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醫(yī)學(xué)免費論文:微小病變腎病綜合征并發(fā)急性腎衰竭的臨床病理特點
【摘要】目的 ：探討微小病變腎病綜合征（minimal change nephrotic syndrome，MCNS)并發(fā)特發(fā)性急性腎衰竭(idiopathic acute renal failure，IARF)的臨床病理特點。方法 ：回顧性分析15例成人MCNS并發(fā)IARF（腎衰組)臨床病理表現(xiàn)及轉(zhuǎn)歸情況，隨機抽取成人MCNS無并發(fā)急性腎衰竭15例（非腎衰組)作對照。結(jié)果 ：腎衰組血肌酐為（307.7±168.6)μmol/L，少尿型占73.3%（11例)，急性腎衰竭好轉(zhuǎn)率為86.7%(13例)。與非腎衰組相比，腎衰組水腫程度較重，收縮壓水平較高(P <0.01)；腎衰組腎小管上皮細(xì)胞濁腫和腎小管上皮細(xì)胞扁平化發(fā)生率較高（P <0.01)，腎小管腔內(nèi)蛋白管型的發(fā)生率較高(P <0.05)；腎病綜合征的緩解時間和平均住院時間較長（P <0.01)。結(jié)論：成人原發(fā)性MCNS并發(fā)IARF患者臨床上水腫程度較重和收縮壓水平較高，病理表現(xiàn)主要為急性腎小管損傷，腎功能損傷多呈可逆性質(zhì)，預(yù)后好。
【關(guān)鍵詞】 微小病變腎病 腎病綜合征 急性腎衰竭
Clinical and pathological features of minimal change nephrotic syndrome complicated with acute renal failure
YOU Xiaohan，ZHOU Ying，HUANG Chaoxing醫(yī).學(xué)全.在.線網(wǎng)站bhskgw.cn.
Department of Nephrology，the First Affiliated Hospital of Wenzhou Medical College，Wenzhou，325000
Abstract: Objective: To explore the clinical and pathological characteristics of minimal change nephrotic syndrome （MCNS) complicated with idiopathic acute renal failure （IARF). Methods:Fifteen patients with adult-onset MCNS complicated with IARF （ARF group) were compared with 15 patients with MCNS without ARF （non-ARF group) who were randomly selected. The clinical manifestation，pathological data and outcome were analyzed retrospectively. Results: In ARF group the average serum creatinine level was （307.7±168.6 )μmol/L. 11 cases manifested oliguria ARF （73.3%) and recovery of renal function （86.7%) in ARF group was found in 13 case. The systolic blood pressure was higher and the degree of edema was more serious in the ARF group （P <0.01). The incidence of vacuolar degeneration in tubular epithelium and flattened tubular epithelium was higher in the ARF group （P <0.01). The incidence of proteinaceous casts was higher in the ARF group （P <0.05). The remission time of nephrotic syndrome as well as the hospitalization time （P <0.05)was longer in the ARF group. Conclusion: IARF usually occurs in nephrotic patients with higher blood pressure and more serious edema. The main histopathologic change is acute tubule injury.Recovery of renal function occurs in most cases. The prognosis is good.
Key words: minimal change disease；nephritic syndrome；acute renal failure
1966年Chamberlain首次報道原發(fā)性腎病綜合征（nephritic syndrome，NS)患者并發(fā)原因不明的急性腎衰竭（acute renal failure，ARF)，即特發(fā)性急性腎衰竭(idiopathic acute renal failure，IARF)。微小病變腎�。╩inimal change dieases，MCD)是原發(fā)性NS的常見病理類型之一，現(xiàn)已明確IARF最好發(fā)于微小病變腎病綜合征（minimal change nephrotic syndrome，MCNS)，但其發(fā)生機制至今不明。我們回顧性分析了1993年7月-2008年5月我院成人MCNS并發(fā)IARF 15例臨床病理特點及轉(zhuǎn)歸情況，探討成人MCNS并發(fā)IARF的臨床病理特點及其發(fā)生機制。
1 對象和方法
