微小病变肾病综合征并发急性肾衰竭的临床病理特点  

Clinical and pathological features of minimal change nephrotic syndrome complicated with acute renal failure

作　　者：尤小寒[1] 周莹[1] 黄朝兴[1] 

机构地区：[1]温州医学院附属第一医院肾内科,浙江温州325000

出　　处：《温州医学院学报》2010年第1期32-35,共4页Journal of Wenzhou Medical College

摘　　要：目的:探讨微小病变肾病综合征(minimal change nephrotic syndrome,MCNS)并发特发性急性肾衰竭(idiopathic acute renal failure,IARF)的临床病理特点。方法:回顾性分析15例成人MCNS并发IARF(肾衰组)临床病理表现及转归情况,随机抽取成人MCNS无并发急性肾衰竭15例(非肾衰组)作对照。结果:肾衰组血肌酐为(307.7±168.6)μmol/L,少尿型占73.3%(11例),急性肾衰竭好转率为86.7%(13例)。与非肾衰组相比,肾衰组水肿程度较重,收缩压水平较高(P<0.01);肾衰组肾小管上皮细胞浊肿和肾小管上皮细胞扁平化发生率较高(P<0.01),肾小管腔内蛋白管型的发生率较高(P<0.05);肾病综合征的缓解时间和平均住院时间较长(P<0.01)。结论:成人原发性MCNS并发IARF患者临床上水肿程度较重和收缩压水平较高,病理表现主要为急性肾小管损伤,肾功能损伤多呈可逆性质,预后好。Objective：To explore the clinical and pathological characteristics of minimal change nephrotic syndrome（MCNS）complicated with idiopathic acute renal failure（IARF）.Methods：Fifteen patients with adult-onset MCNS complicated with IARF（ARF group）were compared with 15 patients with MCNS without ARF（non-ARF group）who were randomly selected.The clinical manifestation,pathological data and outcome were analyzed retrospectively.Results：In ARF group the average serum creatinine level was（307.7±168.6）μmol/L.11 cases manifested oliguria ARF（73.3%）and recovery of renal function（86.7%）in ARF group was found in 13 case.The systolic blood pressure was higher and the degree of edema was more serious in the ARF group（P 0.01）.The incidence of vacuolar degeneration in tubular epithelium and flattened tubular epithelium was higher in the ARF group（P 0.01）.The incidence of proteinaceous casts was higher in the ARF group（P 0.05.） The remission time of nephrotic syndrome as well as the hospitalization time（P 0.05）was longer in the ARF group.Conclusion：IARF usually occurs in nephrotic patients with higher blood pressure and more serious edema.The main histopathologic change is acute tubule injury.Recovery of renal function occurs in most cases.The prognosis is good.

关 键 词：微小病变肾病 肾病综合征 急性肾衰竭 

分 类 号：R363[医药卫生—病理学]