糖尿病肾病肌酐尿素分离伴意识障碍的诊治  

Diagnosis and Treatment of Patients with Diabetic Nephropathy with Consciousness Disorders and Splitting of Blood Urea Nitrogen and Serum Creatinine

作　　者：王彦斌[1] 孟伟[1] 韩国林[1] 张辉[1] 常帅[1] 

机构地区：[1]解放军第474医院肾病科,乌鲁木齐830013

出　　处：《临床误诊误治》2012年第7期17-19,共3页Clinical Misdiagnosis & Mistherapy

基　　金：兰州军区医药卫生科研计划项目(CWS10JA10)

摘　　要：目的探讨伴有意识障碍和肾功能表现为肌酐尿素分离的糖尿病肾病的临床特点及诊治要点。方法对我院收治的1例糖尿病肾病伴急性肾衰竭、糖尿病酮症、糖尿病神经源性膀胱的临床资料进行回顾性分析。结果本例因血糖高22年、蛋白尿6年、肾功能异常2年、意识模糊1周入院。曾在外院行血液透析治疗,症状可好转,为再次行此治疗入我院。经仔细分析病史结合尿素54.3 mmol/L、肌酐322μmol/L、血糖19.8mmol/L、血酮0.7 mmol/L,确定无血液透析指征,予补液、降糖、补钾、静脉营养等治疗,同时留置导尿时发现尿潴留。经上述综合治疗后血酮降至正常,血糖控制满意,意识逐渐转清,肾功能逐渐好转。结论病程长、血糖控制差、饮食欠佳的糖尿病肾病患者,尤其老年患者并发症多,临床接诊此类患者应详细询问病史,并结合相关检查仔细分析,以免误诊误治。Objective To explore the clinical features and summarize the highlights of diagnosis and lreatment of diabetic nephropathy （DN） patients with consciousness disorders and creatinine urea disassociation of renal function manifest. Methods The clinical data of one patient with D1N combined with acute renal failure （ARF） , diabetic ketosis and diabetic neurogenic bladder was retrospectively analyzed. Results The patient was admitted for hyperglycemia for 22 years, proteinuria for 6 years, abnormal renal function for 2 years and consciousness disorders for 1 week. The patientg medical symptoms improved after haemodialysis treat- ment in other hospitals, and was admitted into our hospital for furthur treatment of haemodialysis. We dissected the patient~ medical history and gave him chemical examinations such as BUN 54.3 mmol/L, creatinine 322 p, mol/L, glucose 19.8 mmol/L and acet- onaemia 0.7 mmol/L, which showed no indication of haemodialysis. In the process of urethral catheterication, uroschesis was found during treatment of fluid replacement, kata-saccharide, added kalium and intravenous nutrition. The patient~ acetonaemia was nor- mal, blood glucose was controlled well and renal function improved after the treatment. Final diagnosis was DN combined with ARF, diabetic ketosis, and diabetic neurogenic bladder. Conclusion DN patients with a long course of the disease with poor control of glucose and inadequate diet, especially gerontal patients, should undergo careful examination and treatment to avoid misdiagnosis and mistreatment.

关 键 词：糖尿病肾病 糖尿病酮症 糖尿病神经病变 误诊 

分 类 号：R587.24[医药卫生—内分泌]