以肾功能衰竭为首发症状的肾结核四例临床诊治分析

Analysis of diagnosis and treatment of four renal failure with nephrotuberculosis cases as initial symptom

目的探讨以肾功能衰竭为首发症状的。肾结核患者的误诊原因及治疗药物的选择。方法回顾性分析2005年3月至2015年4月在沈阳市胸科医院和沈阳市红十字会医院收治的以肾功能衰竭为首发症状的4例肾结核患者的临床资料及抗结核治疗情况。结果4例患者中，男3例，女1例；以恶心、呕吐伴乏力，以及血尿素氮、血肌酐超过正常值为主诉入院；其中1例并发肺结核，2例肺部存在陈旧性病灶，另外1例胸部CT检查未见异常患者否认肺结核病史。4例患者在确诊肾结核前均有误诊或漏诊史，通过结核病相关的实验室检查、肾活检及术后病理检查确诊为肾结核，并根据。肾功能情况予以口服利福平、异烟肼和莫西沙星进行抗结核治疗。4例患者中2例肾功能轻度受损的患者在治疗后肾功能完全恢复正常；1例患者血肌酐下降至100μmol／L，但抗结核治疗10个月后，因肾功能恶化处于尿毒症期，行血液透析治疗；1例患者因发病时已经处于尿毒症期，继续维持透析治疗。结论临床医生一定要警惕肾结核的误诊和漏诊；同时在抗结核药物的选择上要充分考虑肾功能情况。

Objective To investigate the causes of misdiagnosis and treatment of renal failure with nephrotu- berculosis as initial symptom. Methods Retrospective analysis clinical data and treatment of 4 renal failure cases with nephrotuberculosis as initial symptom from Shenyang Chest Hospital and Shenyang Red Cross Hospital be- tween March 2005 and April 2015 were retrospectively analyzed. Results Four patients （male： 3, female： 1） were hospitalized with complain of nausea, vomiting and fatigue, and their blood urea nitrogen and serum creatinine were also higher than the normal value. Of the 4 cases, one was combined with pulmonary tuberculosis, two were with old lesions in the lung, and the last was without the history of pulmonary tuberculosis and the chest CT was normal. All the 4 patients were misdiagnosed or miss diagnosised before diagnosis of nephrotuberculosis based on la- boratory examination, renal biopsy or pathological result. After received oral anti-tuberculosis treatment （rifampi- cin, isoniazid and moxifloxacin） according to the renal function, renal function of two patients with mild impaired re- nal fuction recovered~ serum creatinine of one patient decresed to 100μmol/L, as the renal function continued dete- tiorate, hemodialysis was used after lO-month anti-tuberculosis; the other one was treated with hemodiaiysis as he or she was in uremia when diagnosed of nephrotuberculosis. Conclusion Clinicians should pay more attention to nephrotuberculosis, and the renal function must be considered when choose anti-tuberculosis drugs.