![\"慢性肾病中的慢性移植肾肾病的治疗原则\"](\"http://01luntan.com/ly_img/uimgs/1503047474510.jpg\" "\\"慢性肾病中的慢性移植肾肾病的治疗原则\\"")
肾病综合症的发病率很高，这个病可以发生在任何年龄的人身上，所以导致不少人担心自己会得这个病，为了我们的健康，我们一定要了解这种疾病，在生活中多加预防，保障我们的身体健康，接下来就请专家给我们讲讲，肾病综合症的预防措施有哪些。
\n1、一般措施：尿少而肿甚者，应卧床休息，注意保暖。卧床可增加肾血流量，有利于利尿，并减少对外界接触的机会以防交叉感染。但仍应保持适度床上及床旁活动，以防肢体血管的血栓形成。水肿消退、症状缓解后可逐步增加活动，可户外活动至轻度劳动。如果出现活动后尿蛋白增加则应酌情减少活动。
\n2、饮食调护：中医治疗，十分强调饮食宜忌，孙思邈在《千金要方》中明确指出：“大凡水肿难治，瘥后特须慎于口味”，“莫恣意咸物”。历代又不断给予补充，择其要点，可概括为盐、水、油腻厚味以及借助食物补益精血四方面。亦就是现代所提出的水和钠盐、蛋白质、脂肪以及微量元素等适当摄较低的蛋白摄入可以纠正肾小球毛细血管的高压状态。因此，对于慢性、非极期的肾病综合征应摄入较少量、高质量蛋白0.7-1G/KG.D。若出现慢性肾功能损害时，则应按照低蛋白饮食(0.65G/KG.D)。
\n3、脂肪摄入：肾病综合征患者应限制动物脂肪的摄取量，特别是富含胆固醇的食品如动物内脏，各类蛋黄等，可给予蔬菜豆类饮食和可溶性纤维(燕麦、米糠等)。富含多不饱和脂肪酸量食物，如：鱼油，可以补偿花生四烯酸的消耗，进入细胞膜磷脂，生成前列腺素类物质，降低血脂和尿蛋白，有利于减轻肾小球硬化程度。
\n4、微量元素的补充：由尿中丢失的铜、锌、铁等元素，可由正常饮食中补充。合理摄入补益精血的食物，不仅能够补充缺失的维生素和微量元素，而且还对水肿期及恢复期尤为重要，如鱼、鲜果、蔬菜、瓜果类等。其中鲫鱼健脾、黑鱼祛风、鲤鱼行水，均对水肿病有益。但有牙痛、红肿疮痍者或肠道湿滞者均不宜食用鲫鱼或鲤鱼。
\n","barId":"1696","topicTypeId":null,"topicThemeId":"1023","readLevel":0,"files":"","clickNoLikeCount":0,"clickLikeCount":0,"clickCount":0,"score":0,"partCount":0,"replayCount":0,"publishStatus":0,"publishTime":0,"isCream":null,"canReply":0,"shareUrl":null,"foodCouponVal":0,"emailNotice":0,"permission":0,"zlyShare":0,"status":0,"sort":0,"highlight":0,"highlightEffectTime":0,"digest":0,"digestEffectTime":0,"top":0,"topEffectTime":0,"closed":0,"stamp":0,"icon":0,"bgcolor":null,"fontcolor":null,"favtimes":0,"isAdopt":0,"adoptId":null,"sortDate":0,"metaSearch":null,"rn":4},{"id":"1413","isDel":0,"createAt":0,"createBy":null,"createName":null,"updateAt":0,"updateBy":null,"updateName":null,"userId":null,"title":"儿童肾病综合征的护理要注意什么","content":"
肾病综合征是小儿常见肾脏疾病，以大量蛋白尿、低白蛋白血症、高脂血症和水肿为主要临床特点，家属在护理患儿时应注意以下问题。
\n一、为患儿制定合理健康的饮食计划
\n家属要为患者制定合理健康的饮食计划。在饮食的控制上，每天要保证0.8～1.0g/kg的蛋白质摄入量，蛋白质的摄入以食用大豆或动物蛋白为宜。每天摄入的热量应大于126kJ/kg。如果水肿严重，饮食要保持较低的盐分，待患儿消除水肿、尿量正常之后再恢复用盐量。同时，要保证各种维生素和微量元素的充足摄入。
\n二、预防患者发生感染
\n预防感染对于肾病患儿非常重要，因为患肾病的儿童免疫力低下，容易激发感染，威胁患儿的生命。要加强对口腔、皮肤的护理，每天进行2～3次的苏打水漱口，用甲紫和碘伏等对破损的皮肤进行消毒。在治疗和护理的每一个步骤中，都要坚持无菌操作。
\n三、与患儿多沟通
\n家属要按照出院医嘱，加强与孩子的沟通与交流。患儿由于长期患病治疗，容易产生焦虑压抑等心理问题，对于孩子出现的这些负面情绪，家长要及时进行指导，帮助孩子增加对抗病魔的决心和信心。家长要帮助患儿长期地、正确地坚持治疗。家长要帮助孩子进行适当的体育锻炼，保持孩子的体力，增强体质。
