病率.     

慢性肾病、慢性肾功能衰竭全方位审视

慢性肾病（CKD）、慢性肾功能衰竭（CRF）是全身性疾病在肾脏的表现、特别与血管性免疫性和代谢性疾病相关。肾脏又是一个排泄器官,中西药的过度应用,尤其是具有毒性药物如雷公藤类、抗生素类累积性损伤肾脏。所以,根本性控制在于预防和少用药物。近年来因为应用了肾替代疗法、包括肾移植带来一些社会、经济、生活质量、移植肾来源等问题。本文以全新的理念提出质疑且对其共性治疗重新评估替代疗法,并重视个案分析对某些肾病的病名提出它的概念的非合理性,对其共性治疗的误导应予以反思。最后,建议逐步改变单纯生物医学模式的替代疗法,重视整体全方位地发挥自身潜在调节力量缓解或治愈或延长寿命,这样可以大大地减少CKD、CRF、ESRD的发病率。     

慢性肾功能衰竭治疗的思考

慢性肾功能衰竭治疗的思考湖南医科大学附属二院肾内科博士生（４４１００１１）彭佑铭慢性肾衰是一个临床综合征。由各种慢性肾脏疾病晚期,肾单位毁损到一定程度时,引起肾功能减退,临床上出现水、电解质紊乱和酸碱失衡及代谢毒素所致全身中毒症状。该病在我国发病率...     

从慢性肾功能衰竭治疗技术的发展看科学发展与伦理矛盾的解决

1　伦理问题伴随着技术的产生而产生慢性肾功能衰竭是一个综合征 ,是由于各种慢性肾脏疾病逐渐恶化、功能衰竭所致。病情发展缓慢 ,不可逆转 ,预后差。对这种疾病的治疗是从无知到有知、从无效到有效的过程。在半个世纪以前 ,人们已作了种种尝试和大量试验来治疗肾功能衰竭。主要是给予诸如花生油、葡萄糖、奶酪等高热量无蛋白食品、控制蛋白摄入、利尿治疗 ;这些治疗办法对病情的发展并无直接的控制作用 ;在当时甚至应用过一些十分原始的方法 ,比如热疗、热浴、发汗、放血等疗法。所有的慢性肾功能衰竭的病人都以死亡告终。1913年美国人阿…     

终末期肾病治疗方法的比较

终末期肾病是各种病因所致的慢性肾脏疾病的最终阶段.血液透析、腹膜透析和肾移植是目前临床上治疗终末期肾病的主要肾脏替代疗法,针对三者的优缺点,从治疗方式、疗效、费用等方面进行比较,研究结果显示肾移植的治疗效果在整体上优于CAPD和血液透析,持续性非卧床腹膜透析(CAPD)的治疗效果略优于血透,肾移植是成本-效果比最好的ESRD替代治疗方法.     

慢性肾脏病患者心理状态研究进展

慢性肾脏病是一种很难治愈的一种疾病,绝大多数的患者需要中西医结合治疗。患有慢性肾脏病的患者最终需要肾脏替代疗法来缓解症状,如透析治疗或选择肾脏移植。巨大花费同疾病本身使患者身心均受到很大的压力,CKD患者抑郁、焦虑情况普遍存在,影响患者生存质量、营养状态和治疗配合性及疾病的预后,因此解决其心理问题至关重要。     

难治性丙型肝炎研究新进展

随着聚乙二醇化干扰素（IFN）的普及应用和慢性丙型肝炎规范化治疗的开展,其治愈率不断提高.但疗效不佳的慢性丙型肝炎患者不断积累,难治性慢性丙型肝炎患者成为临床医生必须面对的挑战.难治性丙型肝炎患者应当分为两类,第一类为“难治疗”性慢性丙型肝炎患者,该类患者由于宿主条件限制,不能耐受IFN联合利巴韦林（RBV）的标准治疗,如儿童和老年人、慢性肾功能衰竭患者等.第二类为“难治愈”性慢性丙型肝炎患者,该类患者可以耐受标准治疗方案,但按照应答指导的治疗原则（RGT）治疗后,效果仍然不佳或复发.本文就近年关于难治性丙型肝炎的研究进展,从难治性丙型肝炎的定义、机制、治疗诸方面作一综述.     

