急性肾功能衰竭流行病学调查

The epidemiologic investigation in patients with acute renal failure

目的 :前瞻性研究急性肾功能衰竭 (ARF)发病情况 ,总结ARF病因和发生率 ,为早期防治提供理论依据。 方法 :收集我院 1998年 7月～ 2 0 0 1年 12月各科住院ARF患者 2 6 9例 ,分析肾前性、肾实质性和肾后梗阻性ARF的各种病因、发生率、治疗和预后转归。 结果 :2 6 9例ARF患者中 ,男性 15 6例 ,女性 113例 ,平均年龄 (49 8± 19 6 )岁 ,其中 >6 0岁组占 31 6 %。肾前性ARF 37例 (13 8% ) ,病因为术后缺血、失液、肾病综合征等。肾实质性ARF 2 2 1例 (82 2 % ) ,其中小管间质病变 16 7例 ,主要病因为药物、感染、休克、横纹肌溶解综合征 (RM)等。药物性ARF 5 2例 ,有药物因素参与者 5 4例 ,两者共计占ARF 39 4 % ;RM -ARF 16例 (5 9% )。 95例行肾活检 ,其中小球 小血管病变 4 7例 ,小管 间质病变 (包括急性肾小管坏死和急性间质性肾炎 ) 37例。医源性ARF 90例 ,占 33 5 % ,病因为外科手术后和肾前性因素以及药物因素。肾后梗阻性ARF 11例 ,占 4 % ,病因为各种妇科肿瘤和泌尿道肿瘤、畸形、结石、前列腺肥大和后腹膜淋巴结肿大。本组死亡率 14 5 % ,其中校正死亡率 (直接与ARF相关的死亡率 )12 6 %。 结论 :ARF流行病学已发生改变 ,发病呈高龄化趋势 ,老年ARF发病率上升 ;肾前性ARF常因认识不足?

Objective:To find out early management to improve the progression of acute renal failure(ARF),the incidence,patterns,etiology and clinical manifestation of ARF was investigated. Methodology:269 patients with ARF due to different causes from 1998.7 to 2001.12 in our hospital were enrolled in this study.These patients were defined as three types:pre renal,renal parenchymal and post renal ARF.The etiology,patterns,clinical manifestation,treatment and prognosis of all the three types were analyzed. Results:They were 156 males and 113 females with mean age (49 8±19 6) years old.31 6% patients were elder than 60 years old.The patterns of ARF were pre renal (37,13 8%),renal parenchymal(221,82 1%) and post renal ARF(11,4 1%).37 patients with pre renal ARF consisted of post operation ischemia,fluid loss,nephrotic syndrome.221 cases with renal parenchymal ARF were suffered from either tubulointerstitial injuries or glomerular vascular lesions.167 cases were tubulointerstitial injuries caused by drugs,post operative ischemia,infection,shock and rhabdomyolysis.Drug induced ARF were 106 cases,among them directly 52,and indirectly 54 cases.Rhabdomyolysis inducing ARF was 16 cases(5 9%).95 patients were operated for renal biopsy,47 cases had glomerulo vascular lesions and 37 had tubulointerstitial injuries including ATN and AIN.90(33 5%) patients were iatrogenic ARF caused by post operation,pre renal factors and drugs.11 case with post renal ARF resulted from the pelvic or urinary tract tumors,malformation,stones,benign prostatic hypertrophy and post peritoneal lymphadenopathy.Mortality of ARF was 14 5% and adjusted mortality directly related to ARF was 12 5%. Conclusion:The epidemiology of ARF has been changed.There was a trend of high incidence in the elder.Pre renal ARF is easy to be neglected due to the absence of full recognition.The drug induced ARF is going to be a primary cause although the tubulointerstitial injuries are still the major cause of the renal parenchymal ARF.The early diagnosis plays an important role not only in helpful to treatment,but also in improving prognosis,and increasing survival rate in patients with ARF.