原发性肾病综合征并发重症特发性急性肾功能衰竭的临床特征  

Clinical Features of Primary Nephrotic Syndrome Accompanied Severe Idiopathic Acute Renal Failure

作　　者：庄永泽[1] 张河震[1] 陈建[1] 张明炜[1] 王丽萍[1] 

机构地区：[1]南京军区福州总医院肾脏科,福建福州350025

出　　处：《医学临床研究》2004年第5期505-509,共5页Journal of Clinical Research

摘　　要：【目的】探讨原发性肾病综合征 (PNS)并发重症特发性急性肾衰 (iARF)的临床病理特点与治疗。【方法】采用腹膜透析 (PD)联合激素、免疫抑制剂、抗凝、降脂等综合治疗 7例PNS并发重症iARF患者 ,总结分析其临床病理资料。【结果】患者均有典型的NS表现 ,其中少尿型iARF6例、非少尿型 1例 ;4例伴大量腹水 ,血肌酐 (Scr) 316～ 185 7μmol/L ,5例血清纤维蛋白原升高。病理改变为局灶节段系膜增生性肾炎及弥漫系膜增生性肾炎各 3例 ,微小病变 1例。均伴有不同程度肾小管间质病变。 3例iARF后肾活检者均有肾间质水肿 ,炎细胞浸润 ,其中 2例小灶性肾小管上皮坏死。PD 10～ 4 0d ,1例死亡、6例iARF治愈 ;PNS完全缓解 (CR)、部分缓解 (PR)及无效 (NR)各 2例 ;随访 15～ 96个月 ,CR 4例、PR及NR各 1例。【结论】PNS并发iARF重症患者以少尿型为主 ,伴高凝状态 ,多见于肾小球病变较轻者 ,且伴小管间质的急性病变。PD联合激素、抗凝等治疗可使多数患者病情逆转。To investigate the clinicopathological features and treatment of primary nephritic syndrome (PNS) accompanied severe idiopathic acute renal failure(SIARF).Seven cases of PNS accompanied SIARF were treated by peritoneal dialysis(PD)in combination with comprehensive therapy, including prednisone, immunosuppressive agents, anticoagulation and hypolipidic measures.Their clinicopathological data were summarized and analyzed.All patients had typical clinical manifestations of PNS,with oliguric SIARF in 6 cases ,non-oliguric SIARF in 1 case and massive ascites in 4 cases (serum creatinine 316～1857μmol/L).Serum fibrinogen levels increased in 5 cases.As for their pathological changes, 3 cases of focal segmental mesangial proliferative nephtiris, 3 cases of diffuse mesangial proliferative nephtiris and 1 case of minimal change disease were found. Various degree of renal tubulointerstitial changes existed in all 7 patients. Renal interstitial edema and inflammatory cell infiltration were observed in 3 patients subjected to renal biopsy after SIARF happened,two cases out of them displayed micro focal necrosis of renal tubular epithelia. The lasting duration of PD was 10～ 40 days, one case died and 6 cases of SIARF was cured. Complete remisson(CR)of PNS ,partial remission(PR) and no response(NR) to treatment were shown in each 2 cases respectively. Follow-up for 15～96 months revealed that CR occurred in 4 cases,PR and NR in each 1 case, respectively.[Conclusion]Oligouric type is predominant in PNS patients accompanied SIARF. Associated hypercoagulability is usually seen in patients with slight glomerular lesion and acute tubulointerstitial damage. Amelioration can be achieved by PD combined with hormone therapy and anticoagulative remedy in majority of the patients.

关 键 词：肾变病综合征/并发症 肾功能衰竭 急性/并发症 

分 类 号：R692[医药卫生—泌尿科学]