\n","barId":"1696","topicTypeId":null,"topicThemeId":"1022","readLevel":0,"files":"","clickNoLikeCount":0,"clickLikeCount":0,"clickCount":0,"score":0,"partCount":0,"replayCount":0,"publishStatus":0,"publishTime":0,"isCream":null,"canReply":0,"shareUrl":null,"foodCouponVal":0,"emailNotice":0,"permission":0,"zlyShare":0,"status":0,"sort":0,"highlight":0,"highlightEffectTime":0,"digest":0,"digestEffectTime":0,"top":0,"topEffectTime":0,"closed":0,"stamp":0,"icon":0,"bgcolor":null,"fontcolor":null,"favtimes":0,"isAdopt":0,"adoptId":null,"sortDate":0,"metaSearch":null,"rn":4},{"id":"3680","isDel":0,"createAt":0,"createBy":null,"createName":null,"updateAt":0,"updateBy":null,"updateName":null,"userId":null,"title":"胎儿先天肾囊肿","content":"
女,。肚中胎儿现9个月（34周），于32周时B超查出有2.9*2.4cm囊肿，位于左肾下方，是否为肾囊肿，本地医院无法确诊。怎么办啊
","barId":"1696","topicTypeId":null,"topicThemeId":"1020","readLevel":0,"files":"","clickNoLikeCount":0,"clickLikeCount":0,"clickCount":0,"score":0,"partCount":0,"replayCount":0,"publishStatus":0,"publishTime":0,"isCream":null,"canReply":0,"shareUrl":null,"foodCouponVal":0,"emailNotice":0,"permission":0,"zlyShare":0,"status":0,"sort":0,"highlight":0,"highlightEffectTime":0,"digest":0,"digestEffectTime":0,"top":0,"topEffectTime":0,"closed":0,"stamp":0,"icon":0,"bgcolor":null,"fontcolor":null,"favtimes":0,"isAdopt":0,"adoptId":null,"sortDate":0,"metaSearch":null,"rn":4},{"id":"3973","isDel":0,"createAt":0,"createBy":null,"createName":null,"updateAt":0,"updateBy":null,"updateName":null,"userId":null,"title":"取结石，治囊肿","content":"双肾0.3cm结石，右肾1cm囊肿,今年参军 体检过不了，只希望取出结石，去除囊肿
","barId":"1696","topicTypeId":null,"topicThemeId":"1019","readLevel":0,"files":"","clickNoLikeCount":0,"clickLikeCount":0,"clickCount":0,"score":0,"partCount":0,"replayCount":0,"publishStatus":0,"publishTime":0,"isCream":null,"canReply":0,"shareUrl":null,"foodCouponVal":0,"emailNotice":0,"permission":0,"zlyShare":0,"status":0,"sort":0,"highlight":0,"highlightEffectTime":0,"digest":0,"digestEffectTime":0,"top":0,"topEffectTime":0,"closed":0,"stamp":0,"icon":0,"bgcolor":null,"fontcolor":null,"favtimes":0,"isAdopt":0,"adoptId":null,"sortDate":0,"metaSearch":null,"rn":4},{"id":"1415","isDel":0,"createAt":0,"createBy":null,"createName":null,"updateAt":0,"updateBy":null,"updateName":null,"userId":null,"title":"肾结石的临床症状有哪些","content":"肾结石这个病可能大家觉得不是很严重，只要手术后就会好的，但它带给患者的痛苦是无法表达的，这个疾病在生活当中有着很高的发病率，对于患者的影响也是比较大的，所以这个疾病一定要积极的进行治疗，为了帮助大家及时的发现疾病我们来了解一下肾结石的临床症状有哪些?
