原发性肾病综合征并发急性肾衰竭48例临床分析

摘要

Objective To analyze the clinical manifestations, pathological type, ARF publication mechanism, treatment and prognosis of the primary nephrotic syndrome (PNS) with acute renal failure (ARF).Methods Retrospectively analyzed the clinical manifestations, the pathogenesis of ARF and its treatment and prognosis of those 48 patients with primary nephrotic syndrome (PNS) complicated with ARF in the Nephrology Institute of our hospital. Results 48 patients had the same clinical manifestations; the main pathological types are minimal change and minor change. After 4-to-20-days' treatment, all patients urine output was upto 1030～4300 ml; the average urine volume within 24h was (1800±500) ml. Most patients' renal function returned to normal, and the treatment effective rate was 83.33%. According to the clinical remission criteria, 35 patients with PNS got complete remission; 5 cases got partial remission; 8 patients got no remission; complete remission and partial remission time was 17 ～ 115 d, and the average time was(60.2± 31.3) d. Conclusion The main pathogenesis of PNS with ARF is tubulointerstitialy damage and renal tubular lumen protein tube blockage caused by sudden ARF. According to PNS clinical history and manifestations, its diagnosis is not difficult. The treatment key is the early detection of ARF and correcting the reversible factors of both PNS and ARF; thus PNS complicated with ARF will have a better prognosis.%目的 分析原发性肾病综合征(PNS)并发急性肾衰竭(ARF)的临床表现、病理类型、ARF的发病机制、治疗方法及预后情况.方法 回顾性分析我院肾内科收治的PNS并发ARF患者48例的临床表现、ARF的发病机制、治疗方法及预后情况.结果 48例患者的临床表现基本相同,病理类型以微小病变和轻微病变为主;所有患者在治疗4～20天内尿量达1030～4300ml,平均24h尿量为(1800±500)ml;大部分患者肾功能恢复正常,治疗有效率为83.33%,按临床缓解标准:PNS完全缓解患者35例,部分缓解患者5例,未缓解患者8例,完全缓解及部分缓解时间为17～115天,平均(60.2±31.3)天.结论 PNS并发ARF的发病机制主要是小管间质损害及蛋白管型堵塞肾小管管腔所致,根据PNS病史及突发ARF的临床表现,诊断不难.治疗的关键在于早期发现ARF、纠正可逆因素、兼顾PNS和ARF两个环节,且PNS并发ARF预后较好.