Prevalence of Uropathogenic Escherichia coli among Adult Male Patients 40 Years and above with Haematuria and Impaired Kidney Attending General Hospitals in Benue State

Haematuria is the presence of red blood cells in urine. It is most often caused by urinary tract infections of which Escherichia coli is frequently implicated. Impairment of kidney functions could occur as a result of infection or other complications of the kidney. The aim of the study was to determine the prevalence of uropathogenic Escherichia coli among adult male patients with haematuria and impaired kidneys attending a general hospital in Benue state. Three hundred and sixty-eight (368) samples of urine were collected from 368 male patients (≥ 40 years) attending the 23 general hospitals in Benue state. Each of the urine samples was divided into two parts for haematuria and isolation and identification of Escherichia coli. Blood samples (368) were also collected from the patients and used for quantitative determination of creatinine and estimation of glomerular filtration rate. The presence of haematuria was 45.1% and ranges from 12.5% to 100%. Prevalence of haematuria with respect to age shows that patients within the age group of 90 - 99 years had the highest rate (100%) and the least were those within the ages of 40 - 49 years (20.0%). Isolation rate of uropathogenic Escherichia coli was 16.3% and ranged from 6.3 to 37.5%. Patients within the age group of 90 - 99 years had the highest elevated impaired renal function of 4 (80%), followed by patients within the ages of 80 - 89 years [17 (77.3%)] and the lowest were those within the ages of 40 - 49 [6 (10.0%)]. The overall presence of haematuria in the patients was high (45.1%) with similar high Escherichia coli isolation rate and impaired renal function which could mean that acute or chronic kidney disease may set in.

Pathogenesis of glomerular haematuria

Haematuria was known as a benign hallmark of some glomerular diseases, but over the last decade, new evidences pointed its negative implications on kidneydisease progression. Cytotoxic effects of oxidative stress induced by hemoglobin, heme, or iron released from red blood cells may account for the tubular injury observed in human biopsy specimens. However, the precise mechanisms responsible for haematuria remain unclear. The presence of red blood cells （RBCs） with irregular contours and shape in the urine indicates RBCs egression from the glomerular capillary into the urinary space. Therefore glomerular haematuria may be a marker of glomerular filtration barrier dysfunction or damage. In this review we describe some key issues regarding epidemiology and pathogenesis of haematuric diseases as well as their renal morphological fndings.

The Role of Dutasteride in Acute Prostatic Haematuria

Background: Dutasteride has been found to reduce chronic prostatic bleeding and when taken 2 - 6 weeks preoperatively reduces bleeding during transurethral prostate resection. The aim of this study is to determine if the drug will be effective in the control of acute gross prostatic haematuria. Patients and Method: 87 Consecutive patients with gross haematuria were enrolled. Clotting Profile, Cystoscopy and Intravenous Urography were done to exclude haematuria from medical, renal and bladder causes. Patients suspected to have prostatic haematuria were further evaluated using serum Prostate specific antigen (PSA) and Prostate scan. Those with elevated PSA ≥ 10 ng/ml and abnormal digital rectal examination (DRE) finding had prostate biopsy. The patients were randomly divided into 2 treatment groups. The control group had Normal saline irrigation and broad spectrum antibiotics while the second group received 0.5 mg oral dutasteride in addition. The time taken and volume of irrigation fluid used before haematuria stopped were noted. Statistical analysis was done using SPSS version 20.0. Result: 75 patients had haematuria of prostatic origin. 49 (65.3%) of these had benign prostatic hyperplasia (BPH) and 26 (34.7%) had cancer of prostate. 25(51%) of the 49 patients with BPH had Normal saline irrigation and antibiotics while 24 (49%) had oral dutasteride in addition. 14 (53.8%) of the prostate cancer patients had Normal saline irrigation and antibiotics while 12 (46.2%) had dutasteride in addition. Haematuria resolved in significantly shorter length of time using lesser volume of irrigation fluid in those treated with dutasteride than in those on control arm. Conclusion: Addition of 0.5 mg oral dutasteride daily leads to early resolution of acute prostatic haematuria.

