难治性肾病综合征致急性肾衰竭诊治分析  

Analysis of Diagnosis and Treatment of Refractory Nephrotic Syndrome Caused by Acute Renal Failure

作　　者：刘洁[1] 苏秀霞[4] 陈云爽[2] 滑丽美[3] 

机构地区：[1]解放军白求恩国际和平医院信息科,石家庄050082 [2]解放军白求恩国际和平医院肾内科,石家庄050082 [3]解放军白求恩国际和平医院营养科,石家庄050082 [4]解放军260医院麻醉科,石家庄050041

出　　处：《临床误诊误治》2016年第B10期18-20,共3页Clinical Misdiagnosis & Mistherapy

摘　　要：目的探讨重症肾病综合征诊断及治疗要点。方法对我院收治的难治性肾病综合征1例的临床资料进行回顾性分析。结果本例因颜面、双下肢水肿，尿中有较多泡沫5d入院。临床表现为大量蛋白尿、高度水肿、高脂血症、低蛋白血症，按肾病综合征抗凝、活血、保肾、利尿为主，同时予泼尼松龙60mg／d治疗防止肾衰竭及血栓形成，期间出现呼吸道、消化道及下肢感染，且颜面及下肢水肿进行性加重，治疗2个月时尿量减少至300ml／d，考虑肾衰竭，予连续性血液透析。为明确病因行。肾穿刺活检示：小球系膜局灶节段性增生伴硬化趋势，局灶球囊壁细胞增生伴新月体形成，小动脉壁增厚伴闭塞；免疫组织化学染色示：IgG、IgM均（＋），IgA（-），C3（＋），考虑局灶节段硬化性肾小球肾炎。将泼尼松龙60mg／d口服改为泼尼松龙100mg／d静脉滴注，同时加用环磷酰胺（50mg、2／d），来氟米特，雷公藤多苷等联合免疫治疗，同时继续上述治疗，病情好转出院，定期返院行环磷酰胺治疗。结论肾病综合征预后的个体差异很大，决定因素在于肾病综合征的病理类型。局灶节段硬化性。肾小球肾炎一般预后不佳，尽早明确病因诊断并予足量糖皮质激素、抗凝及细胞毒药物，可改善预后。Objective To investigate key points of diagnosis and treatment for refractory nephrotic syndrome induced by acute renal failure. Methods Clinical data of 1 patient with refractory nephrotic syndrome was retrospectively analyzed. Results The patient was admitted for facial surface, double oedema legs and more bubbles in urine for 5 d, and clinical manifestations were a large number of proteinuria, height edema, hyperlipidemia and hypoalbuminemia. The patient was trea- ted with antieoagulation of nephrotic syndrome, activating blood circulation, keeping kidney and diuresis, and 60 mg/d Pred- nisone was given at the same time for preventing renal failure and thrombosis. During the treatment, infections were found in respiratory tract, the digestive tract and the lower limb, and facial surface and lower limb edema had progressive aggravation. After treatment for 2 months, the urine volume reduced to 300 ml/d, and kidney failure was doubted, and then continuous he- modialysis was given. Results of renal needle biopsy showed that mesangial focal segmental hyperplasia combined with harden- ing, focal lesion in capsule wall cell hyperplasia combined with crescent formation and small arterial wall thickening with oc- clusion. Immunohistoehemieal showed that IgG （ ＋ ） , IgM （ ＋ ） , IgA （ - ） and C3 （ ＋ ） , and then focal segmental scleros- ing glomerulonephritis was doubted. The 60 mg/d Prednisone orally was changed into 100 mg/d Prednisone by intravenously guttae, and Cyclophosphamide （50mg, 2/d）was added at the same time, and combined immunization therapy with Lefluno- mide and Tripterygium Glycosides were also given based on the above treatments. The patient＇s condition improved and dis- charged, and Cyclophosphamide therapy was performed regularly. Conclusion Prognosis of nephrotic syndrome can be very individual difference, and determinative factor is pathological type. Focal segmental sclerosing glomerulonephritis has poor prognosis generally, and therefore etiology diagnosis should be con

关 键 词：肾病综合征 肾功能不全 糖皮质激素类 细胞毒素类 

分 类 号：R692[医药卫生—泌尿科学]