\n肾结石的临床表现具体如下：
\n1、剧烈疼痛，苦不堪言
\n结石嵌顿在肾盂输尿管交界部或输尿管内下降时，可出现肾绞痛，为突然发作的阵发性刀割样疼痛，疼痛剧烈难忍，病人辗转不安，疼痛从腰部或侧腹部向下放射至膀胱区，外阴部及大腿内侧，有时有大汗、恶心呕吐。
\n2、堵塞尿路，引起急性肾功能障碍
\n当继发急性肾盂肾炎或肾积脓时，可有发热、畏寒、寒颤等全身症状。双侧上尿路结石或肾结石完全梗阻时，可导致无尿。
\n3、较小的结石活动范围大，危害周边组织
\n当小结石进入肾盂输尿管连接部或输尿管时，引起输尿管剧烈的蠕动，以促使结石排出，于是出现绞痛和血尿。肾绞痛严重时，面色苍白，全身出冷汗，脉细而速，甚至血压下降，呈虚脱状态，同时伴有恶心、呕吐、腹胀便秘。绞痛发作时，尿量减少，绞痛缓解后，可有多尿现象。
\n4、无尿
\n双侧上尿路结石引起双侧完全兴梗阻或独肾上尿路结石完全兴梗阻时，可导致无尿。有时肾结石感染症状为尿路结石的表现。特别是儿童上尿路结石，大多数表现为尿路感染，值得注意。
\n","barId":"1696","topicTypeId":null,"topicThemeId":"1016","readLevel":0,"files":"","clickNoLikeCount":0,"clickLikeCount":0,"clickCount":0,"score":0,"partCount":0,"replayCount":0,"publishStatus":0,"publishTime":0,"isCream":null,"canReply":0,"shareUrl":null,"foodCouponVal":0,"emailNotice":0,"permission":0,"zlyShare":0,"status":0,"sort":0,"highlight":0,"highlightEffectTime":0,"digest":0,"digestEffectTime":0,"top":0,"topEffectTime":0,"closed":0,"stamp":0,"icon":0,"bgcolor":null,"fontcolor":null,"favtimes":0,"isAdopt":0,"adoptId":null,"sortDate":0,"metaSearch":null,"rn":4},{"id":"5553","isDel":0,"createAt":0,"createBy":null,"createName":null,"updateAt":0,"updateBy":null,"updateName":null,"userId":null,"title":"慢性肾病中的慢性移植肾肾病的治疗原则","content":"
慢性移植肾肾病是肾移植一年后导致移植肾失功的常见病因，目前发生机理尚未完全明确。
\n一、慢性移植肾肾病的诊断
\n临床表现大部分表现为移植肾功能缓慢下降，伴有进展性蛋白尿和高血压。并影响肾实质的所有成分，包括肾血管、肾小球、肾间质和肾小管。肾血管病变可见血管内膜增厚，内膜下结缔组织聚集，并可见单核细胞、肌纤维母细胞浸润、内膜弹力层分层和断裂。血管内皮的炎症损伤是慢性移植肾肾病的初始病变，由此导致内膜进展性增厚及管腔狭窄。免疫荧光可见IgG、C3和纤维蛋白原沉积，管周毛细血管染色C4d可阳性。肾小球病变包括肾小球基底膜增厚，偶见双轨形成类似于膜增殖性肾小球肾炎。其它肾小球病理改变还包括肾小球体积增大，可呈分叶状并可见节段性硬化，严重者可见球性硬化。电镜下可见系膜细胞插入及内皮下电子透亮物沉积，部分病例还可见类似膜性肾病的上皮下沉积。免疫复合物沉积不是移植肾肾小球病的主要表现。肾小管间质病变包括不同程度的间质纤维化、灶状淋巴细胞及浆细胞浸润，可见肾小管萎缩和小管上皮细胞脱落。这些病变为非特异性，除慢性移植肾肾病外还可见于其它疾病如CsA或FK506肾毒性，慢性移植肾肾病其它病理改变还有肾小管周边毛细血管基底膜断裂和分层。
\n
二、慢性移植肾肾病的鉴别诊断
