急性肾盂肾炎并发急性肾损伤14例临床分析

Clinical analysis of 14 patients with acute kidney injury from acute pyelonephritis

目的分析急性肾盂肾炎并发急性肾损伤(AKI)患者的临床特点。方法回顾性分析浙江省立同德医院肾内科2010年1月—2013年1月住院的14例急性肾盂肾炎并发急性肾损伤患者临床资料。结果并发急性肾损伤14例(11.0%),男1例,女13例;平均年龄(59.43±22.30)岁;基础疾病7例;B超泌尿系异常5例;使用肾损药物4例;血容量不足1例;最高体温平均(38.74±1.21)℃;治疗前血白细胞平均(12.91±4.49)×109/L;中性粒细胞比例:(85.23±9.63)%,超敏CRP(125.6±125.9)mg/L,治疗前α-微球蛋白平均(50.19±22.24)mg/L,治疗前血肌酐平均(178.93±113.86)μmol/L,尿培养阳性6例(42.9%),大肠埃希菌3例,肺炎克雷伯杆菌1例,屎肠球菌1例,产气肠杆菌1例。13例患者抗感染治疗肌酐恢复基础水平,1例患者抗生素联合甲基强的松龙治疗恢复正常。结论并发AKI并非少见,且程度重,更易发生在年龄较大、有泌尿系异常、感染重的患者。早期、有效抗感染治疗多数肾功能快速恢复,但少数需联合激素治疗。

Objective To analysis the clinical characteristics of patients with acute kidney injury（AKI） from acute pyelo- nephritis. Methods The clinical data of 14 patients with AKI from acute pyelonephritis from January 2010 to January 2013 were retrospectively studied. Results Among 14 patients, 1 was male and 13 were female with an average age of （59.43 ± 22.30） years old. 7 cases were with an underlying disease ;5 cases were with urinary tract abnormalities by ul- trasound ;4 cases were with drug history of renal damage medicine;1 case was with hypovolemia;The average temperature was（38.74 ± 1.21 ） ℃. Before the treatment,the average WBC count was （ 12.91 ±4.49） x 109/L,in which the percent- age of neutrophils was （85.23 ± 9.63 ） % ; The level of C-reactive protein was （ 125.6 ± 125.9） mg/L, α-microglobulin （ct-MG） was （50.19 ± 22.24） rag/L, and serum creatinine （sCr） was （ 178.93 ± 113.86 ） μmol/L. A positive urine cul- ture was found in 6 cases（42.9% ） ,in which 3 cases were Escherichia coli, 1 case Klebsiella pneumoniae, 1 case Entero- coccus faecium and 1 case Enterobacter aerogenes. The levels of sCr in 13 cases recovered by Antimicrobial therapy, 1 case received antibiotic and steroid therapy. Conclusion AKI is common and serious in old patients with urinary abnor- malities or severe infection. The early and effective antimicrobial therapy can improve the renal function, the combined steroid is necessary in some cases.