Surgical Haematuria: An Analysis of Causes in a Southern Nigerian State

Background: Surgical haematuria is not very common but ominous when it occurs. Knowledge of the causes will help in the adequate management of the disease. Aim: To evaluate the causes of surgical haematuria in Port Harcourt, Nigeria. Materials and Method: This is 10 years retrospective study of patients who presented at the University of Port Harcourt Teaching Hospital and 4 other private urology centres in Port Harcourt with haematuria of surgical aetiology between January 2012 and December 2021. Their history, examination findings and investigations were evaluated. Patients with medical haematuria and incomplete records were excluded from the study. Results: Three hundred and forty-six patients were evaluated. The mean age was 58.12 ± 5.1. Two hundred and sixty-four (76.3%) were men and eighty-two (23.7%) were females. The three commonest causes of haematuria were Benign prostatic enlargement, prostate cancer and urolithiasis with a frequency of 126 (36.41%), 66 (19.08%) and 40 (11.56%) respectively. The cause of haematuria was benign in 232 (67.06%) subjects and malignant in 114 (32.94%). Conclusion: The commonest causes of haematuria are of prostatic origin, mainly benign although malignancy is a significant cause.

Urinary Schistosomiasis Prevalence and Diagnostic Performance of Reagent Strip at Point-of-Care

Due to limited resources and experience, rapid diagnostic techniques are advocated in nations with a resource shortage when diagnosing schistosomiasis. We used rapid diagnostic tests to access the prevalence and intensity of schistosome infection in North Central, Nigeria. A total of 1951 participants were recruited for this study. The participants were screened for S. haematobium infection;haematuria and proteinuria were monitored in the recruited patients with a commercial reagent strip. Of the 1951 participants recruited for the study, 587 were found to be infected. Children aged 0 to 10 years showed the highest levels of haematuria with (100%) specificity. Meanwhile, other age groups (11 - 20, 21 - 30, 31 - 40 and above 40 years) had rates higher than 90%. The degree of haematuria increased with egg intensity. The same was seen in proteinuria, with a percentage of 41.9%. A significant difference (p S. haematobium in rural endemic areas.

合并肉眼血尿和急性肾损伤IgA肾病患者的临床病理特征及预后影响因素

目的:探讨合并肉眼血尿和急性肾损伤(AKI)IgA肾病(IgAN)患者的临床、病理特征及其影响肾功能恢复的因素。方法:回顾性分析2001年12月至2018年2月在联勤保障部队第九OO医院伴肉眼血尿和AKI的原发性IgAN患者(AKI组)30例,并随机抽取同期发生肉眼血尿但无AKI的IgAN患者60例(无AKI组),比较两组患者的临床资料和病理。结果:(1)AKI组与无AKI组,年龄≥55岁、血尿持续天数≥10 d、基础血清肌酐(SCr)、白蛋白、24 h尿蛋白定量差异有统计学差异(P<0.05),AKI组肾小管萎缩、间质细胞浸润、肾血管硬化更严重。相关因素分析发现,伴肉眼血尿的IgAN患者发生AKI的相关危险因素包括肉眼血尿持续时间≥15 d和24 h尿蛋白定量高。(2)23.3%的AKI患者在肉眼血尿消失后,肾功能未能完全恢复。肾功能恢复组与肾功能不完全恢复组在性别、收缩压、舒张压、24 h尿蛋白定量、最高SCr值均无统计学差异;在年龄、肉眼血尿持续时间、基础SCr值、球性硬化积分、肾小管萎缩差异存在统计学意义(P<0.05)。多元逐步Logistic回归模型仅发现基础估算的肾小球滤过率影响肾功能转归。结论:肉眼血尿持续时间长、蛋白尿多是IgAN患者发生AKI的危险因素,且部分基础肾功能水平较差的患者在发生AKI后肾功能不能完全恢复。

