急性肾梗死15例临床特征分析

Clinical characteristics of acute renal infarction:an analysis of 15 cases

回顾性分析2011年1月至2021年12月大连大学附属中山医院收治的15例急性肾梗死(ARI)患者的临床资料。病因为心源性肾梗死14例, 抗磷脂综合征1例;合并心房颤动12例, 房性早搏2例, D-二聚体水平升高12例, 乳酸脱氢酶(LDH)水平升高15例, 尿潜血阳性和尿蛋白阳性11例。治疗方式为导管接触性溶栓4例, 静脉溶栓2例, 抗凝治疗9例。随访发现6例再发栓塞, 其中2例死亡。对于存在血栓高风险因素的急性发作、持续性腹痛患者, 若合并高水平LDH、尿潜血(+)和/或尿蛋白(+)提示可能为ARI, 增强CT或CT血管造影可辅助早期确诊。即使存在长时间的肾动脉栓塞也应尽可能尝试重建血流, 后期规范化抗凝治疗至关重要。

Clinical data of 15 patients diagnosed with acute renal infarction(ARI)in Affiliated Zhongshan Hospital of Dalian University from Jan 2011 to Dec 2021 were retrospectively analyzed.Of the included 15 patients,there were 14 cases of cardiac origin and 1 case of antiphospholipid syndrome.We found that there were 12 cases of atrial fibrillation,2 cases of atrial premature beats,12 cases of elevated level of D-dimer,15 cases of elevated level of LDH,11 cases of positive urine occult blood and positive urine protein.Among the 15 patients,catheter-directed thrombolysis was performed in 4 cases,of which 3 cases were revascularized successfully,intravenous thrombolysis in 2 cases and alone anticoagulation therapy in 9 cases.It is suggested that CECT or CTA can assist the early diagnosis of ARI especially in patients with acute onset and persistent abdominal pain with high risk factors of thromboembolism,high levels of LDH,microscopic hematuria and/or proteinuria.Despite prolonged embolic ischemia,try to reconstruct blood flow to save the kidney as much as possible.Late standardized anticoagulant therapy is of critical importance to prevent recurrent embolic episodes.