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难治性泌尿系统疾病

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《难治性泌尿系统疾病》以临床上常见的难治性泌尿系统疾病为切入点,就其难治原因、临床表现、辅助检查、诊断、治疗以及临床典型病例进行重点论述。编写特点:立足于临床实践,深入浅出,实用性强:内容全面涵盖了肾脏病中常见的主要难治疾病;内容新颖,反映了肾脏疾病诊断和治疗的最新进展;理论与实践结合,针对每一疾病,附有典型病例和专家诊治经验分析,其中不少是怍者多年临床经验的结晶。
Content Description

《难治性泌尿系统疾病》是“现代难治病诊治学丛书”之一,由国内多位泌尿系统领域的著名 专家共同编写而成。《难治性泌尿系统疾病》针对泌尿系统的难治性疾病,在充分阐述疾病生理、病理生理和发病机制的基础上,总结了疾病难诊难治的原因,详细介绍了疾病 的临床表现、实验室检查、诊断方法和标准以及治疗方法。并且针对每一疾病,还附有典型的临床病例,以及专家临床诊治经验分析,对各级临床医生颇具参考价值。《难治性泌尿系统疾病》反映了该领域有关诊治方面的新观念、新思路,可满足临床肾内科各级医生的医疗和教学所需。
Author Description

钱家麒,男,1939年6月出生,上海交通大学医学院附属仁济医院内科主任、内科教研室主任、肾脏科主任,主任医师,内科教授,博士研究生导师,上海市卫生局血液透析质量控制中心主任,中华医学会肾病分会副主任委员,上海医学会肾脏病专科委员会主任委员;中华肾脏病杂志副总编辑,中国中西医结合肾病杂志副主编,临床肾脏病杂志副主编,Hongkong Journal of Nephrology、中华内科杂志、肾脏病与透析肾移植杂志编委,透析与人工器官杂志等十余种杂志的编委。国际肾脏病学会会员,美国肾脏病学会会员,欧洲肾脏病学会会员,亚太肾脏病学会理事,国际腹膜透析学会亚太地区核心委员;上海市医疗质量管理委员会专家咨询委员,中华医学科技奖评审委员会委员,上海市科委成果奖评审委员会委员等。由于在医学、教学和科研中成绩突出,享有国务院颁发的国家特殊津贴。曾赴美国哈佛大学医学院医疗系及附属Brigham and women’s医院世界著名的肾脏病中心研究。
Catalogue

第一章肾病综合征
第二章局灶性节段性肾小球硬化
第三章膜性肾病
第四章IgA肾病
第五章急进性肾小球肾炎
第六章狼疮性肾炎
第七章血栓性微血管病
第八章原发性小血管炎
第九章紫癜性肾炎
第十章糖尿病肾病
第十一章肾淀粉样病变
第十二章肝炎病毒相关性肾炎
乙型肝炎病毒相关性肾炎
丙型肝炎病毒相关性肾炎
第十三章肝肾综合征
第十四章多发性骨髓瘤肾损害
第十五章橫纹肌溶解综合征肾损害
第十六章妊娠肾病
原发性肾脏病与妊娠
继发性肾脏病与妊娠
多囊肾患者的妊娠问题
终末期肾衰患者的妊娠问题
肾移植患者的妊娠问题
妊娠并发肾脏疾病

第十七章尿路感染
第十八章肾小管间质性肾炎
急性肾小管间质性肾炎
慢性肾小管间质性肾炎
第十九章尿酸及尿酸盐导致的肾脏损害
第二十章马兜铃酸肾病
第十一章缺血性肾病

第十二章肾小管酸中毒
低血钾型远端肾小管酸中毒
近端肾小管酸中毒
高血钾型远端肾小管酸中毒
肾功能不全型肾小管酸中毒

第二十三章遗传性肾病
Alport综合征
Fabry病
第二十四章梗阻性肾病

第二十五章肾脏囊肿性疾病
常染色体显性多囊肾病
常染色体隐性多囊肾病
青少年肾消耗病-肾髓质囊性病
结节性硬化
vonHippel-Lindau综合征
第二十六章急性肾衰竭
第二十七章慢性肾功能不全
第二十八章血液透析相关性高血压
第二十九章肾性贫血
第三十章透析患者的营养不良
第三十一章肾性骨营养不良
继发性甲状旁腺功能亢进性骨病
低转运性骨病
第三十二章慢性移植物肾病
Book Abstract

