慢性肾衰竭误诊为肾外系统疾病临床分析

Clinical Analysis of Chronic Renal Failure Misdiagnosed as Extrarenal Multisystem Disease

目的探讨误诊为肾外系统疾病的慢性肾衰竭(CRF)的原因及防范措施。方法回顾性分析2021年2月至2023年3月收治的误诊为多种肾外系统疾病的CRF 14例的临床资料。结果4例以食欲不振、恶心呕吐、腹部不适及黑便为主症就诊,胃镜示胃黏膜充血、散在糜烂灶或出血点,误诊为慢性胃炎,予相应治疗无好转,经肾功能检查确诊CRF;4例以皮肤干燥瘙痒、毛发枯萎及皮疹为主症就诊,误诊为皮肤瘙痒症,予中药治疗无好转,行肾功能检查确诊CRF;2例以疲乏无力、头晕及面色苍白为主症就诊,血红蛋白降低,误诊为贫血,予相应治疗效果不佳,行尿常规及肾功能检查确诊CRF;3例以头痛、头晕、血压升高、胸闷及心悸为主症就诊,误诊为原发性高血压,经调换降压药物后效果不佳,行尿常规及肾功能检查确诊CRF;1例以双眼视物模糊为主症就诊,误诊为双眼视网膜水肿,发现高血压后,加行泌尿系彩超及肾穿刺活检,确诊为CRF。误诊时间1~5个月。14例确诊后治疗1~3个月后病情缓解出院。出院后随访6个月~1年,13例病情稳定,1例失访。结论CRF早期症状复杂多样,可出现多种肾外系统症状,若患者肾脏症状轻微,仅以某一肾外系统症状为主要表现就诊时,若接诊医生对本病肾外系统症状认识不足,问诊及查体不细致,未及早行相关医技检查,极易误诊;加强对本病肾外系统症状的认识,细致查体,详细问诊,仔细鉴别诊断,及早行相关检查,有助于提高本病早期诊断率。

Objective To explore the causes and preventive measures of chronic renal failure(CRF)misdiagnosed as extrarenal system disease.Methods The clinical data of 14 patients with CRF who were misdiagnosed as multiple extra-renal system diseases from February 2021 to March 2023 were retrospectively analyzed.Results The main symptoms of 4 pa-tients were loss of appetite,nausea and vomiting,abdominal discomfort and black stool.Gastroscopy showed hyperemia of gas-tric mucosa and scattered erosive focus or hemorrhagic spot,which was misdiagnosed as chronic gastritis.No improvement was found after corresponding treatment,and CRF was confirmed by renal function examination.The main symptoms of 4 patients were dry skin,pruritus,withered hair and rash.They were misdiagnosed as pruritus.However,after treatment with traditional Chinese medicine,no improvement was reported.CRF was confirmed by renal function examination.Two patients presented with fatigue,weakness,dizziness,pale face,and decreased hemoglobin,who,therefore,were misdiagnosed with anemia.However,the corresponding treatment was not effective,and CRF was confirmed by urine routine and renal function examina-tion.The main symptoms of 3 patients were headache,dizziness,elevated blood pressure,chest tightness and palpitation,which were misdiagnosed as primary hypertension.After changing antihypertensive drugs,the effect was not favorable.CRF was confirmed by urine routine and renal function examination.One patient presented with blurry vision in both eyes and was misdiagnosed as retinal edema in both eyes.After hypertension was found,color ultrasound of urinary system and renal needle biopsy were performed,and CRF was confirmed.The misdiagnosis lasted 1-5 months.Fourteen patients were discharged from hospital after 1-3 months of treatment following diagnosis.Based on follow-up of 6 months to 1 year after discharge,13 patients had stable condition and 1 patient was lost to follow-up.Conclusion The early symptoms of CRF are complex and varied,and a variety of extrarenal system symptoms may appear.If the patient presented with mild kidney symptoms and only one extraren-al system symptom as the main manifestation,the attending physician has insufficient understanding of the symptoms of the ex-trarenal system of the disease,the inquiry and physical examination are not careful,and the relevant medical and technical ex-amination is not performed early,it is more likely to lead to misdiagnosis.Strengthening the understanding of the symptoms of the extrarenal system of this disease,careful physical examination,detailed inquiry,careful differential diagnosis,and early examination are helpful to improve the early diagnosis rate of this disease.