全自动尿沉渣仪分析法与显微镜法判断血尿来源的准确性比较

目的对比全自动尿沉渣分析仪分析法和显微镜法判断血尿来源的准确性,为临床参考提供数据资料。方法 206例血尿患者作为研究对象,其中肾小球病变患者101例,非肾小球病变患者105例。分别用UF1000i全自动尿沉渣分析仪(简称UF1000i)分析法和显微镜法分析尿液中红细胞(RBC)的形态,判断其来源并统计分析其检测性能的优劣。结果显微镜法的敏感性为88.1%,特异性为74.3%;UF1000i分析法的敏感性为92.1%,特异性为82.8%,2种方法检测结果的差异有统计学意义。受试者工作特征(ROC)曲线分析发现,显微镜法ROC曲线下面积(AUC)为0.869,UF1000i分析法AUC为0.928。结论 UF1000i分析法在肾小球性和非肾小球性血尿的鉴别中具有高敏感性和高特异性,其判断血尿来源的诊断价值优于经典相差显微镜法。

从复旦大学附属儿科医院31年肾脏病理及临床资料反思肾活检指征

目的了解复旦大学附属儿科医院肾脏风湿科肾脏疾病的病理学类型及临床特点,并对肾活检指征进行反思。方法回顾性分析1979至2009年肾活检病理学分型和临床资料,并以10年为一个间期分3个阶段进行分析比较。结果 31年中肾活检1 633例,其中1 419例满足入选条件进入分析。①原发性、继发性和遗传性肾脏疾病分别占63.9%(907例)、23.2%(329例)和12.1%(172例)。②原发性肾脏疾病中,IgA肾病(26.6%,241/907例)、微小病变病(23.0%,209/907例)和轻微病变(18.1%,164/907例)所占比例较高,局灶节段肾小球硬化仅占3.0%(27/907例);继发性和遗传性肾脏疾病分别以紫癜性肾炎(47.1%,155/329例)和薄基膜肾病(80.8%,139/172例)所占比例最高。③31年间肾活检病理学类型构成比的变化趋势为IgA肾病、轻微病变和紫癜性肾炎在各阶段所占比例逐渐增加,系膜增生性肾小球肾炎及HBV相关性肾炎所占比例逐渐减少。④肾活检临床表现以血尿(38.8%,551/1 419例)和原发性肾病综合征(30.9%,439/1 419例)多见。血尿中单纯性镜下血尿占14.5%(206/1 419例),其病理类型主要为薄基膜肾病(52.9%,109/206例)和轻微病变(23.3%,48/206例);原发性肾病综合征初发为单纯性肾病的患儿中激素依赖及频复发占11.1%(157例),其病理学类型主要为微小病变(61.8%,97例)和轻微病变(17.2%,27例)。结论肾活检病理学的构成比中仍以原发性肾脏疾病多见,主要为IgA肾病和微小病变,临床表现以血尿和原发性肾病综合征为主。肾活检对于单纯性镜下血尿患儿意义相对有限,临床上可密切随访尿蛋白和尿微量蛋白,如有异常再考虑行肾活检。而对于原发性肾病综合征激素依赖及频复发,特别是初发表现为单纯性肾病的患儿,临床上应关注糖皮质激素的不良反应,如出现严重不良反应,需加用免疫抑制剂特别是环孢素A和他克莫司前应考虑行肾活检。

