以急性肾功能衰竭为首发表现的系统性红斑狼疮八例临床分析

Acute renal failure in systemic lupus erythematosus

目的了解以急性肾功能衰竭(ARF)为首发表现的系统性红斑狼疮(SLE)的临床特征,提高对该病的诊治水平。方法收集上海长征医院1995年1月至2006年4月收治随访的以ARF为首发表现的SLE 8例,结合文献复习,对其临床表现、治疗方法、预后进行分析。结果①SLE急性肾功能减退的症状以少尿型为主,伴随症状及并发症重且多。②在实验室检查中自细胞及血红蛋白较低,补体下降明显,肾脏病理以狼疮肾炎(LN)Ⅳ型、Ⅳ+Ⅴ型为主。③治疗上以大剂量激素加环磷酰胺(CTX)冲击治疗为主,病情危重时可予以缓慢连续超滤(SCUF)、连续静脉静脉血液透析滤过(CVVHDF)、维持性血液透析等治疗。结论急性肾功能衰竭可以出现在SLE病程中,但也可以是SLE的首发症状。大剂量激素和CTX冲击治疗有明显疗效。对反应不佳的可行SCUF、CAVHDF和血液透析治疗,能明显改善患者的预后。

Objective To understand the clinical features of acute renal failure （ARF） as the initial presentation of systemic lupus erythematosus （SLE）. Methods Eight cases of ARF in SLE from Jan 1995 to Apr 2006 were investigated, descriptive analysis and literature review were performed. Results （1） The symptom of ARF in SLE was mainly oliguria, with severe accompany symptoms and complications. （2） The level of leucocyte and hemoglobin was low in laboratory tests, also the complement level decreased significantly. The most frequent renal pathology was type Ⅳ, Ⅳ＋Ⅴ LN.（3） Large dose steroid and CTX were the mainstay of treatment. In addition, SCUF, CVVHDF and hemodialysis could be used for lethal conditions. Conclusion ARF can be the first manifestation of SLE and it usually represents more severe disease and more complications. Large dose steroid and CTX can improve prognois. In cases refractory to steroid and if the effect is obsolete, CTX treatment SCUF, CVVHDF and hemodialysis can be use.