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目的了解原发性肾病综合征(PNS)并发急性肾功能衰竭(ARF)的可能诱因、临床表现、病理、治疗方法及预后情况。方法回顾分析辽宁省人民医院肾内科肾内科2000年1月至2007年12月收治的PNS并发ARF19例患者的可能诱因、临床表现、病理、治疗方法及预后情况。结果(1)PNS并发ARF的可能诱因共9例,其中药物6例,有效循环血容量不足2例,感染1例。(2)临床表现:尿蛋白平均(5.36±1.61)g/24h,血浆白蛋白平均(23±7)g/L,所有患者均伴有不同程度水肿,13例出现浆膜腔积液,11例伴高脂血症。所有患者均有少尿,平均持续(11±7)d,血肌酐平均(669±368)μmol/L,血尿素氮平均(31±15)mmol/L。(3)病理表现:14例行肾组织学检查。肾小球轻微病变6例,系膜增生性肾小球肾炎4例(其中轻度3例,中度1例),其余类型4例。除1例外其余13例均有不同程度的小管间质改变,如小管上皮细胞空泡变性、坏死甚至脱落,小管腔蛋白管型,小管萎缩,间质水肿、炎性细胞浸润及纤维化等。(4)多数采用甲基泼尼松龙冲击治疗和其后(或)标准泼尼松口服治疗,再常规对症处理。(5)预后:完全缓解7例,部分缓解8例,无效3例,死亡1例。结论(1)PNS并发ARF的可能诱因需尽快去除或避免。(2)病变轻微的肾小球疾病导致的PNS易并发ARF,小管间质病变是引起ARF的病理学基础,极低蛋白血症和大量蛋白尿与PNS并发ARF有一定关系。(3)PNS并发ARF多是一种可逆性肾功能衰竭。
Objective To investigate the possible causes, clinical manifestation, pathology, treatment and prognosis of patients with primary nephrotic syndrome (PNS) complicated with acute renal failure (ARF). Methods The possible causes, clinical manifestations, pathology, treatment and prognosis of 19 patients with PNS complicated with ARS admitted to Department of Nephrology, Renmin Hospital of Renmin Hospital of Liaoning Province from January 2000 to December 2007 were retrospectively analyzed. Results (1) The possible causes of PNS complicated with ARF were 9 cases, including 6 cases of drug, less than 2 cases of effective circulating blood volume and 1 case of infection. (2) The clinical manifestations: urinary protein average (5.36 ± 1.61) g / 24h, mean plasma albumin (23 ± 7) g / L, all patients were associated with varying degrees of edema, serosal effusion in 13 cases, 11 Case with hyperlipidemia. All patients had oliguria with an average duration of (11 ± 7) d, mean serum creatinine (669 ± 368) μmol / L, and mean blood urea nitrogen (31 ± 15) mmol / L. (3) pathological manifestations: 14 cases of renal histological examination. 6 cases of mild glomerular lesions, 4 cases of mesangial proliferative glomerulonephritis (mild in 3 cases, moderate in 1 case), the remaining 4 cases. In addition to 1 exception the remaining 13 cases have varying degrees of tubulointerstitial changes, such as tubular epithelial cell vacuolar degeneration, necrosis or even shedding, small tubular lumen tube, tubular atrophy, interstitial edema, inflammatory cell infiltration and fibrosis . (4) the majority of methylprednisolone impact therapy and subsequent standard oral prednisone (or), and then conventional symptomatic treatment. (5) Prognosis: 7 cases were completely relieved, 8 cases partially relieved, 3 cases ineffective and 1 died. Conclusions (1) The possible causes of PNS complicated with ARF should be removed or avoided as soon as possible. (2) PNS with mild pathological changes caused by mild glomerular disease complicated with ARF and tubulointerstitial lesion is the pathological basis of ARF. Hypoalbuminemia and massive proteinuria have some relationship with PNS complicated with ARF. (3) PNS complicated with ARF mostly is a reversible renal failure.