经皮肾穿刺活检术在急性肾衰竭患者诊治中的作用

Significance of percutaneous renal biopsy analysis for patients with acute renal failure

目的探讨经皮肾穿刺活检术(PRB)对急性肾功能衰竭(ARF)病因诊断及治疗方案的影响,进一步提高ARF的诊疗水平。方法收集南方医院1992年11月至2007年12月的176例ARF患者,均符合48h内血肌酐(SCr)上升≥26·5μmol/L;SCr增长≥50%;尿量<0·5ml/(kg·h)持续6h的临床ARF诊断标准。回顾性分析行PRB前后的病因诊断及治疗方案修订情况。结果PRB术后病因诊断率由术前的64·2%(113/176)提高至96·6%(170/176)。PRB前后病因诊断符合率95·6%(108/113),病因诊断错误率4·4%(5/113)。170例患者经PRB后确诊为ARF,6例临床误诊为ARF的患者经PRB后修正诊断为慢性肾功能不全(CRI)。术后有47·2%(83/176)的患者治疗方案得到了补充,5·6%(10/176)的患者更改了治疗方案,治疗方案修正率合计52·8%(93/176)。PRB后确诊了8例IgA肾病患者,其中1例明确为由IgA肾病慢性迁延为CRI,6例为ARF合并IgA肾病,1例为IgA肾病引发新月体形成从而导致ARF,占ARF发病率的0·6%(1/170)。结论PRB对明确ARF病因诊断,及时明确治疗方案和判断预后有重要意义。

Objective To explore the effects of percutaneous renal biopsy（PRB） on the etiological diagnosis and therapeutic regimen of patients with acute renal failure（ARF）,so as to further improve the diagnostic and therapeutic levels of ARF.Methods From Nov.1992 to Dec.2007,176 patients were admitted in the Renal Division of Nanfang Hospital.All the patients matched the diagnostic criteria and were clinically diagnosed as ARF：within 48h the serum creatinine（SCr） ascended（≥26.5μmol/L） and increased by more than 50%,and the urine volume of less than 0.5ml/kg·h persisted in 6 hours.All the patients were undergone PRB and the clinical data were analyzed retrospectively.Results The final etiological diagnosis rate elevated from 64.2%（113/176） before PRB to 96.6%（170/176） after PRB.The coincidence of etiological diagnosis before and after PRB was 95.6%（108/113）.Of 176 cases,170 were finally diagnosed as ARF,and the 6 remainders who were clinically misdiagnosed as ARF were finally diagnosed as chronic renal insufficiency（CRI）.The therapeutic regimen for 83 patients was supplemented and for another 10 patients was modified after PRB,the total adjusted rate was up to 52.8%（93/176）.After PRB,8 patients were finally diagnosed as IgA nephropathy,of them one case was specifically diagnosed as IgA protractedly leading to CRI,6 cases were ARF complicated with IgA,and one case was crescent formation induced by IgA nephropathy that leading to ARF.Conclusion PRB is a very useful technique for the etiological diagnosis of ARF on determining the therapeutic regimen and defining the prognosis.