儿童孤立性血尿型紫癜性肾炎135例临床分析

目的探讨儿童孤立性血尿型紫癜性肾炎(HSPN)的临床特征。方法回顾性分析2003年11月至2014年12月河南中医药大学第一附属医院儿科收治的孤立性血尿型HSPN患儿的临床资料。结果 135例患儿纳入本研究,其中男80例,女55例,男女比例为1.45∶1;年龄(9.24±5.32)岁;单纯皮肤紫癜31例,紫癜伴腹痛33例,紫癜伴关节痛28例,紫癜伴腹痛、关节痛43例;血尿病程(8.62±7.28)个月;7例患儿行肾组织活检。135例患儿中,给予普通治疗31例,免疫抑制剂治疗104例;普通治疗患儿治疗后痊愈19例,孤立性血尿8例,轻度蛋白尿3例,中度蛋白尿1例;免疫抑制剂治疗患儿治疗后痊愈72例,孤立性血尿23例,轻度蛋白尿7例,中度蛋白尿1例,重度蛋白尿1例;普通治疗与免疫抑制剂治疗患儿预后比较差异无统计学意义(z=0.65,P=0.516)。结论孤立血尿型HSPN患儿整体预后良好,但仍有少数患者可发展为中、重度蛋白尿。

胡桃夹现象的多层螺旋CT血管成像诊断

目的:探讨引起血尿的胡桃夹现象发病机制及其诊断新方法。方法:应用多层螺旋CT动态扫描,采用不同的图像后处理技术进行血管成像,比较确诊胡桃夹现象患者4例与正常对照者10例的血管显示情况及解剖变异。结果:CT血管成像发现胡桃夹现象患者左侧肾静脉在腹主动脉与肠系膜上动脉之间明显受压,其夹角平均为(39.3±4.3)°,而正常对照组的夹角平均为(90±10)°。在肾静脉水平肠系膜上动脉与腹主动脉之间的直线距离,正常对照组平均为(12±1.8)mm,而胡桃夹现象患者平均为(3.1±0.2)mm,两组比较差异有显著性意义(P<0.05)。结论:多层螺旋CT扫描行肾静脉及周围血管重建证实引起血尿的胡桃夹现象的主要发病机制是左侧肾静脉受压。多层螺旋CT三维血管成像在胡桃夹现象临床诊断中具有潜在的应用价值,具有立体直观、无创简便优点,可作为胡桃夹现象临床筛查的一种常规确诊手段。

尿红细胞位相显微镜检查诊断肾小球性血尿的临床评估

目的 :探讨以 3次尿红细胞位相显微镜检查作为血尿的定位诊断方法。以尿红细胞 >80 0 0个 /ml,其中畸形红细胞 >70 % ;G1红细胞≥ 5 % ,作为肾小球性血尿的诊断标准 ,评估其准确性及临床应用价值。方法 :用双盲法研究 12 8例血尿患者 ,其中 6 6例 (经肾活检证实 )为肾小球疾病 ,6 2例为非肾小球性疾病。通过评估患者一次尿红细胞位相显微镜及三次尿中任意一次尿红细胞位相显微镜检查达到肾小球性血尿诊断标准与肾小球疾病的符合率 ,计算出其灵敏度和特异度。结果 :此诊断标准的灵敏度为 90 .9% ,特异度为 96 .8%。结论 :与以往的报道比较 ,本诊断方法对肾小球性血尿定位诊断的准确性更好 ,而且简便易于掌握 ,适于临床应用。

肾结核的诊断要点分析

目的:分析和总结肾结核的临床特点,提高早期诊断水平。方法:收集近5年我院收治的69例存档病例资料,系统采集病史资料及各项辅助检查数据。结果:本研究包括28例男性,41例女性。最常见症状依次为膀胱刺激征46例(66.7),腰腹痛30例(43.5),肉眼血尿29例(42.0)。尿常规异常58例(85.5);尿抗酸杆菌检查27例,阳性3例(11.1)。超声、静脉肾盂造影、逆行肾盂造影、CT、MRI、膀胱镜检+活检的诊断率分别为63.2(43/68)、46.9(15/32)、85.7(12/14)、64.3(9/14)、90.9(10/11)、10(1/10)。结论:当就诊患者长期有不能解释的泌尿系症状时,应考虑结核性疾病可能。综合分析病史,联合应用各种实验室和影像学检查结果,是早期诊断的必要条件。

