以肾外症状为主要表现的慢性肾衰竭误诊原因分析

Causes of Misdiagnosis of Chronic Renal Failure with Extrarenal System as the Main Manifestation

目的 探讨以肾外症状为主要表现的慢性肾衰竭(CRF)误诊原因及防范误诊措施。方法 对2020年4月—2022年5月收治的以肾外症状为主要表现就诊的CRF 15例的临床资料进行回顾性分析。结果 本组15例中,6例以消化系统主要表现就诊误诊为慢性胃炎,4例以头痛、头晕、血压升高等为主要表现就诊误诊为原发性高血压病;3例以皮肤干燥无光泽、皮肤瘙痒为主要表现就诊误诊为皮肤瘙痒症;2例以全身疲乏无力、头晕、心悸及面色苍白为主要表现就诊误诊为贫血。误诊时间2个月~1年(0.9±0.2)年。15例均按误诊疾病予相关治疗病情改善不明显,后经完善相关检查,综合分析病情后明确诊断为CRF。15例确诊后予对症治疗,病情好转,随访0.5~1年后病情稳定。结论 CRF早期临床表现复杂多样且无特异性,可累及全身多个肾外系统组织,易误诊,临床医生应加强对本病早期多样性表现的认识,全面分析病情,以减少误诊误治。

Objective To explore the causes of misdiagnosis of chronic renal failure(CRF)with extrarenal symptoms as the main manifestations and preventive measures.Methods A retrospective analysis was conducted on the clinical data of 15 CRF patients with extrarenal symptoms as main manifestations treated from April 2020 to May 2022.Results Of the 15 cases in this group,6 cases were misdiagnosed as chronic gastritis with the main manifestations of digestive system,and 4 cases were misdiagnosed as primary hypertension with vascular headache,dizziness,elevated blood pressure and other main manifestations.Three cases were misdiagnosed as pruritus due to the main manifestations of the skin system,and 2 cases were misdiagnosed as anemia due to general fatigue,dizziness,palpitation and pallor as the main manifestations.Misdiagnosis lasted from 2 months to 1 year(0.9±0.2)year.All the 15 cases were given targeted treatment according to misdiagnosed diseases,and the improvement of the condition was not obvious.After improving relevant examinations,comprehensive analysis of the condition confirmed CRF.After diagnosis,15 patients received symptomatic treatment,their condition improved,and the condition was stable after 0.5 to 1 year of follow-up.Conclusion The early clinical manifestations of CRF are complex,diverse and non-specific,and can involve multiple extrarenal system tissues throughout the body,which,therefore,is more likely to cause misdiagnosis.Clinicians should strengthen the understanding of the early manifestations of this disease and comprehensively analyze the condition,so as to reduce misdiagnosis and mistreatment.