2016年 · 第32卷第06期

A 78-year-old male was admitted to the hospital on 2 January 2016 with "fever 2 h". After dialysis on the same day, sudden chills and fever occurred, without nasal congestion, runny nose, cough, expectoration, diarrhea and other discomfort. In the past: hypertension, aortic valve and tricuspid valve calcification, lacunar infarction, carotid atherosclerosis; Chronic renal failure, peritoneal dialysis combined with hemodialysis, hemodialysis once a week, hemodialysis catheter was closed with heparin once a week, and peritoneal dialysis catheterization was performed on December 30, 2010; On September 18, 2012, arteriovenous fistuloplasty of left upper limb forearm was performed, and the fistula was occluded in October 2012. On November 20, 2012, hemodialysis catheter placement of right internal jugular vein with tunnel and polyester sleeve was performed; No history of blood transfusion, no history of infectious diseases such as hepatitis and tuberculosis, and no history of drug allergy. Admission physical examination: body temperature 38.6℃, blood pressure 170/80 mmHg, breathing 18 times/min, pulse 90 times/min, clear mind, normal eye movement, unpalpable and swollen superficial lymph nodes in the whole body, soft neck, clear breathing sounds in both lungs, no dry and wet rales, regular rhythm, grade 3/6 systolic rumbling murmur in the aortic valve area, soft abdomen, no tenderness and rebound pain, no subcostal reach of liver and spleen, no edema in both lower limbs, physiological reflexes, negative pathological signs, no redness, swelling and tenderness at the outlet and tunnel of hemodialysis catheter. Post-admission examination: blood routine showed 9.14×10 white blood cells⁹/L, neutrophils 85.5%↑, neutrophils 7.81×10⁹/L ↑, red blood cells 3.09×10¹²/L↓, hemoglobin 99 g/L↓, platelets 134×10⁹/L; Blood biochemistry: albumin 27.7 g/L, glucose 6.16 mmol/L↑, urea nitrogen 9.28 mmol/L↑, creatinine 580.5 μ mol/L↑, uric acid 217.2 μ mol/L, carbon dioxide 19.6 mmol/L↓, potassium 3.2 mmol/L↓, normal myocardial enzymes; Coagulation routine normal; procalcitonin 1.9 μ g/L↑; C-reactive protein 37.9 mg/L↑; erythrocyte sedimentation rate 59 mm/h↑; Electrocardiogram showed sinus rhythm, 94 beats/min, left ventricular high voltage, ST-T abnormality suggesting myocardial ischemia or injury. CT of the lung showed: (1) Chronic bronchitis and emphysema. (2) Slight infection of both lungs. (3) Aortic and coronary atherosclerosis. Peripheral blood and catheter blood cultures showed Bacillus cereus. The peritoneal dialysis fluid was normal, and the peritoneal dialysis fluid culture was sterile. Hospitalization and treatment: After admission, cefoperazone sodium and tazobactam sodium injection 2g, twice a day, peripheral intravenous administration, combined with cefazolin sodium injection, catheter closure, no fever after the second day, the initial blood culture result 3 days later was Bacillus cereus, due to the poor vascular condition of the patient and the difficulty in establishing a new pathway, the catheter retention treatment was attempted, and at the same time, the blood culture of the catheter was still Bacillus cereus, and the moxifloxacin hydrochloride injection 0.4g catheter was administered once a day, and the norvancomycin injection 0.4g was sealed for 6 hours. After 13 days of combined use, he was discharged from hospital, and was treated with clindamycin tube sealing, 3 times a week for 1 month. The reexamination of the catheter blood culture before discharge showed negative, and there was no fever after hemodialysis.

Monoclonal immunoglobulinopathy (MIDD) is characterized by the deposition of monoclonal immunoglobulin and its free fragment light chain and/or heavy chain in tissues and organs of the whole body and causing dysfunction. The kidney is most susceptible to involvement^[1,2]。 MIDD is divided into three types: light chain deposition disease (LCDD), light heavy chain deposition disease (LHCDD) and heavy chain deposition disease (HCDD). Among them, LCDD is more common, while LHCDD and HCDD are rare. This article will report a case of LHCDD, and its specific diagnosis and treatment are as follows.

kidney stem-like cells are a class of cells in the kidney that have the same markers as stem cells and are involved in the repair of the kidney. In recent years, it has been found that renal stem cell-like cells are widely distributed in the kidney and have the effect of treating kidney diseases. Therefore, we briefly describe the latest research on the prospect of renal stem cell-like cells in the treatment of renal diseases.

In 2015, European Renal Best Practice (ERBP) issued guidelines for the diagnosis and treatment of patients with diabetes complicated with chronic kidney disease stage 3b or above (DM-CKD3b-5)^[1]It has certain novelty and practical value. This article will interpret and explore the guide.

Minimally pathological nephropathy (MCD) is the most common pathological type of nephrotic syndrome in children and adolescents, accounting for about 70% to 80% of the total incidence^[1]。 The main pathological characteristics of MCD were extensive foot process fusion under electron microscope but no obvious changes under light microscope. Focal stage glomerulosclerosis (FSGS) is the second most common pathological type, accounting for about 10% to 20%^[2]Obvious glomerular sclerosis and interstitial fibrosis were observed under light microscope as the main pathological features, while extensive foot process fusion was also observed under electron microscope. Both MCD and FSGS are podocytosis^[1,2,3]Because some patients whose initial renal puncture results were MCD, the results were FSGS when they underwent renal puncture examination again, and there was no significant difference in the early pathological manifestations of MCD and FSGS, there is widespread controversy as to whether MCD and FSGS are different stages of the same disease or two different types of disease^[3]。 In recent years, the research of CD80 in podocytosis has become an international hot spot, but there is still a lack of relevant research reports in China, so we review the relevant literature and summarize it as follows.