造血干细胞移植中出血性膀胱炎的预防及护理

目的总结造血干细胞移植中出血性膀胱炎(HC)防治与护理。方法 85例行造血干细胞移植的患者采用常规水化、碱化尿液、利尿,应用美司钠解毒等积极预防,对出现HC的患者积极观察,重度者采用持续膀胱冲洗和相关对症治疗。结果 85例造血干细胞移植患者术后发生HC25例,发生率为29. 41%,早发HC6例,迟发HC19例,经治疗和护理后均治愈出院。结论造血干细胞移植术后,积极采用水化、碱化尿液、强迫利尿等措施,可有效预防HC发生,对出现HC的患者积极评估,根据轻重程度采取对应干预措施,对促进患者康复有积极作用。

血管紧张素转换酶基因多态性与小儿紫癜性肾炎的关系

目的 探讨血管紧张素转换酶多态性 (ACE)与紫癜性肾炎 (HSPN)之间的关系。方法 用PCR方法对HSPN患儿及正常儿童进行ACE基因多态性检测 ,并对不同基因型的HSPN患儿治疗前后的蛋白尿和血尿水平进行比较。结果 HSPN组与正常对照组ACE基因多态性分布比较差异无显著性 (P >0 0 5 ) ;HSPN患儿中DD型表现有大量蛋白尿和明显血尿的频率显著高于II型 ,II型治疗 2个月后蛋白尿和血尿减轻或转阴的频率显著高于DD与DI型。结论 ACE基因多态性可能对HSPN的发生无明显意义 ,但可能与其临床表现中明显的个体差异及治疗后疾病不同的转归有关。

膀胱非移行细胞肿瘤的诊断与治疗(附18例报告)

目的：提高膀胱非移行细胞肿瘤的诊治水平。方法：结合文献对收治的18例膀胱非移行细胞肿瘤的诊断与治疗进行讨论。结果：18例膀胱非移行细胞肿瘤占同期352例膀胱肿瘤的5．1％。其中良性非移行细胞肿瘤3例（16．7％），恶性非移行细胞肿瘤15例（83．3％），后者以鳞癌、腺癌及其与移行细胞癌混合癌为主，占73．3％，且临床分期T3期以上者亦占73．3％。以血尿和膀胱刺激症状为主要临床表现。治疗以膀胱全切除及部分切除为主，其1、3及5年生存率分别为85．7％、66·7％及57．1％。结论：膀胱非移行细胞肿瘤的预后与其临床分期、治疗方式选择有关。

应用病理图象分析系统做尿红细胞形态学分析诊断肾小球性血尿

Objective To explore the clinical value of computer-assisted pathologic imaging analysis in evaluating urinary red blood cell morphology. Method 24 nephropathy patients were treated as study group, and 28 patients whose haematuria due to shockwave lithotomy were treated as control. Urine sediment of each patient was stained,and red blood morphology analysis with computer-assisted imaging system was made. Result The sensitivity and specificity were 83.3% and 90.9% respectively in diagnosis of glomerular haematuria; for non-glomerular haematuria,the sensitivity and specificity all were 100%. Conclusion There are high sensitivity and specificity in diagnosis of glomerular haematuria using computer-assisted imaging analysis.It is reliable and has significant clinical value.

