肾小球疾病伴发急性肾损伤患者18例临床特点分析

Clinical characters of 18 glomerular disease patients complicated with acute kidney injury

目的研究分析肾小球疾病伴发急性肾损伤患者的诱发因素、临床病理特点、治疗及转归，以提高此类疾病的防治水平。方法回顾性分析长征医院肾内科病理确诊为肾小球疾病伴发急性肾损伤患者的临床、病理、治疗和预后资料。采用SPSS 13．0软件进行分析。结果（1）共收集病例18例，其中13例存在感染或使用药物等明确诱发因素；（2）临床表现：高血压15例，无尿或少尿11例，肉眼血尿7例，17例血肌酐〉353．6μmol／L，均存在尿蛋白；（3）病理类型：新月体肾炎5例、IgA肾病4例、其他肾小球疾病9例；小管问质重度病变12例，中、轻度6例；（4）常规给予患者对症支持治疗，予激素和（或）免疫抑制剂治疗12例，行肾脏替代治疗15例。3个月内血肌酐降至正常14例，1例降至200μmol／L。结论肾小球疾病伴发急性肾损伤常可能存在诱发因素；临床和病理表现多样；及时控制感染，根据病情应用激素及免疫抑制剂治疗，适时行肾脏替代治疗，多数患者预后较好。

Objective To improve the level of prevention and treatment of glomerular disease complicated with acute kidney injury by analyzing the clinical and pathological features, treatment and outcome of this disease. Methods The patients who were diagnosed as glomerular disease complicated with AKI pathologically in Department of Nephrology, Changzheng Hospital were reviewed. The data of clinical and pathological features, treatment and outcome were analyzed. SPSS 13. 0 software was applied for data statistical analysis. Results （1） In 18 cases, 13 presented with clear predisposing factors,such as infection and drug use; （2）Clinical manifestations included hypertension （15 cases）, anuria or oliguria（ 11 cases）, gross hematuria（7 cases）, serum creatinine 〉353.6μmol/L（ 17 cases） ; proteinuria （ 18 cases） ; （3） Pathology：There were 5 cases of crescentic glomerulonephritis, 4 cases of IgA nephropathy, 9 cases of＂ other glomerular diseases. There were 12 casos of severe tubulointerstitial lesions, and 6 cases of mild or moderate lesions; （4）All patients were routinely given supportive treatment, 12 cases were given corticosteroids and （or） immunosuppressant treatment, and 15 cases were given renal replacement therapy（RRT）. Within three months, the level of SCr was declined to the normal level in 14 cases,and to 200 μmol/L in 1 case. Conclusions Glomerular disease complicated with AKI is often ac companied predisposing factors and shows different clinical and pathological features. The majority of these patients will turn out to be a good prognosis with infection control, corticosteroids and immunosuppressive therapy according to the disease, and promptly treatment with renal replacement.