急性肾衰竭64例临床病理学分析

Classification of acute renal failure according to histopathologic characteristics

目的:探讨急性肾衰竭(ARF)患者的病理学类型及预后转归。方法:回顾性分析64例经临床及肾活检确诊的ARF患者病理学类型及肾功能恢复状况。结果:ARF的病理学类型包括肾小球疾病(15.6%)、肾小管-间质病变(60.9%)、继发性肾脏病如血管炎及狼疮性肾炎等(23.5%)。急性间质性肾炎和急性肾小管坏死是肾小管-间质性损害所致ARF最常见的原因。以出院时间作为观察终点,预后最好的是肾小管-间质病变,其治愈-好转率达89.2%;最差的是新月体肾炎和血管炎,好转率为40%,无效而行维持性血透的占60%。老年人极易发生ARF,本组≥60岁患者占25%,其病因以肾小管-间质病变占绝对优势(75%)。结论:ARF病理学类型多样,预后与病理学类型相关,及时肾活检对ARF的鉴别诊断、指导治疗、判断预后均有重要意义。

Objective To classify acute renal failure total of 64 patients with ARF were analyzed retrospectively （ARF） according to histopathologic according to renal histopathologic c hanges. Results His- topathologic lesions could be classified into three types ,namely glomerular disease （15.6%）,tubular-interstitial disease （60.9%） and secondary renal disease （vasculitis, lupus nephritis, etc. ,23.5 % ）. The most common reasons associated with ARF were acute tubular necrosis and acute interstitial nephritis. All patients were classified into four grades accord- ing to their recovery situation of renal functions at the time of discharge, complete recovery, partial recovery, no recovery and death ,respectively. The percentage of complete and partial recovery was 89.2% in acute tubular-interstitial lesions, and that of partial recovery was only 40% in crescentic glomerulonephritis. The elderly was susceptible to ARF （25%）, and acute tubular-interstitial lesions constituted the major histologic type （75%）. Conclusions The prognosis of ARF is associated with varied histologic types, so renal biopsy would be not only important for diagnosis of ARF, but also in se- lecting appropriate therapy.