慢性肾脏病基础上的急性肾功能衰竭

Acute-on-chronic renal failure

目的 了解慢性肾脏病基础上急性肾功能衰竭(A/C)的发病情况及临床和病理特点。方法 对我科12年间(1990年1月至2001年1月)经肾活检证实的此种病例进行原因、与基础肾脏病关系、预后影响因素及转归的分析。结果 104例符合选择标准,占急性肾功能衰竭(ARF)病例数的35.5％。慢性肾脏病发生ARF的常见原因为药物引起的急性间质性或间质肾小管病变,狼疮肾炎(LN)活动以及肾病综合征伴特发性ARF。104例患者中,共有39例ARF与药物相关。关于基础肾脏病,ARF原因为病变活动的患者以LN为主,特发性ARF者以微小病变性肾病(MCD)为主,而ARF原因为恶性高血压的患者则以IgA肾病与硬化性肾小球肾炎多见。在104例患者中,有2例死亡;39例需要血液透析治疗,治疗后有23例脱离透析。出院时,48例患者血肌酐恢复到正常水平。多元Logistic回归分析提示,高血压、接受透析治疗、高血肌酐水平预示肾功能不易恢复。在有明确院外诊断的21例患者中,有15例被诊为“慢性肾功能衰竭”,占71.4％。结论 慢性肾脏病基础上发生的ARF并不少见。警惕药物引起的肾损害(尤其对于老年人)、控制结缔组织病的活动以及积极控制血压和维持循环血量对于预防肾脏病患者发生ARF十分重要。经过适当治疗后,大部分患者的肾功能有所改善。因此。

Objective To investigate the incidence and clinicopathological characteristics of acute-on-chronic renal failure (A/C) . Methods Clinical data from all patients diagnosed as A/C by clinical materials and renal biopsy for a 12-year period (Jan, 1990 to Dec, 2001) were collected, and the cause of acute renal failure (ARF), relationship between cause and underlying renal diseases and factors affecting prognosis were analyzed. Results One hundred and four A/C patients accounted for 35. 5% of biopsied ARF cases during the same period. Acute interstitial Aubulointerstitial disease, increased activity of lupus nephritis (LN) and idiopathic ARF in nephrotic syndrome (NS) were the most common causes of ARF in A/C. And 39 A/C cases (35.6% ) were drug-related. Offending drugs were mostly antibiotics, non-steroid anti- inflammatory drugs or combination of them. Idiopathic ARF was commonly seen in minimal change diseases with ARF. Flare-up of underlying diseases was mostly occurred in LN patients. The causes of 9 malignant hypertension cases were IgA nephropathy, sclerotic nephritis and so on. The mortality of this group was 1. 9% (2 cases): one patient died of multiple organ failure resulted from basal disease; the other suffered from sudden death of unknown reason. Thirty-nine cases needed renal replacement therapy, and after 28. 5 days' treatment on the average, 23 of them did not need dialysis any more. Serum creatinine (Scr) returned to normal level in 48 patients (46. 2% ) when discharged. Twenty-one cases had been diagnosed before consulting to our department. Among them, 15 cases (71. 4% ) were diagnosed as 'chronic renal failure . Multivariate Logistic regressive analysis showed that hypertension, dialysis therapy and high Scr level indicated poor renal prognosis. Conclusions A/C is an common part of ARF. Being aware of adverse effects of drugs (especially for elders), decreasing the activity of connective tissue diseases, controlling the blood pressure and keeping proper circulating volume are very important for patients with chronic renal diseases. After reasonable therapy, most patients' renal function can be improved. Early correct diagnosis and treatment are important.