目的 探讨原发性肾病综合征(primary nephrotic syndrome, PNS)误诊为糖尿病肾病(diabetic nephropathy, DN)的原因及防范措施.方法 对2012年1月-2016年5月宝鸡市人民医院收治的86例PNS中曾误诊为DN 7例的临床资料进行回顾分析.结果 本组误诊率8.14%.就诊初期6例误诊为DN,1例误诊为DN、糖尿病视网膜病变,误诊时间(5.62±1.86)d.7例按误诊疾病给予对症治疗后病情均无好转,经进一步完善生化及肾活组织病理检查后确诊为膜性肾小球肾炎3例,微小病变性肾病2例,系膜增生性肾小球肾炎及局灶节段性肾小球硬化各1例,予泼尼松、雷公藤总苷、低分子肝素及降糖等治疗15~30 d后均病情好转出院.结论 PNS临床表现缺乏特异性,易与相关疾病混淆.临床上对于糖尿病病史较短且无高血压病及其他相关并发症患者,若水肿、蛋白尿与血、尿糖异常增高同时出现时,应警惕PNS,要及时完善相关医技检查,条件允许情况下尽可能行肾活组织病理检查,以早期明确诊断.%Objective To investigate misdiagnosed causes and preventive measures of primary nephrotic syndrome (PNS).Methods A total of 86 PNS patients admitted January 2012 and May 2016, among whom 7 patients were misdiagnosed as having diabetic nephropathy (DN), was retrospectively analyzed.Results The misdiagnosis rate was 8.14%.Among the 7 misdiagnosed patients, 6 patients were misdiagnosed as having DN, and 1 patient was misdiagnosed as having DN and diabetic retinopathy, and the misdiagnosed time was (5.62±1.86)d.Conditions of the 7 misdiagnosed patients were not improved after symptomatic treatments for misdiagnosed diseases.After further biochemical and renal biopsy tests, 3 patients were confirmed as having membranous glomerulonephritis, 2 as having minimal lesion of nephropathia, 1 as having mesangial proliferative glomerulonephritis and 1 as having focal glomerulosclerosis, and all patients were discharged after condition improvement by Prednisone, Tripterygium Glycosides, low molecular heparin and hypoglycemic treatments for 15-30 d.Conclusion Clinical manifestations of PNS lack specificity, and it is easy to be confused with related diseases.Patients with a short history of diabetes mellitus and without hypertensive disease or other related complications should be suspected as having PNS when the patients have edema, proteinuria and abnormally increased blood and urine sugar levels simultaneously.Relevant auxiliary examinations and renal biopsy if possible should be performed in time to confirm the diagnosis in early period.
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