不能确诊为终末期肾病患者行肾活检的价值及安全性分析

The value and safety analysis of renal biopsy in patients with suspicious diagnosis of end-stage renal disease

目的分析病因不明需行血液透析的肾衰竭患者行肾穿刺活检明确诊断的价值和安全性,为临床避免误诊及肾穿刺活检的指征掌握提供参考。方法收集2006年3月至2016年3月陆军军医大学第一附属医院肾科收治的261例不能确诊为终末期肾病(ESRD)的血液透析患者行肾穿刺活检的临床资料。根据肾穿刺活检病理类型分为慢性肾衰竭组、急性肾损伤(AKI)组、慢性肾功能不全急性加重组(简称慢功加重组),总结各组的预后及并发症发生情况。结果 261例肾衰竭患者中,慢性肾衰竭组100例,AKI组84例,慢功加重组77例。肾穿刺活检术后经1年随访,共计125例(47.9%)患者进入ESRD需维持性肾脏替代治疗,其中慢性肾衰竭组100例、AKI组2例、慢功加重组23例。136例患者经积极治疗肾功能部分或完全恢复,摆脱血液透析,其中AKI组有82例、慢功加重组有54例。22例患者出现并发症,其中慢性肾衰竭组14例,AKI组3例,慢功加重组5例,以上并发症均为一过性发生,未对患者造成实质性的严重损害。结论对病因不明确需行血液透析的肾衰竭患者行肾穿刺活检有助于更好的挽救肾功能,避免过渡治疗。

Objective To analyze the value and safety of renal biopsy in hemodialysis patients with unknown renal insufficiency,to prevent clinical misdiagnosis and to provide reference for indication of renal biopsy.Methods The clinical data of 261 patients who had been suspiciously diagnosed as end stage renal disease（ESRD）were collected from the Department of Nephrology,The first hospital affiliated of the Army medical university,Third Military Medical University from March 2006 to March 2016.According to the pathological type of renal biopsy,the patients were divided into three groups：chronic renal injury group,acute renal injury group and acute exacerbations of chronic renal injury group.The prognosis and complication were analyzed.Results One year later,our study showed that there were a total of 125 patients who entered ESRD and needed continuous renal replacement therapy,among which there were 100 cases in chronic renal injury group,2 in acute renal injury group and 23 in acute exacerbations of chronic kidney injury group.Simultaneously,a total of 136 patients had partly or completely recovered and escaped from hemodialysis after active treatment,among which there were 82 cases in acute renal injury group,and 54 were in acute exacerbations of chronic kidney injury group.There were 22 patients with complications,including 14 in chronic renal injury group,3 in acute renal injury group and 5 in acute exacerbation of chronic renal injury group.All of the complications were transient and displayed little damage to patients.Conclusions Renal biopsy in patients with unknown renal failure can better to save kidney function and avoid transition therap.It is feasible to carefully grasp the indication of renal biopsy for the patient who has higher rate of complication occurrence with chronic renal injury than that with acute renal injury.