1 0 0 0 OA 慢性腎不全患者の2回の出産成功例
- 著者
- 中西 祥子 中西 員茂 藤堂 恵 久保 和雄 二瓶 宏
- 出版者
- The Japanese Society for Dialysis Therapy
- 雑誌
- 日本透析医学会雑誌 (ISSN:13403451)
- 巻号頁・発行日
- vol.32, no.8, pp.1135-1141, 1999-08-28 (Released:2010-03-16)
- 参考文献数
- 14
28歳, 女性. 15週で妊娠判明時に血清クレアチニン4.4mg/dlを指摘され, 慢性腎不全の診断にもかかわらず患者の強い希望により妊娠継続した. 血液透析を行いながら32週で経膣分娩にて1790gの男児出産し, 産後8日目の血液透析を最後に離脱した. その後外来経過観察中徐々に腎機能低下, 産後1年10か月にて血液透析再導入となり, 週1回4時間の透析療法を行っていたが, 再び妊娠した. 透析時間延長, 回数を増やし38週にて経膣分娩にて2764gの女児を出産. 産後は週2回各4時間の血液透析となる. その後徐々に高窒素血症進行し, 週3回各4時間の血液透析を行っているが, 大きな合併症なく今日に至っている.2児とも奇形なく, 発育については第1子のみ生後8か月までは標準を下回ったがそれ以後は支障なく, それぞれ10歳, 8歳となり日常および学校生活を順調に過ごしている.
1 0 0 0 OA 近位尿細管機能評価法としてのリチウムクリアランスの意義
- 著者
- 西 園子 曽根 正好 二瓶 宏 清水 倉一
- 出版者
- 社団法人 日本腎臓学会
- 雑誌
- 日本腎臓学会誌 (ISSN:03852385)
- 巻号頁・発行日
- vol.38, no.4, pp.177-184, 1996 (Released:2010-07-05)
- 参考文献数
- 23
Proximal and distal sodium reabsorption values were calculated from lithium clearance in 63 patients with renal diseases, 13 cirrhotic patients with ascites and 12 control subjects. In the patients with renal diseases, fractional excretion of lithium (FELT) and fractional proximal reabsorption of sodium (FPRNa) were not changed in patients whose glomerular filtration rate (GFR), was over 30 ml/min, but FELi was increased and FPRNa was decreased when the GFR was lower than 30ml/min. Moreover, fractional distal reabsorption of sodium (FDRNa) was decreased in patients whose GFR was under 40ml/min. These results indicate that proximal tubular function is well adapted to the degree of renal function even if the etiologies of renal diseases are different. Five patients with nephrotic syndrome (minimal change type) were subjected to lithium clearance method before and after steroid treatment. FPRNa in nephrotic patients was reduced after the treatment, though there was no significant difference in FDRNa. In cirrhotic patients, FELT, FPRNa and FDRNa did not differ from the values in the control subjects, which were not influenced by the decreace in GFR. Thus, the reduction of FPRNa with GFR which was observed in renal disease, was absent in liver cirrhosis. In conclusion, these data indicate that renal adjustment of sodium excretion in chronic renal disease at first takes place in the distal parts of the nephron and later in the proximal tubule, and in addition, that in appopriate reabsorption of sodium from the proximal tubule probably plays a role in ascites formation in cirrhotic patients.