老年肾病综合征的临床观察

Clinical Observation of Nephrotic Syndrome in the Elderly

目的探讨老年肾病综合征的临床表现、病理特征、治疗与转归和合并症等临床变化情况,为其诊治提供参考。方法选取湖北省黄石市中医院肿瘤科收治的76例老年肾病综合征患者进行回顾性分析,观察并分析患者的临床表现、病理分型和合并症等。结果 (1)入院时76例患者中原发性老年肾病综合征有62例(81.58%),继发性老年肾病综合征有14例(18.42%)。(2)入院时多合并高血压病、感染、肾功能损害和心血管疾病等。(3)治疗1年后,48例有效(63.16%),11例无缓解(14.47%)、自动出院12例(15.79%)、肾功能恶化而维持透析2例(2.63%)、死亡3例(3.95%)。(4)76例患者中36例(47.37%)接受肾穿刺病理组织活检确诊,其中27例(75.00%)为原发性肾病综合征,病理类型分别为膜性肾病14例(48.15%)、系膜增生性肾小球肾炎2例(7.41%)和IgA肾病6例(22.22%)、局灶节段性肾小球硬化症5例(18.52%);9例(25.00%)为继发性肾病综合征,病理类型分别为糖尿病肾病5例(55.56%)、高血压性肾病1例(11.11%)、狼疮性肾炎2例(22.22%)和显微镜下血管炎1例(11.11%)。结论老年肾病综合征合并症较多,用药时必须谨慎,但尽早进行病理组织活检,明确病理类型,可为其治疗提供有益的参考。

Objective To investigate the clinical manifestations,pathological features,treatment outcome,complications and other clinical changes of nephrotic syndrome in the elderly.Methods76hospitalized elderly with nephritic syndrome were selected and an retrospective analysis was made to the clinical manifestations,pathological classification and complication occurrence in the elderly.Results At admission,out of the76,there were62elderly(81.58%)with primary nephritic syndrome while14elderly(18.42%)with secondary nephritic syndrome;most of the elderly were complicated with hypertension,infection,renal dysfunction and cardiovascular diseases at admission;1year after treatment,effectiveness was found in48cases(63.16%)while no remission in11cases(14.47%),and12cases(15.79%)had the discharge with their own decision,2cases(2.63%)maintained dialysis due to renal function deterioration and3cases(3.95%)died;out of the76cases,36cases(47.37%)received renal biopsy:27cases(75.00%)were final-diagnosed to be with primary nephrotic syndrome with the pathological classification of membranous nephropathy in14cases(48.15%),mesangial proliferative glomerulonephritis in2cases(7.41%),IgAnephropathy in6cases(22.22%)and focal segmental glomerular sclerosis in5cases(18.52%)while9cases(25.00%)were final-diagnosed to be with secondary nephrotic syndrome with the pathological classification of diabetic nephropathy in5cases(55.56%),hypertensive renal disease in1case(11.11%),lupus nephritis in2cases(22.22%)and microscopic plyangiitis in1case(11.11%).Conclusions The elderly nephrotic syndrome leads to various complications and certain attention should be paid in drug administration;early renal biopsy and pathological classification determination can provide useful reference for the treatment.