Suomen laakarilehti. Finlands lakartidning最新文献

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[Uremia]. [尿毒症]。

Suomen laakarilehti. Finlands lakartidning

Pub Date : 2020-12-07 DOI: 10.32388/5hkzzv

B. Kuhlback

Copyright © 2007 Massachusetts Medical Society. Medical progress has altered the course and thus the definition of uremia, which once encompassed all the signs and symptoms of advanced kidney failure. Hypertension due to volume overload, hypocalcemic tetany, and anemia due to erythropoietin deficiency were once considered signs of uremia but were removed from this category as their causes were discovered. Today the term “uremia” is used loosely to describe the illness accompanying kidney failure that cannot be explained by derangements in extracellular volume, inorganic ion concentrations, or lack of known renal synthetic products. We now assume that uremic illness is due largely to the accumulation of organic waste products, not all identified as yet, that are normally cleared by the kidneys. No specific time point demarcates the onset of uremia in patients with progressive loss of kidney function. The features of uremia identified in patients with end-stage kidney failure may be present to a lesser degree in people with a glomerular filtration rate that is barely below 50% of the normal rate, which at 30 years of age ranges between 100 and 120 ml per minute per 1.73 m2 of body-surface area. Thus, in the United States alone, uremic symptoms may be present to some degree in an estimated 8 million people who have a glomerular filtration rate below 60 ml per minute per 1.73 m2 of body-surface area.1 However, early symptoms of uremia, such as fatigue, are nonspecific, making the condition difficult to identify. At present, moreover, we can slow progression to kidney failure but can treat uremia only by replacing kidney function. Thus, the question of whether a patient has uremia comes down to whether dialysis or a transplant would be beneficial. Treatment of uremia is now dominated by dialysis, in large part because donor kidneys are in short supply. In the United States in 2004, approximately 100,000 people began receiving kidney-replacement therapy for end-stage renal disease, and 335,000 people were receiving ongoing treatment with dialysis.2 In some cases, patients are treated with dialysis for decades, but overall outcomes are disappointing. The 5-year survival rates between 1995 and 1999 were under 35% for both hemodialysis and peritoneal dialysis. Patients treated with dialysis are hospitalized on average twice a year, and their quality of life is often low. Not all of the illness of a patient undergoing dialysis can be ascribed to uremia. Indeed, the evolution of dialysis has made the effects of uremia more difficult to distinguish, since the severity of classic uremic symptoms is attenuated. Instead, patients undergoing dialysis now have a new illness, which Depner3 aptly named the “residual syndrome.” This illness comprises partially treated uremia; ill effects of dialysis, such as fluctuation in the extracellular fluid volume and exposure to bioincompatible materials; and residual inorganic ion disturbances, including acidemia and hyperph

版权所有©2007马萨诸塞州医学会。医学的进步改变了尿毒症的病程，也改变了尿毒症曾经包括晚期肾衰竭的所有体征和症状的定义。容量超负荷引起的高血压、低钙血症性手足口炎和红细胞生成素缺乏引起的贫血曾被认为是尿毒症的征兆，但随着病因的发现，它们被从这一类别中删除了。如今，“尿毒症”一词被广泛用于描述伴随肾衰竭的疾病，而这种疾病不能用细胞外体积、无机离子浓度紊乱或缺乏已知的肾脏合成产物来解释。我们现在认为尿毒症主要是由于有机废物的积累，这些废物通常可以通过肾脏清除，但目前尚未全部确定。在肾功能进行性丧失的患者中，没有特定的时间点来界定尿毒症的发病。在终末期肾功能衰竭患者中发现的尿毒症特征可能在肾小球滤过率略低于正常滤过率50%的人中出现，在30岁时，肾小球滤过率在每1.73平方米体表面积100至120毫升/分钟之间。因此，仅在美国，估计有800万肾小球滤过率低于每分钟60毫升每1.73平方米体表面积的人可能会出现一定程度的尿毒症症状。1然而，尿毒症的早期症状，如疲劳，是非特异性的，因此很难识别这种情况。此外，目前我们可以减缓肾衰竭的进展，但只能通过替代肾功能来治疗尿毒症。因此，患者是否患有尿毒症的问题可以归结为透析或移植是否有益。尿毒症的治疗现在主要是透析，这在很大程度上是因为供体肾脏供应短缺。2004年，美国约有100000人开始接受终末期肾病的肾脏替代治疗，335000人正在接受持续的透析治疗。2在某些情况下，患者接受了数十年的透析治疗，但总体结果令人失望。1995年至1999年间，血液透析和腹膜透析的5年生存率均低于35%。接受透析治疗的患者平均每年住院两次，他们的生活质量往往很低。并非所有接受透析的患者的疾病都可以归因于尿毒症。事实上，透析的发展使尿毒症的影响更难区分，因为典型尿毒症症状的严重程度会减轻。相反，接受透析的患者现在有了一种新的疾病，Depner3恰当地将其命名为“残余综合征”。这种疾病包括部分治疗的尿毒症；透析的不良影响，如细胞外液体积的波动和暴露于生物不相容材料；以及残留的无机离子紊乱，包括酸血症和高磷血症。在许多患者中，残余综合征由于年龄的增长和导致肾功能丧失的系统性疾病的影响而变得复杂。尽管接受透析的患者有复杂的疾病，但有令人信服的理由相信，有机废物的去除不足是一个重要的因素-

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[Infectious mononucleosis]. [传染性单核细胞增多症]。

Suomen laakarilehti. Finlands lakartidning

Pub Date : 2020-10-01 DOI: 10.1891/9780826185235.0005h

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Hydrothorax 胸水

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Core Topics in Critical Care Medicine: Status epilepticus 重症医学核心主题:癫痫持续状态

Suomen laakarilehti. Finlands lakartidning

Pub Date : 2010-01-01 DOI: 10.1017/CBO9780511712289.041

F. Smith, J. Yeung

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Infections in hospitals 医院感染

Suomen laakarilehti. Finlands lakartidning

Pub Date : 1981-01-01 DOI: 10.1007/978-94-011-6252-4_7

I. Rantasalo

引用次数: 0

[Rehabilitation activities in connection with health insurance]. [与健康保险有关的康复活动]。

Suomen laakarilehti. Finlands lakartidning

Pub Date : 1967-05-10

A Hänninen

引用次数: 0

[Young doctors and scientific research]. [年轻的医生和科学研究]。

Suomen laakarilehti. Finlands lakartidning

Pub Date : 1967-05-10

R Jaakkola

引用次数: 0

[Ophthalmic cryosurgery]. (眼科冷冻手术)。

Suomen laakarilehti. Finlands lakartidning

Pub Date : 1967-05-10

J A Castrén

引用次数: 0

[Development of out-patient services in a psychiatric department: a study on the activities of an after-care clinic]. [精神科门诊服务的发展:对护理后诊所活动的研究]。

Suomen laakarilehti. Finlands lakartidning

Pub Date : 1967-04-20

R Elosuo, V Hägglund, E M Paakkinen, Y O Alanen

引用次数: 0

[Improvement of athletic performance by drugs]. [通过药物提高运动成绩]。

Suomen laakarilehti. Finlands lakartidning

Pub Date : 1967-04-10

O Mustala

引用次数: 0

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