肾病综合征合并特发性急性肾功能衰竭10例分析

IDIOPATHIC ACUTE RENAL FAILURE IN NEPHROTIC STNDROME──A REPORT OF 10 CASES

１０例肾病综合征患者在病程中合并无明显诱因的急性肾功能衰竭，其临床特征均为大量蛋白尿、高度水肿，病程中突发少尿，尿渗透压降低、肾功能急骤性恶化，血肌酐及尿素氮升高，肾脏病理组织学显示肾小球无明显病变或轻微病变，但多数病人肾间质高度水肿及部分病人有肾小管上皮细胞呈灶状脱落坏死。经利尿、肾上腺皮质激素等治疗肾功能逐步恢复正常。提示肾病综合征合并特支性急性肾功能衰竭并不少见，发生率为４．１％（１０／２４５）；并易发生于肾小球病变轻微患者：如微小病变肾病（６／１０）、轻度系膜增殖性肾炎（４／１０），绝大多数患者急性肾功能衰竭是可逆的。

en cases of idiopathic acute renal failure(IARF)in idiopathic nephrotic syndrome(NS)were repor-ed.Heavy proteinuria and severe edema were the main clinical manifestations in these cases. Sudden olig-uria,decrease of urinary osmolarity and increase of blood urea nitrogen and creatinine occurred without anydifinite cause. Pathological examination showed normal or near normal glomeruli,diffuse interstitial edemaand patchy necrosis of the tubular cells. The renal function in all the patients recovered after therapy withdiuretics,prednisone,etc. It is shown that IARF in idiopathic NS commonly occurred in patients withnormal ol near normal glomeruli, for example, minimal change disease(6/10 cases),mild mesangial pro-liferative glomerulonephritis(4/10 cass).The incidence of IARF in idiopathic NS was4.1%(10/245 cas-es ),the IARF was mostly reversible.