慢性肾脏病基础上的急性肾衰76例临床分析

Clinical Analysis of 76 Cases Acute Renal Failure Based on Chronic Kidney Disease

目的了解慢性肾脏病基础上的急性肾衰竭(A/C)的病因及肾活检对A/C诊断意义。方法回顾性分析76例A/C患者的临床诊治及转归情况。结果药物引起的急性间质病变或间质肾小管病变、肾前性原因、慢性肾脏病并发严重的感染、是常见原因,占75.00%;恶性高血压占9.21%;狼疮肾炎(LN)活动占9.21%;肾病综合征(NS)伴特发性ARF占6.58%。积极治疗原发病,尽早去除诱因,52例患者肾功能恢复到基础水平,16例患者血肌酐(Scr)下降大于15%,8例患者肾功能无明显改变,其中1例进入维持性透析。53例行肾活检,35例通过肾活检修正诊断,改变原有治疗方案。结论A/C临床并不少见,早期诊断、正确的治疗绝大多数患者肾功能有所改善。肾活检对明确A/C诊断有重要意义。

Objective To investigate the pathogeny of acute renal failure on chronic kidney disease （A/C） and the significance of renal biopsy on the diagnosis of A/C. Methods Retrospective analysis was applied to analyze the clinic diagnosis, treatment and prognosis of 76 cases A/C. Results Acute interstitial/tubulointerstitial disease caused by drugs, prerenal ARF and chronic kidney diseases with severe infection were the most common causes of ARF in A/C （75.00%） ; followed by malignant hypertension （9.21%）, increased activity of lupus nephritis （LN） （9.21%） and idiopathic ARF in nephritic syndrome （NS） （6.58%）. After treating primary disease and removing the pathogenic factors, renal function in 52 patients could be improved to the primary levels, serum creatinine （Scr） in 16 patients drops over past 15%, renal function in 8 patients could not be improved, 1 case patient became maintenance dialysis. Renal biopsy have be carried out in 53 patients, primary diagnosis in 35 patients were revised and primary treatment were adjusted by renal biopsy. Conclusions A/C is a common part of ARF. After early correct diagnosis and reasonable therapy, most patients＇renal function can be improved. Renal biopsy plays an important role in the diagnosis of A/C.