背景动静脉内瘘是维持性血液透析患者最常用的血管通路,动静脉内瘘的使用寿命在很大程度上取决于正确的维护,目前我国缺乏动静脉内瘘维护的最佳证据。目的检索和分析有关维持性血液透析患者动静脉内瘘维护的相关证据,对最佳证据进行总...背景动静脉内瘘是维持性血液透析患者最常用的血管通路,动静脉内瘘的使用寿命在很大程度上取决于正确的维护,目前我国缺乏动静脉内瘘维护的最佳证据。目的检索和分析有关维持性血液透析患者动静脉内瘘维护的相关证据,对最佳证据进行总结分析。方法于2017年10月-2018年9月,通过计算机检索BMJ最佳临床实践(British Medical Journal best practice)、Uptodata、Cochrane图书馆、JBI(Joanna Briggs Institute)图书馆、英国卫生与临床优化研究所(NICE)、加拿大安大略注册护士协会(RNAO)、苏格兰学院间指南网(SIGN)、美国指南网(NGC)、国际指南网(GIN)、美国疾病控制中心(CDC)、Pub Med和中国知网中的所有证据。结果共筛选到有用的文献10篇,包括临床决策支持1篇、临床实践指南6篇、专家共识1篇和系统评价2篇。最终形成4个方面共12条最佳证据总结,其中10条A级推荐、2条B级推荐,内容包括:动静脉内瘘使用时间的选择、动静脉内瘘使用前准备、穿刺和进针方法、对患者和护士的教育和培训。结论本研究检索了国内外多个数据库,总结了维持性血液透析患者动静脉内瘘维护的最佳证据,便于血液透析室护士按照最佳证据对患者内瘘进行使用和日常维护,指导患者学会自我维护动静脉内瘘的方法,以延长内瘘的使用寿命。展开更多
Increasing numbers of clinical and experimental studies have proved that proteinuria plays a key role in the progression of chronic renal disease.In recent years,some molecular mechanisms of how proteinuria causes fur...Increasing numbers of clinical and experimental studies have proved that proteinuria plays a key role in the progression of chronic renal disease.In recent years,some molecular mechanisms of how proteinuria causes further kidney injuries have been revealed by many researches,although there are still many questions to be answered.Proteinuria triggers chemokine expression of tubular epithelial cells and activates complements,which result in interstitial inflammation and fibrosis;proteinuria also induces the apoptosis of tubular epithelial cells.Albumin in urine is considered as the main culprit,but other elements in proteinuria have also been suspected to cause renal damage,too.On the other hand,serum proteins leaking from glomerular barrier also adversely affect podocytes.Ultrafiltered serum proteins induce morphological changes and functional impairment of podocytes,resulting in exacerbating proteinuria;furthermore,TGF-β1 up-regulated by podocytes in response to protein overload contributes to the sclerosis of glomeruli.Studies on the mechanism of how proteinuria accelerates kidney diseases are important because they may offer novel therapeutic targets for controlling chronic kidney disease.For example,targeting directly on the complement synthesis and activation in proximal tubules,or chemokine production in tubular cells might be beneficial for preventing the progression of chronic proteinuric kidney disease to end stage renal disease.展开更多
文摘背景动静脉内瘘是维持性血液透析患者最常用的血管通路,动静脉内瘘的使用寿命在很大程度上取决于正确的维护,目前我国缺乏动静脉内瘘维护的最佳证据。目的检索和分析有关维持性血液透析患者动静脉内瘘维护的相关证据,对最佳证据进行总结分析。方法于2017年10月-2018年9月,通过计算机检索BMJ最佳临床实践(British Medical Journal best practice)、Uptodata、Cochrane图书馆、JBI(Joanna Briggs Institute)图书馆、英国卫生与临床优化研究所(NICE)、加拿大安大略注册护士协会(RNAO)、苏格兰学院间指南网(SIGN)、美国指南网(NGC)、国际指南网(GIN)、美国疾病控制中心(CDC)、Pub Med和中国知网中的所有证据。结果共筛选到有用的文献10篇,包括临床决策支持1篇、临床实践指南6篇、专家共识1篇和系统评价2篇。最终形成4个方面共12条最佳证据总结,其中10条A级推荐、2条B级推荐,内容包括:动静脉内瘘使用时间的选择、动静脉内瘘使用前准备、穿刺和进针方法、对患者和护士的教育和培训。结论本研究检索了国内外多个数据库,总结了维持性血液透析患者动静脉内瘘维护的最佳证据,便于血液透析室护士按照最佳证据对患者内瘘进行使用和日常维护,指导患者学会自我维护动静脉内瘘的方法,以延长内瘘的使用寿命。
文摘Increasing numbers of clinical and experimental studies have proved that proteinuria plays a key role in the progression of chronic renal disease.In recent years,some molecular mechanisms of how proteinuria causes further kidney injuries have been revealed by many researches,although there are still many questions to be answered.Proteinuria triggers chemokine expression of tubular epithelial cells and activates complements,which result in interstitial inflammation and fibrosis;proteinuria also induces the apoptosis of tubular epithelial cells.Albumin in urine is considered as the main culprit,but other elements in proteinuria have also been suspected to cause renal damage,too.On the other hand,serum proteins leaking from glomerular barrier also adversely affect podocytes.Ultrafiltered serum proteins induce morphological changes and functional impairment of podocytes,resulting in exacerbating proteinuria;furthermore,TGF-β1 up-regulated by podocytes in response to protein overload contributes to the sclerosis of glomeruli.Studies on the mechanism of how proteinuria accelerates kidney diseases are important because they may offer novel therapeutic targets for controlling chronic kidney disease.For example,targeting directly on the complement synthesis and activation in proximal tubules,or chemokine production in tubular cells might be beneficial for preventing the progression of chronic proteinuric kidney disease to end stage renal disease.