难治性丙型肝炎研究新进展

随着聚乙二醇化干扰素(IFN)的普及应用和慢性丙型肝炎规范化治疗的开展,其治愈率不断提高.但疗效不佳的慢性丙型肝炎患者不断积累,难治性慢性丙型肝炎患者成为临床医生必须面对的挑战.难治性丙型肝炎患者应当分为两类,第一类为“难治疗”性慢性丙型肝炎患者,该类患者由于宿主条件限制,不能耐受IFN联合利巴韦林(RBV)的标准治疗,如儿童和老年人、慢性肾功能衰竭患者等.第二类为“难治愈”性慢性丙型肝炎患者,该类患者可以耐受标准治疗方案,但按照应答指导的治疗原则(RGT)治疗后,效果仍然不佳或复发.本文就近年关于难治性丙型肝炎的研究进展,从难治性丙型肝炎的定义、机制、治疗诸方面作一综述.     

论开展亲属活体供肾移植的风险与对策

肾脏移植是救治终末期肾功能衰竭的最佳手段。亲属活体捐献肾脏是扩大供肾来源的有效手段。当前国内开展亲属肾移植存在伦理、法律和健康风险,主要来自供体和医疗两方面。为防范风险,医务人员应严格审查供受者的血缘关系,签署完整规范的法律文书,进行全面细致的术前评估,制定完善的手术方案。     

教育在慢性肾小球肾炎治疗矛盾中的作用

慢性肾小球肾炎 (以下简称慢性肾炎 )是一种常见病、多发病 ,对人体的健康和生命危害极大 ,是具有进行倾向的慢性肾脏炎症 ,它的发展速度与保养和治疗良好与否密切相关。慢性肾炎治疗的目的是防止和延续肾功能进行性减退 ,延长肾功能代偿期的时间 ,提高患者的生活质量[1 ] 。目前采取饮食调节、对症治疗、教育等综合措施来控制病情。而教育在慢性肾炎治疗中有着药物不可比拟的作用 ,它能把有关的医学成果化成患者的医学知识 ,发挥他们的主观能动性 ,为彻底解决这些矛盾提供前提条件。具体体现在以下几个方面。1　调节饮食———教育患者勿看…     

瑶医学“心肾相交论”内涵及临床指导意义

“心肾相交论”是瑶医药理论的脏腑生命观,心主要的功能是主宰其他脏腑的生理机能,对人的心理活动也进行调节;肾是气血化生之根源.如果心功能受损,那么其调节作用减弱,瑶医的整体观内涵得不到体现,人体作为一个整体的属性就不复存在,人体就会进入病理状态,甚至危及生命.对于肾,瑶医学认为人的出生、生长、发育和成熟直至衰老死亡的过程,是肾“气化”功能由盛到衰的自然过程.“心肾相交论”强调心肾功能的正常是人保存生命最基本的前提.通过探讨“心肾相交论”的学术思想,用以指导临床医疗实践,提高对瑶医药理论的认识.     

Bio-X: Removing Bodily Contingency in Regenerative Medicine

This paper addresses the social, cultural, and ethical dynamics of research in regenerative medicine. The author turns to both science fiction and recent developments in regenerative medicine for clues about the future of the body and medical practice, suggesting that regenerative medicine uses the body as its own resource for the purposes of preserving life, and that by attempting to remove the body from the limitations of both mortality and contingency, regenerative medicine fundamentally alters the meaning of “human.”     

Neurocognitive outcomes in children with chronic kidney disease: Current findings and contemporary endeavors

