急性肾衰竭100例临床分析

Clinical study of 100 cases with acute renal failure

目的 总结急性肾衰竭(ARF)的病因、临床特点以及影响预后的因素。方法 回顾性分析本科1997年1月至2004年12月收治的100例ARF患者的临床和病理资料。结果 100例ARF患者中,男性63例,女性37例,平均年龄(48．14±17．80)岁。肾前性ARF20例,感染 特别是急性胃肠炎占很大比重。肾性ARF 70例,其中急性间质性肾炎(AIN)9例(12．9％),急性 肾小管坏死(ATN)33例(47．1％),小球及微血管病变28例(40．0％);药物导致的肾损害33例 (47．1％),包括AIN 7例及ATN 26例;35例行肾活检。肾后性ARF10例,病因为妇科、泌尿道、 胃肠道肿瘤和结石。病因分布在3个年龄组间无显著差异。老年组的Scr值、Hb和红细胞比容 (Hct)均低于中年组,而ATN-ISI评分值、存在高血压和肾脏病史的比例高于中年组和青年组。 少尿、血尿、蛋白尿、GFR等参数在3组间无显著差异。本研究中死亡5例(病死率5％),57例治 愈,29例好转,9例无效。单因素分析显示,年龄、蛋白尿、血清白蛋白、Hb、Hct、器官衰竭的数 目、ATN-ISI评分是影响预后的因素。多因素Logistic回归分析显示,年龄和器官衰竭的数目是影 响病死率的因素。结论 急性胃肠炎和肾毒性药物导致的ARF需要引起关注。早期诊断有助于 ARF的治愈,提高存活率。在已经进展到ARF阶段后,要注意预防并发症特别是多脏器功能不 全综合征(NODS)的发生。

Objective To analyze the etiologies, clinical characteristics and prognostic factors of 100 cases with acute renal failure （ARF）. Methods This retrospective study included clinical and pathological data of 100 patients with ARF in our department from January 1997 to December 2004. Results There were 63 males and 37 females with mean age （48.14±17.80） years old. The patterns of ARF included pre-renal （20, 20%）, renal parenchymal （70, 70%） and post renal ARF （10, 10%）. Infective diseases, especially acute gastroenteritis, were major causes of prerenal ARF. Renal parenchymal ARF could be classified into glomerular vascular lesions （28, 40.0%）, acute interstitial nephritides （9,12.9%）, and tubulointerstitial injuries （33, 41.7%）. Among these 70 cases, 33 （47.1%） were induced by drugs. Renal biopsy were performed in 35 patients. Histologic types included acute tubular necrosis （12 cases）, acute interstitial nephritides （ 2）, mesangial proliferative glomerulonephritis （ 9）, minimal change glomerulonephritis （6） , endocapillary proliferative glomerulonephritis （2）, membrane proliferative glomerulonephritis （1）, crescentic glomerulonephritis （ 1 ）, Ig A nephropathy （ 1 ） and focal segmental glomerulosclerusis （ 1 ）. Pelvic, urinary tract or gastroenteric tumors and stones leaded to pest renal ARF. There were no significant differences of etiology among different age groups. Scr, Hb and Hct of older age group were lower than those of middle age group. Whereas ATN-ISI score, the proportion of patients with high blood pressure and with renal disease history were higher than those of middle and young age groups. There were no differences of GFR, hyperproteinuria, haematuria or oliguria among these three groups. The mortality of ARF in our study was 5%. Univariate analysis showed that prognosis was correlated with age, serum albumin, Hct, ATN-ISI score, the presence of hyperproteinuria and the number of organ system failures. The multivariable logistic regression showed that age and the number of organ system failures were predictors of mortality. Conclusions Attention must be paid to the treatment of acute gastroenteritis and the use of drugs with nephrotoxieity. The early diagnosis plays an important role not only in treatment, but also in increasing survival rate. Prevention of complications, especially MODS, is a key management to decrease mortality in severe ARF.