肾移植受者 BK 病毒感染的诊治进展

BK病毒（BK V ）是人类多瘤病毒的一个亚群,有很高的隐性感染率,研究显示全球超过80％的人口BK V血清学阳性。随着移植后强效免疫抑制剂的使用,BK V感染正成为移植肾失活的重要原因。据统计,约1％～10％的肾移植受者在免疫抑制状态下,可因BKV激活而引起BKV肾病（BKVN）,而BKVN可引起约45％的远期移植肾失活。由于目前缺乏明确有效的抗病毒药物,早期监测病毒载量、减少免疫抑制剂对控制BKVN、保留移植肾功能至关重要。本文就肾移植相关的BKV感染概况及BKVN的诊断、治疗进展进行综述。     

逆行性肾盂造影联合输尿管软镜在诊断小肾盏癌中的价值

探讨逆行性肾盂造影联合输尿管软镜在诊断小肾盏癌中的价值。回顾分析5例小肾盏癌临床资料,术后病理检查结果均提示尿路上皮癌I级（Ta-G1）,术后定期行膀胱内灌注化疗药物,且均未出现肿瘤其他部位转移等并发症发生。对5例患者均进行随访,1年期间每3个月行尿常规及B超检查均正常,1年生存率达100％。患者出现血尿症状,虽然常规检查（尿常规、B超、IVU、CT或MRI等）诊断不明确者,都可行逆行性肾盂造影检查。一旦逆行性肾盂造影检查提示异常图像,均可提示肾盏癌,使误诊率及漏诊率降至最低程度,尽可能阻断早期肿瘤的发展。故逆行性肾孟造影联合输尿管软镜可提高早期小肾盏癌的术前诊断率。     

Marital role strain,illness intrusiveness,and their impact on marital and individual adjustment in end-stage renal disease

Abstract

A marital role theory approach was used to investigate individual psychosocial well-being and marital adjustment in 89 end-stage renal disease (ESRD) patients and their spouses. Four different patient groups were selected according to a continuum of clinical milestones in the treatment of ESRD, including pre-dialysis (n=17), incenter dialysis (n=18), home dialysis (n=19), and posttransplant patients (n=17). A nephrology clinic control group (n=18) was also included. Standardized instruments were employed to investigate marital role strain (Marital Role Questionnaire, KDS-15), marital adjustment (Locke-Wallace Marital Adjustment Test), subjective well-being (Affect Balance Scale, Rosenberg Self-Esteem Inventory), and psychopathology (Symptom Checklist 90-R). Hierarchical multiple regression analyses provided strong and consistent support for the major hypotheses relating elevated marital role strain to compromised marital adjustment and individual well-being. Further analyses demonstrated that increased perceived intrusiveness of ESRD was significantly related to greater marital role strain, poorer marital adjustment, and decreased individual well-being. This is consistent with the idea that perceived intrusiveness may be an important mediator of marital role strain and of coping with chronic illness. “Objective” intrusiveness, defined in terms of patient group, was not significantly related to marital or individual well-being. These findings support a dyadic approach to the psychosocial study of chronic illness.     

A Self-Management Program for Adolescents and Children with Renal Transplantation

This paper describes the development and implementation of a self-management program designed to address noncompliance in adolescents with renal transplants. Transplantation provides the best treatment alternative for End-Stage Renal Disease (ESRD), but is a procedure that subsequently demands recipients follow a life-long medication regimen. Nonadherance to medical therapy is a serious problem for adolescents; it is one of the most common causes of chronic graft rejection in this population. To improve compliance rates for this population, a self-management program was designed: (1) to provide social support; (2) to review information about medications and transplant management; and (3) to both teach and provide transplantation patients the opportunity to practice self-management skills. Details about the program, including recruitment issues and session content, are provided. Evaluations by participants indicated that the program was effective in creating a supportive environment for both patients and their parents, and in addressing health-related concerns.     

Waiting for a kidney from a deceased donor: an interpretative phenomenological analysis

Demand for kidneys from deceased donors far outstrips supply. Despite this, there appears to be little research that focuses solely on the experience of waiting for a kidney from a deceased donor. This study uses the qualitative methodology interpretative phenomenological analysis to explore the lives of 10 people on the transplant list, with the aims of illuminating the potential psychological challenges those on the list may face during this time, and providing information to help clinicians more fully support such people in the future. Two themes connected to the experience of waiting – adjustment to the uncertainty of waiting and thinking about receiving a kidney from a living donor – are presented here. Participants describe a sense of confusion and uncertainty around life on the list, and discuss their strategies for dealing with this. Novel complexities around the ambiguous challenge of receiving an organ from a deceased donor are revealed. It is recommended that health care teams provide a forum for this patient group to work through these feelings of confusion and ambiguity.     

近三十年小儿肾小球疾病治疗的回顾

总结了28年共2453篇有关小儿肾小球疾病治疗的文献,发现其发展规律符合科学的发展观药物的选择趋向于疗效肯定而且毒副作用小的药物,新方法新技术不断涌现,药物疗效的评价日趋合理,药物作用机制从系统、器官水平深入到细胞、分子及基因水平,各学科间的合作与联系增加。     

乙肝阳性者能否作为供体

为了扩大器官移植的供体来源,研究乙肝阳性者能否作为供体具有重大的现实意义.简要介绍国内外乙肝阳性者作为供体的临床事实,重点分析了乙肝阳性者作为供体可能存在的问题,并提出了相应的解决方案.     

乙酰肝素酶剪接变体T5mRNA在肾癌中的表达

探讨乙酰肝素酶（Hpa）剪接变体T5mRNA在肾癌（RCC）组织中的表达,分析其与RCC发生发展及预后的关系。采用逆转录-聚合酶链反应（半定量RT—PCR）方法检测RCC组织标本及癌旁正常组织标本中T5mRNA的表达。结果RCC组织中T5mRNA阳性率高于癌旁正常组织（P〈0．05）;T5mRNA阳性表达率与RCC病理...     

重视终末期肾病患者的心理治疗

心理治疗在终末期肾病(ESRD)治疗中的作用非常重要,不但可缓解患者的心理压力,还可改善患者的生理障碍、减少并发症,因此重视对ESRD患者的心理治疗,可使患者保持良好的生理、心理状态,并能提高患者的生活质量,改善预后。