慢性肾衰竭10例误诊原因分析并文献复习  

Clinical Analysis of 10 Cases of Chronic Renal Failure Misdiagnosis and Literature Review

作　　者：董玉荣 东艳蕊 杨淑芹[1] 郜攀峰[2] 王静[2] 李宽红 DONG Yu-rong;DONG Yan-rui;YANG Shu-qin;GAO Pan-feng;WANG Jing;LI Kuan-hong(Department of Renal Endocrinology,People's Hospital of Nanpi,Nanpi,Hebei 061500,China;Department of Nephrology and Hematology,People's Hospital of Nanpi,Nanpi,Hebei 061500,China)

机构地区：[1]南皮县人民医院肾内分泌科,河北南皮061500 [2]南皮县人民医院消化血液科,河北南皮061500

出　　处：《临床误诊误治》2020年第1期4-8,共5页Clinical Misdiagnosis & Mistherapy

基　　金：河北省中医药管理局科研计划项目(2019314)

摘　　要：目的分析慢性肾衰竭的误诊原因,总结防范误诊措施,降低临床误诊率。方法回顾性分析我院2016年6月—2018年6月收治的10例慢性肾衰竭误诊病例资料。结果本组3例以头痛、头晕及血压升高为主诉就诊,误诊为原发性高血压;2例以食欲缺乏、上腹胀满不适、恶心呕吐为主诉就诊,经纤维胃镜检查误诊为慢性胃炎;2例以头晕、乏力、面色苍白为主诉就诊,查血红蛋白降低,误诊为贫血;2例以皮肤干燥、瘙痒、皮疹为主诉就诊,误诊为皮肤瘙痒症;1例以咳嗽、咳痰伴胸闷为主诉就诊,听诊有湿啰音,X线检查示两肺门阴影,诊断为肺部感染。10例均按初始诊断给予对症治疗3 d^3个月后病情无好转,请专家会诊综合分析病情并行尿常规和(或)肾功能检查最终确诊为慢性肾衰竭。误诊时间6 d^3个月。确诊后给予原发病及对症治疗后,病情均显著改善。结论慢性肾衰竭起病隐匿,可累及消化道、心血管、血液及神经等多个系统,临床表现复杂多样且无特异性,临床极易误诊;详细问诊,仔细查体,全面分析相关医技检查结果,是减少本病误诊的关键。Objective To analyze the causes of misdiagnosis of chronic renal failure(CRF)and to summarize preventive measures,in order to reduce the rate of clinical misdiagnosis.Methods We performed a retrospective analysis on 10 cases of CRF misdiagnosed in our hospital from June 2016 to June 2018.Results In this group,2 patients complained of appetite deficiency,upper abdominal distension,nausea and vomiting,and were misdiagnosed as chronic gastritis by fiberoptic gastroscopy;3 patients complained of headache,dizziness and elevated blood pressure,while they were misdiagnosed as essential hypertension;2 patients complained of dizziness,fatigue and paleness,the hemoglobin was decreased,and they were misdiagnosed as anemia.In addition,dryness,pruritus and rash were the main complaints in 2 patients,who were misdiagnosed as having pruritus.One patient complained of cough,sputum and chest tightness,and there were moist rales in auscultation.X-ray examination showed shadows in the hilum of both lungs and pulmonary infection was diagnosed.According to the initial diagnosis,10 patients were given symptomatic treatment for 3 days to 3 months,and the condition did not improve.Experts were invited to consult and analyze the condition comprehensively,and urinary routine and/or renal function tests were carried out to confirm the final diagnosis of CRF.The duration of misdiagnosis was 6 days to 3 months.After diagnosis and symptomatic treatment,the condition was improved significantly.Conclusion CRF has a hidden onset and can involve various systems such as digestive tract,cardiovascular system,blood and nerve.Given complex and non-specific clinical manifestations,it is more likely to be misdiagnosed in clinical practice.Detailed inquiry,careful physical examination,and comprehensive analysis of the results of relevant medical and technical examinations are the keys to reduce the misdiagnosis of CRF.

关 键 词：肾功能不全 误诊 胃炎 高血压 贫血 缺铁性 

分 类 号：R692.5[医药卫生—泌尿科学]