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

The Clinical and Pathological Features of 17 Cases Idiopathic Nephrotic Syndrome Complicated with ARF

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:对院2000年1月至2004年12月收治的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iMS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 December,2004were analyzed using another 17cases of iNS complicated with ARF randomly chosen from the same period as control group.Result： Type acclunted for 76.5% of iNS complicated with ARF.Patients of iNS complicated with ARF were often accompanied by severe edema,hydrothorax or hydroperitonia,hypertension,congestive heart failure or pulmonary edema,the rate of which was 76.5%,64.7%,47.1%,58.8% 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 mesangial proliferative glomerulonephritis,but the constituent ratio of glomerular pathology type had no 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 patholohy type.