\n1．膜增殖性肾小球肾炎：膜增殖性肾小球肾炎型的移植肾肾小球病需与其他病理类型的肾小球疾病，特别是与丙型肝炎病毒感染有关的膜增殖性肾小球肾炎及复发性膜增殖性肾小球肾炎相鉴别。这些疾病光镜下表现相似，在电镜下移植肾肾小球病可见基底膜增厚和双轨征，但常无免疫复合物沉积；丙肝病毒有关的膜增殖性肾小球肾炎可见显著的内皮下免疫复合物沉积。由于移植肾肾小球病的患者也可能有丙肝病毒抗体阳性，因此只根据丙肝病毒抗体阳性不能区分移植肾肾小球病和丙肝相关性MPGN。
\n2．肾间质纤维化：某些免疫抑制剂中毒，如CsA或FK506肾毒性均可致肾间质纤维化，两者常需鉴别诊断。如组织学上有较特征的肾小球病变或肾小管周围毛细血管基底膜断裂及分层则有助于慢性移植肾肾病的诊断；而新形成的肾小动脉管壁玻璃样变则是CsA肾毒性的特征性改变。但慢性移植肾肾病的特征性病变并不常见，而移植肾肾小动脉病变也可能不是新形成的，因此光镜下两者很难鉴别，此外这两种病变也可同时存在。
\n三、慢性移植肾肾病的治疗
\n由于慢性移植肾肾病发生机制复杂，治疗存在一定难度。相应的的大规模、前瞻性、随机、对照研究还不多。只能针对影响慢性移植肾肾病的各个环节，包括免疫性和非免疫性方面予以治疗。
\n1．免疫抑制治疗：目前临床应用的免疫抑制剂对慢性移植肾肾病治疗作用并不明确，但如果慢性移植肾肾病的原因是由于患者使用免疫抑制剂顺应性较差或减量过快，则可加强免疫抑制治疗。部分患者肾活检发现在慢性移植肾肾病的基础上仍有活动性急性排异反应的证据，对该部分患者应用皮质激素冲击治疗可能有效。另一方面，由于CsA或FK506具有肾毒性，也可能参与慢性移植肾肾病过程，因此对于CsA或FK506肾毒性患者，减少这些药物，可能受到有益效果。初步的临床研究发现对无急性排异表现的患者，减少CsA或FK506剂量，同时加用霉酚酸酯（2－3g/d），可减慢这些患者肾功能下降的速度。但目前还缺乏相应的临床研究。
\n2．非免疫抑制治疗：非免疫抑制治疗包括积极控制血压及降血脂治疗。在各种原发性慢性肾小球肾炎中，血管紧张素转换酶抑制剂（ACEI）或血管紧张素II 受体拮抗剂(ARB)都能有效地降低全身及肾小球毛细血管压，减少尿蛋白的排泄。有临床研究发现ACEI 或ARB能够降低高血压肾移植患者的尿蛋白排泄率，同时不会对肾脏血液动力学带来不良影响，这种疗法对移植肾失功的长期作用有待进一步研究。
\nHMG－CoA还原酶抑制剂，如他汀类常用于降脂治疗，并可延缓移植物血管病变的进展。其它治疗手段包括抗血小板聚集药物、血栓素拮抗剂、鱼油及低蛋白饮食等，但是对慢性移植肾肾病的疗效还需要随机对照的临床试验来验证。
\n","barId":"1696","topicTypeId":null,"topicThemeId":"1015","readLevel":0,"files":"","clickNoLikeCount":0,"clickLikeCount":0,"clickCount":0,"score":0,"partCount":0,"replayCount":0,"publishStatus":0,"publishTime":0,"isCream":null,"canReply":0,"shareUrl":null,"foodCouponVal":0,"emailNotice":0,"permission":0,"zlyShare":0,"status":0,"sort":0,"highlight":0,"highlightEffectTime":0,"digest":0,"digestEffectTime":0,"top":0,"topEffectTime":0,"closed":0,"stamp":0,"icon":0,"bgcolor":null,"fontcolor":null,"favtimes":0,"isAdopt":0,"adoptId":null,"sortDate":0,"metaSearch":null,"rn":5}],"pageObj":{"list":[],"list4Map":null,"pageBegin":0,"pageSize":5,"pageNumber":0,"totalPage":0,"totalRow":0},"loginUser":null,"replies":[],"forumUserFans":null,"herfList":[],"only":"0","topic":{"id":"4179","isDel":0,"createAt":1486646138317,"createBy":"b1a5ca4ddfad11e6a61c00163e04584d","createName":"小海螺","updateAt":0,"updateBy":null,"updateName":null,"userId":"b1a5ca4ddfad11e6a61c00163e04584d","title":"遗传是肾盂癌疾病的病因吗","content":"
肾盂癌疾病的发生严重影响到了人们的身体健康，其实当患上肾癌疾病的时候饱受疾病带来的，因此对于肾癌疾病的病发原因我们在积极的了解的情况下要积极的实施预防措施，那么原发性元疾病的主要病发原因都是有哪些呢!
\n(一)发病原因
\n染料、皮革、橡胶、油漆等工业原料中的芳香伯胺类物质如β-萘胺、联苯胺等是肾盂癌致癌质，色胺酸代谢紊乱、吸烟及长期服用非那西丁类药物者，肾盂癌发病率明显增高。感染或长期结石刺激可引起鳞癌或腺癌。囊性肾盂炎、腺性肾盂炎可发展为肾盂癌。
\n(二)发病机制
\n本病多数为移行细胞癌，少数为鳞癌和腺癌，后二者约占肾盂癌的15%左右，它们的恶性程度远较移行细胞癌为高。临床所见移行细胞癌可在任何被覆有移行上皮的尿路部位先后或同时出现，因此，在诊断及处理上应视为一个整体，不能孤立地对待某一局部的移行细胞癌。
\n肾盂癌绝大多数为移行细胞癌，可分为4级。Ⅰ级：乳头状伴正常黏膜;Ⅱ级：乳头状伴少量多形性变和核分裂;Ⅲ级：扁平移行细胞伴显著多形性变和核分裂;Ⅳ级：极度多形性变。因肾盂壁薄，易发生淋巴或血行转移，预后不良。
\n鳞状细胞癌约占肾盂癌的15%，病变扁平，质硬，迅速浸润达肾脏周围、肾门及区域淋巴结，确诊时多已转移，预后差。腺癌极为少见。肾盂肿瘤可发生于肾盂的任何部位，有多中心发生的特点，可同时或先后发生输尿管肿瘤或膀胱肿瘤，在乳头状瘤或乳头状癌患者中较为多见，而在平坦的浸润性乳头状癌患者中较为少见。关于肾盂肿瘤的多发现象，目前有4种解释：①淋巴途径扩散;②经黏膜直接扩散;③多中心病灶;④肿瘤细胞脱落种植在输尿管或膀胱黏膜上，继续生长而成。
\n","barId":"1696","topicTypeId":"1","topicThemeId":"1015","readLevel":0,"files":"","clickNoLikeCount":0,"clickLikeCount":0,"clickCount":1956,"score":0,"partCount":0,"replayCount":0,"publishStatus":1,"publishTime":1486646138319,"isCream":0,"canReply":0,"shareUrl":null,"foodCouponVal":1,"emailNotice":0,"permission":0,"zlyShare":0,"status":0,"sort":0,"highlight":0,"highlightEffectTime":0,"digest":0,"digestEffectTime":0,"top":0,"topEffectTime":0,"closed":0,"stamp":0,"icon":0,"bgcolor":null,"fontcolor":null,"favtimes":0,"isAdopt":0,"adoptId":null,"sortDate":1486646138317,"metaSearch":null,"rn":null},"userAllInfo":{"id":null,"isDel":0,"createAt":0,"createBy":null,"createName":null,"updateAt":0,"updateBy":null,"updateName":null,"username":null,"password":null,"level":0,"nickName":null,"realName":null,"signName":