肾科重症监护病房的局灶节段性肾小球硬化患者原因分析

Focal segmental glomerulosclerosis in renal intensive care unit: the cause of hospitalization and the clinical characteristics

目的:探讨局灶节段性肾小球硬化(FSGS)患者入住肾科重症监护病房(RICU)的原因及其临床特征。方法:选取2009年7月至2012年12月南京军区南京总医院RICU收治的FSGS患者,回顾性分析其临床特征、既往治疗情况、并发症。结果:2009年7月至2012年12月共48例FSGS患者入住RICU,占所有RICU患者的2.95%,占肾病综合征(NS)患者的31.37%。感染、急性肾损伤(AKI)、电解质紊乱是入住RICU的FSGS患者常见并发症。初发初治患者以AKI的发生率高,接受激素或免疫抑制剂的患者感染发生率高。感染、单纯AKI、感染合并AKI患者分别有11、19、12例。31例次AKI患者中,12例次合并感染,19例次合并低血容量,4例患者为药源性因素所致AKI。结论:FSGS是RICU患者NS的主要病理类型之一,感染、AKI、电解质紊乱是RICU FSGS患者入住RICU的主要原因,三者常重叠存在;感染的发生与激素及免疫抑制剂的使用关系密切,FSGS发生AKI主要与低血容量、感染和药源性因素相关。

Objective： To analyze the cause of hospitalization and the clinical characteristics of focal segmental glomerulosclerosis（FSGS）patients in the renal intensive care unit （RICU）. Methodology： Forty eight patients with FSGS, who addmitted to the RICU from July 2009 to December 2012, were enrolled in this retrospective study. Their clinical characteristic, treatment regimens and complications were investigated. Results： A total of 48 patients with FSGS was accounted for 2.95% of all patients hospitalized in RICU （ 1626 cases） , and 31.4% of all patients with nephrotic syndrome （NS） （total 153 NS）. The infections, acute kidney injury and electrolyte disturbances were the main causes hospitalized in RICU Using steroids or immune inhibitors increased the incidence of infection. Among 31 patients with AKI, there were 12 of co-infection, 19 of low blood volume, and 4 of clear using the renal toxicity of drugs. Conclusion：The infections, AKI, and electrolyte disorders weres the leading causes of patients with FSGS hospitalized in ICU patients with FSGS. Infection closely associated with the use of the steroids and immune inhibitors. The low blood volume and some drugs （including statins, rheomacrodex and chinese herble medicine） were the major causes of AKI.