Given the rise in chronic kidney disease (CKD) in both children and adults, CKD has recently been targeted as a public health priority. Childhood onset kidney disease is generally a noncurable and progressive condition that leads to kidney failure by early adulthood. Fortunately, improved identification of kidney problems allows for early intervention, which is thought to slow progression toward end-stage renal disease. In addition, medical interventions for pediatric end-stage renal disease have also improved, allowing children to take advantage of lifesaving renal replacement treatments such as dialysis and kidney transplantation. In spite of improvements in identification and treatment, CKD causes both direct and indirect insults to a variety of organ systems. This paper reviews recently published studies pertaining to the neurocognitive and psychosocial impact of CKD on children of various ages and at various stages of kidney failure. Specific attention is focused on summarizing peer reviewed research that describes associations between kidney functioning and cognitive functioning, language acquisition, visual spatial abilities, memory, and executive functioning. In addition, peer reviewed research describing psychosocial outcomes associated with CKD related to academic achievement, social-behavioral functioning, and quality of life are summarized. The authors also identified disease-specific factors that likely mediate neurocognitive outcomes (e.g., anemia, hypertension, cardiovascular) and endorse the importance of continued interdisciplinary research collaborations that will provide a better understanding of the mechanisms responsible for improved neurocognitive functioning after transplantation. The authors conclude this review by describing a multicenter, prospective, longitudinal, National Institutes of Health funded study that is currently examining the developmental outcomes of children with mild to moderate CKD. The authors speculate that the Chronic Kidney Disease in Children Prospective Cohort Study (CKiD) findings will provide additional evidence-based guidance for clinicians and researchers working with children and adolescents with deteriorating kidney function to improve medical and developmental outcomes.     

Adult Chronic Kidney Disease: Neurocognition in Chronic Renal Failure

In recent years there has been a keen interest in the neurocognitive sequelae of renal failure and subsequent end-stage renal disease given its increasing prevalence and incidence. This review article summarizes the relevant information on cognitive functioning in chronic kidney disease in adults before the initiation of dialysis, after the initiation of dialysis, and after renal transplantation. In general, compared to pre-dialysis, there is an improvement in cognitive function after the institution of dialysis and further improvement after renal transplantation. Throughout the paper an attempt is made to highlight the importance of considering disease related variables in the neuropsychological assessment of individuals with chronic kidney disease. The paper concludes with a discussion of future avenues of research.     

American Medicine as Religious Practice: Care of the Sick as a Sacred Obligation and the Unholy Descent into Secularization

Modern medicine serves a religious function for modern Americans as a conduit through which science can be applied directly to the human body. The first half of this paper will focus on the theoretical foundations for viewing medicine as a religious practice arguing that just as a hierarchical structured authoritarian church historically mediated access to God, contemporary Western medicine provides a conduit by which the universalizable truths of science can be applied to the human being thereby functioning as a new established religion. I will then illustrate the many parallels between medicine and religion through an analysis of rituals and symbols surrounding and embedded within the modern practice of medicine. This analysis will pay special attention to the primacy placed on secret interior knowledge of the human body. I will end by responding to the hope for a “secularization of American medicine,” exploring some of the negative consequences of secularization, and arguing that, rather than seeking to secularize, American medicine should strive to use its religious features to offer hope and healing to the sick, in keeping with its historically religious legacy.     

现代移植医学与再生医学的差异和互补

人体克隆技术的医学应用,产生了现代移植医学和再生医学两种不同医学模式.二者的医学思路、医疗学术技术、投入产出比、医疗和社会经济效益以及伦理法律等都有显著差异,优劣长短各异而有很强的互补性.     

Patient perceptions of factors influencing adherence to medication following kidney transplant

Research has shown that most patients with end-stage kidney failure prefer treatment by transplantation. This entails taking immunosuppressant drugs daily throughout the life of the kidney. Failure to do so causes transplant rejection and a return to dialysis, or sometimes even death. Up to 50% of transplanted patients report failing to take their medication as prescribed. This qualitative study used focus groups to explore patients' lived experience in relation to medication adherence. Data were analysed using thematic analysis. The main themes to emerge were: fear of kidney failure, loyalty to the renal team and donors, health beliefs, forgetting and side-effects. Reasons for adherence were to avoid kidney failure and to acknowledge their gratitude to the renal team and donors. Participants suggested that non-adherence was largely due to forgetting.     

也谈慢性心衰中西医结合治疗的临床策略

着眼于目前中西医结合治疗慢性心力衰竭（CHF）的困惑所在,提出了几点临床策略：（1）抓预防,做好慢性心衰一级预防;（2）开展大规模流调,规范证候辨识标准;（3）挖掘和整理地区验方;（4）发挥行业协会作用,探索多方力量参与验方筛选与评价;并提出充分发挥中西医结合的诊疗特色,重点优化CHF的中西医结合诊疗方案和评价方法符合我国基本国情.