内科急性肾衰竭的病因、死因及治疗探讨

Etiology, Causes of Death and Treatment of Medical Acute Renal Failure

本文报告我科近年收治的急性肾衰竭(ARF)住院患者44例并对其病因和死因进行分析。一、诊断依据少尿性ARF均排除了肾前性及肾后性少尿。

The etiology and cause of death of 44 cases of ARF admitted to our medical ward during the past few years were analyzed in this article. The etiology of the majority of our cases(63.6%) was postinfectious. The pathogenesis of ARF was related to shock, dehydration, acute interstitial nephritis, endotoxemia and the administration of aminoglucoside antibiotics. The non-post infectious cases were mainly caused by nephrotoxic agents and shock. Among 24 fatal cases, most (18 cases) of them died of the diseases per se, while only six cases died of ARF. Mortality was higher in the cases with shock (10 in 12) and in the cases of age over 60 (9 in 11).Based on the above analysis, we consider that it is important to control the underlying diseases, infection and shock, and careful use of nephrotoxic drugs in order to reduce the incidence of ARF and the mortality of ARF. In some cases, mannitol given orally can take the place of dialysis.Finally the role of acute interstitial nephritis caused by infections, endotoxemia and nephrotoxic drugs in the pathogenesis of ARF was briefly discussed.