原发性肾病综合征并发急性肾功能衰竭临床分析  

The clinical analysis with primary nephritic syndrome accompanied with acute renal failure

作　　者：朱明久[1] 林辉[2] 王坤[2] 

机构地区：[1]淮南东方医院集团总院肾内科,安徽淮南232001 [2]安徽医科大学附属医院肾内科

出　　处：《中国基层医药》2005年第10期1343-1344,共2页Chinese Journal of Primary Medicine and Pharmacy

摘　　要：目的探讨原发性肾病综合征(PNS)并发急性肾功能衰竭(ARF)的诱因、治疗方法及预后。方法回顾分析近六年间360例PNS中并发ARF 28例患者的临床特征、治疗方法和预后情况。结果原发性肾病综合征合并急性肾衰竭的发生率7.8%,其诱因为血流动力学改变10例,感染8例,药物中毒3例,肾静脉血栓形成1例,余6例无明显诱因。肾脏病理检查以肾小球轻微改变为主,而多数患者肾间质高度水肿,部分患者有肾小管上皮细胞呈灶状脱落坏死。所有患者均经肾上腺糖皮质激素、利尿剂及消除诱因等治疗,部分患者给予环磷酰胺冲击治疗,其中2例进行血液透析治疗,所有患者肾功能均有不同程度的恢复。结论原发性肾病综合征并发急性肾衰竭应尽早明确诱因,积极治疗,一般预后良好。Objective To analyse the therapy and prognosis of primary nephrtic syndrome（PNS） accompanied with acute renal failure（ARF）. Methods In 360 PNS patients 28 patients suffered ARF. The clinical feature, treatment and outcome of 28 cases with PNS complicated with ARF were analyzed retrospectively. Results The incidence of PNS complicated with ARF was 7.8 %. ARF was caused by hemodynamics in 10 of 28 cases,by infection in 8, by drugs and renal vein thrombosis in 3 and 1 respectively. In addition, the causes of ARF in 6 cases could not be determined. Pathological examination showed mild abnormal glomeruli,and most of the cases had diffuse interstitial edema and patchy necrosis of the tubular cells. The renal function in each case recovered with different level after being treated with diuretics, prednisone, hemodialysis, eliminating causes and some patients with cyclophosphamide stosstherapy. Among them,two cases received dialyzed. All of the patients had different recovery. Conclusion ARF in PNS commonly occurs in patients with near normal glomeruli, whose incidence is not rare. Its causes and diagnosis should be determined as soon as possible. The renal function is reversible with different level after appropriate treatment.

关 键 词：肾病综合征 肾功能衰竭 原发性肾病综合征 急性肾功能衰竭 并发 临床分析 肾上腺糖皮质激素 肾静脉血栓形成 肾小管上皮细胞 急性肾衰竭 

分 类 号：R692[医药卫生—泌尿科学] R692.5[医药卫生—外科学]