目前,国内外关于难治性肾病综合征尚无一致的定义。一般认为,难治性肾病综合征专指原发性肾病综合征中经糖皮质激素(以下简称激素)治疗后仍频繁复发型、激素依赖型和激素抵抗型的肾病综合征。频繁复发型肾病综合征是指经治疗缓解后半年内复发2次或2次以上者,或1年内复发3次或3次以上者;激素依赖型系指经激素治疗获得缓解,但在激素撤减过程中或停用激素后14d内肾病综合征复发者;激素抵抗型则指规范化激素治疗无效的肾病综合征。难治性肾病综合征的患者由于病程较长,病情往往比较复杂,因此临床治疗上较为棘手。在处理这样的患者之前,应该明确导致肾病综合征难治的原因到底是什么?
一、难治原因分析
1.诊断错误误将一些继发性肾病(如淀粉样变肾病、糖尿病肾病等)和特殊的肾脏疾病(如脂蛋白肾病、纤维样-肾小球病等)当作原发性肾病综合征应用激素治疗,当然不可能取得满意的疗效。或将一些需要不同治疗方案的继发性。肾病,如丙型肝炎病毒引起的冷球蛋白肾病、V型(膜性)狼疮性肾炎,如果单用激素一种药物治疗也难以获得满意的疗效。
2.治疗不规范导致肾病综合征频繁复发治疗肾病综合征的主要药物是激素,该药物的一般治疗原则是“足量、慢减与适当维持”。以泼尼松为例,起始剂量为1mg/(kg·d)(40-60mg/d),清晨顿服,服用8-12周;有效的病例可以每2-3周减原用量的10%-20%,待减至10-15mg/d予适当维持治疗,总疗程半年至一年。起始量足有助于病情缓解,减量慢及适当维持用药可预防疾病反复。但是在临床上,部分患者由于各种各样的原因,可能接受了激素剂量不足、减量过快等不规范的治疗,使原本应该是激素有效型的肾病综合征变成了频繁复发型的肾病综合征。
Introduction

2001年10月,我去南京参加会议,贝政平主任医师来看我,谈及他们想编写一套“现代疑难病学丛书”,我当即认为“疑”字不好定义,贝政平主任医师考虑后又提出编著“现代难治病诊治学丛书”,我十分赞同,因为目前国内外尚无此类书籍,对提高临床医生对难治病的认识具有十分重要的意义。后经国家卫生部朱庆生副部长的认同,他们在中华医学会江苏分会的支持下,进行了认真的市场调研,组织了一批国内外具有知名度的专家、教授进行了论证,并得到了上海科学技术出版社的大力支持,即着手开始组织丛书及各分册编委会,对难治病的定义、如何编写等进行了热烈的讨论,在达成共识后于2004年12月正式开始编写。由于该丛书是国内外第一套全面论述难治病诊治思维及方法的大型丛书,没有任何现有的可借鉴的资料,主要依据作者的临床经验和体会。在朱副部长的亲切关怀下,全体编委们通过他们的不懈努力,在短短的三年里,完成了在我国难治病领域中具有里程碑意义的专著。
“现代难治病诊治学丛书”的众多作者,包括李春岩院土、王海燕、萧树东等在内的数百位国内外医学专家从广大临床医务人员的客观需要出发,从浩瀚的医学文献中遴选出最实用的资料,结合自己数十年的各自的临床经验、体会,精心编著了这套丛书,在医学书库中可谓别具一格。该丛书以临床上的常见难治病作为切入点,按临床各科疾病分册编写,就难治原因分析,治疗方法和个人经验进行重点阐述,是国内外知名专家和教授的临床经验总结,有助于临床各科医生加深对难治病的认识,提高诊断思路和治疗水平,从而减少误诊、误治率。它不但可以启迪各专科的青年医生扩大临床思维,而且对中高年资的临床医生也具有较大的参考价值。
我参加了“现代难治病诊治学丛书”的选题和编写策划,乐为作序,并热忱地向同道们推荐这套丛书。
“现代难治病诊治学丛书”的出版,无疑是我们医学界值得庆贺的一件喜事。深信这套丛书将对我国难治病诊疗水平的提高产生不可磨灭的影响和作用。

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