原发性肾病综合征并发急性肾功能衰竭17例临床与病理分析

CLINICAL AND PATHOLOGICAL ANALYSIS OF 17 CASES IDIOPATHIC NEPHROTIC SYNDROME COMPLICATED WITH ACUTE RENAL FAILURE

目的观察原发性肾病综合征(iNS)并发急性肾功能衰竭(ARF)的临床和病理特征。方法对我院收治的17例iNS并发ARF患者的临床、病理特征及治疗转归进行分析,并与同期17例随机抽取的无ARF的iNS进行比较。结果iNS并发ARF多为少尿型ARF(765%):其合并高度水肿、胸腹腔积液、高血压、心衰肺水肿的比例分别为76.5%、64.7%、47.1%和58.8%,均显著高于对照组。肾小球微小病变和轻度系膜增生性肾小球肾炎占iNS并发ARF的58.8%,但两组之间肾小球病理类型的构成比无显著性差别。iNS并发ARF的小管间病变较重,均表现弥漫间质水肿,7例表现肾小管上皮细胞灶性坏死,5例伴间质炎症细胞浸润。17例iNS并发ARF患者中,2例经利尿等治疗后肾功能恢复,其余15例均行连续性肾脏替代治疗(CRRT),14例肾功能完全恢复。结论临床上iNS并发ARF多为少尿性ARF,常合并高度水肿、胸腹腔积液、高血压、心衰竭肺水肿;可发生于各种肾小球病理类型,小管间质病变均较重;经合理治疗,尤其是CRRT的应用,多预后良好。

Objective To investigate the clinical and pathological features of patients with idiopathic nephrotic syndrome（iNS） complicated with acute renal failure （ARF）. Method The clinical and pathological features of 17 cases of iNS complicated with ARF which were admitted to our hospital from January 2001 to December2004 were analyzed using another 17cases of iNS complicated without ARF randomly chosen from the same period as control group Result More ~ iNS complicated With ARF of oliguria type, accounted for 76.5 %. Patients of iNS complicated ARF were often accompanied with severe edema , hydrothorax or hydroperitonia ,hypertension ,congestive heart failure or pulmonary edema ,the rate of which was 76.5% ,64.7%, 47.1% ,8.8% respectively and was significantly higher than control group . 58.8% of the glomerular pathology type of iNS complicated with ARF was minimal change and mild mesentery proliferative glomerulonephfitis ,but the constituent ratio of glomerular pathology type had no significant difference compared with the control group. All of the patients of iNS complicated with ARF were manifested diffuse interstitial edema,7 with focal necrosis of tubular cells , 5 with patchy inflammatory cell infiltration of the 17 patients of iNS complicated with ARF , the renal function of 2 patients recovered soon after the diuretic therapy. Continuous renal redlace therapy （CRRT） was applied to treat the other 15 patients and the renal function of 14 patients recovered completely. Conclusion Patients of iNS complicated with ARF often manifest oliguria or anuria, severe edema , hydrothorax or hydroperitonia, congestive or pulmonary edema. They would have a good prognosis because of the use of CRRT, iNS complicated with ARF can be occurred in all kinds of glomerular pathology type