肾后性急性肾衰竭临床分析及处理

Clinical analysis and treatment of postrenal acute renal failure

目的探讨肾后性急性肾衰竭的原因及处理方法。方法对21例肾后性急性肾衰竭患者的发病原因及处理方法进行总结分析。双侧输尿管结石12例，盆腔肿瘤7例，孤立肾输尿管结石2例。急诊行体外冲击波碎石术（ESWL）2例。逆行输尿管插管15例，急诊行输尿管切开取石术2例，血液透析后手术治疗2例，超声引导下肾盂穿刺造瘘2例。结果本组病例急诊处理后尿量开始恢复，水肿明显好转消失。2周内恢复正常16例，其他病例随访3个月至1年，虽未完全恢复正常，但明显好转，2例死于癌症。结论肾后性急性肾衰竭处理应针对不同原因选择适当的时机治疗，原则为解除梗阻、改善肾功能。

Objective To investigate the etiology and clinical treatment of postrenal acute renal failure. Methods The etiology and the treatment of 21 cases of postrenal acute renal failure were summarized. Twelve cases were bilateral upper urinary calcuh, 7 cases were secondary to pelvic tumor, 2 cases were caused by urinary calculi with solitary kidney. Two cases performed extracorporeal shock wave lithotripsy （ESWL）, 15 cases performed emergency treatment of retrograde placement of double Jureteral stent, 2 cases performed emergency operation, 2 cases performed hemodialysis, 2 cases performed percutaneous nephrostomy with B-ultrasonography. Results All patients had begun to restore urinary volume after emergency management, the symptom of edema improved obviously. Sixteen cases were restored completely in 2 weeks, the others were followed up for 3 to 12 months, although they were not restored completely, but the symptom of edema improved obviously. Two cases died of cancer. Conclusions As the renal function recover, the patients should be treated individually based on etiology. It is important to remove the obstruction early for resume the renal function.