左肾静脉压迫综合征合并IgA肾病患者的临床分析

目的通过分析6例左肾静脉压迫综合征合并IgA肾病患者的临床资料，提高临床医师对于左肾静脉压迫综合征合并IgA肾病的认识和诊治水平。方法回顾性分析2012年1月至2014年1月我院的6例左肾静脉压迫综合征合并IgA肾病患者的临床资料。6例左肾静脉压迫综合征患者均由左肾静脉彩色多普勒诊断，其中1例患者同时行CT血管三维成像（computed tomography angiography，CTA）诊断；记录患者的性别、年龄、身高、体质量、尿常规、24h尿蛋白定量、血常规、血肌酐、血白蛋白、血尿酸、补体C3、肾活检病理类型及影像学资料等。结果6例患者均为男性，平均年龄（16．5±4．3）岁，平均体质量指数（body mass index，BMI）为17．8±1．3，以血尿、蛋白尿、腰痛为主要临床表现。病理级别为LeeI级LeeⅢ级；6例患者中1例患者为LeeI级，4例患者为LeeⅡ级，1例患者为LeeⅢ级；1例患者有细胞性新月体形成（占。肾小球总数比例的5．9％），1例患者有。肾小球球性硬化（占肾小球总数比例的14．3）％。6例患者均有不同程度系膜增生（轻度～中度）及轻度肾小管萎缩、肾小管纤维化，所有患者均无间质血管炎；2例患者有间质灶性炎细胞浸润；免疫荧光检测，6例患者均有不同程度系膜区IgA沉积（＋＋～＋＋＋）、IgG沉积（＋＋）及补体c3沉积（＋～＋＋），6例患者均无系膜区IgM沉积。结论对于BMI偏低的儿童和青少年出现血尿和（或）蛋白尿，行左肾静脉彩色多普勒检查和仰卧位／站立位尿液检查不仅有助于明确诊断，还有助于指导治疗，避免过度医疗。

对四川省散打队十运会赛前训练运动性疲劳的综合监测

目的:寻找对四川省散打队十运会赛前训练有关运动性疲劳有效的生理、心理监测措施。方法:采用追踪实验法和统计分析法。以四川省散打队备战“十运会”的五名队员为对象。以周为训练单位,采静脉血:每周一晨8时空腹采血,共四周。测试指标:1)生化指标:CK、BU、Hb;2)心理指标:闪光融合频率、自创量表法。结果认为将整体监测与个体监测配合运用,是监测运动性疲劳的可靠手段;而将生化指标与心理指标结合使用,是监测运动性疲劳的有效手段。结论:运用生理生化指标和心理指标对散打运动员进行综合监控,其效果优于单一使用生理生化指标或心理指标。

儿童血尿方治疗儿童胡桃夹性血尿临床观察

目的观察儿童血尿方治疗儿童胡桃夹性血尿的临床疗效。方法共选择60例病例,分为治疗组和对照组各30例;治疗组用儿童血尿方治疗,对照组保守观察;6个月后观察两组尿红细胞计数、左肾静脉内径值及血液流速变化情况。结果治疗组治疗后尿红细胞计数显著减少(P<0.05),左肾静脉内径比值和血液流速降低(P<0.05);对照组上述指标均无明显变化(P>0.05)。组间治疗后比较,尿红细胞计数和左肾静脉血液流速差异有统计学意义(P<0.05)。结论儿童血尿方可有效用于儿童胡桃夹性血尿的治疗。

Renal biopsy:Still a landmark for the nephrologist

Renal biopsy was performed for the first time more than one century ago, but its clinical use was routinely introduced in the 1950s. It is still an essential tool for diagnosis and choice of treatment of several primary or secondary kidney diseases. Moreover, it may help to know the expected time of end stage renal disease. The indications are represented by nephritic and/or nephrotic syndrome and rapidly progressive acute renal failure of unknown origin. Nowadays, it is performed mainly by nephrologists and radiologists using a 14-18 gauges needle with automated spring-loaded biopsy device, under real-time ultrasound guidance. Bleeding is the major primary complication that in rare cases may lead to retroperitoneal haemorrhage and need for surgical intervention and/or death. For this reason, careful evaluation of risks and benefts must be taken into account, and all procedures to minimize the risk of complications must be observed. After biopsy, an observation time of 12-24 h is necessary, whilst a prolonged observation may be needed rarely. In some cases it could be safer to use different techniques to reduce the risk of complications, such as laparoscopic or transjugular renal biopsy in patients with coagulopathy or alternative approaches in obese patients. Despite progress in medicine over the years with the introduction of more advanced molecular biology techniques, renal biopsy is still an irreplaceable tool for nephrologists.