null,"head":null,"phone":null,"mobile":null,"wechat":null,"qq":null,"email":null,"address":null,"identityType":0,"userType":0,"isPhoneBind":0,"status":0,"accountSource":0,"isStrangerMsg":0,"departmentId":null,"departmentName":null,"sex":0,"provinceId":null,"cityId":null,"userLevel":0,"modifyNameCount":0,"forumUser":{"id":"b1a5ca4ddfad11e6a61c00163e04584d","isDel":0,"createAt":1484984778320,"createBy":null,"createName":null,"updateAt":0,"updateBy":null,"updateName":null,"username":"小海螺","password":"yiren2921","level":0,"nickName":"小海螺78","realName":null,"signName":"开心每一天","head":"http://01luntan.com/ly_img/1484985295689.jpg","phone":null,"mobile":null,"wechat":null,"qq":null,"email":"2276635444@qq.com","address":null,"identityType":6,"userType":2,"isPhoneBind":0,"status":0,"accountSource":0,"isStrangerMsg":0,"departmentId":null,"departmentName":null,"sex":1,"provinceId":"110000","cityId":"110108","userLevel":0,"modifyNameCount":1},"forumUserActiveInfo":{"id":"b1ba5254dfad11e6a61c00163e04584d","isDel":0,"createAt":0,"createBy":null,"createName":null,"updateAt":1705892489293,"updateBy":"b1a5ca4ddfad11e6a61c00163e04584d","updateName":"小海螺","userId":"b1a5ca4ddfad11e6a61c00163e04584d","topicCount":2201,"replayCount":900,"favorteCount":0,"beFavorteCount":0,"creamCount":2,"focusCount":1,"fansCount":4,"integralCount":2357,"foodCouponCount":0,"lastLoginTime":0,"lastLoginIp":null,"downloadCount":0,"uploadCount":0},"newPass":null,"focusBar":null,"counter":null,"forumUserIdentificateDto":null},"theme":{"id":"1015","isDel":0,"createAt":0,"createBy":null,"createName":null,"updateAt":0,"updateBy":null,"updateName":null,"topicTypeId":"1","topicTypeName":"资讯","themeName":"专家观点","barType":"101","schemaName":2,"reward":0},"page":1,"favorties":true,"isSelf":false,"order":"asc"}