利福平致急性肾功能衰竭8例分析并文献复习

目的探讨肺结核患者应用利福平所致急性肾功能衰竭（ARF）的原因、特点并提高重视。方法对天津市海河医院近5年来收治的利福平所致的急性肾功能衰竭8例,在年龄、用药特点、治疗及预后等进行分析。结果病例以老年人为主（6/8例）,其中6例既往有应用利福平史,8例患者均在住院后规则应用包括利福平在内的抗结核方案治疗,用药1个月以内出现急性肾功能衰竭。结论在应用利福平抗结核治疗时应提高警惕,密切观察,注意急性肾衰的发生,特别是老年患者和既往曾经应用过利福平的病人。     

江西省吉安市2001—2008年结核病防治工作进展分析

目的 探讨肺结核患者应用利福平所致急性肾功能衰竭(ARF)的原因、特点并提高重视。方法 对天津市海河医院近5年来收治的利福平所致的急性肾功能衰竭8例，在年龄、用药特点、治疗及预后等进行分析。结果病例以老年人为主（6/8例），其中6例既往有应用利福平史，8例患者均在住院后规则应用包括利福平在内的抗结核方案治疗，用药1个月以内出现急性肾功能衰竭。结论 在应用利福平抗结核治疗时应提高警惕，密切观察，注意急性肾衰的发生，特别是老年患者和既往曾经应用过利福平的病人。     

A型流感病毒感染合并急性肾功能衰竭

报告4例1974～1975年冬在美国东南部的田纳西州一次流感流行中发生急性肾功能衰竭的病例。所有患者呼吸道感染后病情均危急,并出现严重呼吸衰竭,需用换气辅助措施来控制低氧血症。患者过去均无肾病史,但患流感后不久都发生急性肾功能衰竭,表现为少尿或无尿及氮质血症。患者的细菌学检查均为阴性。除1例于急性期已死亡外,其余3例恢复期和急性期血清抗A型流感病毒抗体滴度的比较表明有明显增加。4例中2例死亡,说明急性肾功能衰竭是流感的严重合并症。 4例引起急性肾功能衰竭的机制各不相同,一例在发病初全身肌无力,其后排出深棕色的肌球蛋白     

妊娠合并急性肾功能衰竭15例分析

急性肾功能衰竭（肾衰）是由于多种病因引起的肾功能急骤、进行性减退而出现的临床综合征。妊娠期间由于生理病理上发生了一系列的改变，如合并急性肾衰，诊断和治疗均有诸多困难。现对2000-2005年收治的妊娠合并急性肾衰15例进行分析。     

非何杰金淋巴瘤的肾脏损害

目的:了解非何杰金淋巴瘤(NHL)肾脏损害的临床特征和肾脏病理表现.方法:收集住院患者8例临床资料及其中6例肾活检病理资料加以分析.结果:①8例NHL患者诊断为:T细胞淋巴瘤3例,小B细胞淋巴瘤2例,大B细胞淋巴瘤1例,皮肤T细胞淋巴瘤1例,B细胞淋巴瘤1例.②首发症状:以肉眼血尿、下肢水肿和皮疹起病各2例,以发热伴少尿及关节痛伴口腔溃疡各1例.③肾外损害:发热4例,皮疹5例,淋巴结肿大7例;多数患者合并贫血和白/球蛋白比下降或倒置;血清抗核抗体阳性3例,低补体血症5例,抗中性粒细胞胞浆抗体(ANCA)阳性1例.④肾脏损害:临床表现尿检异常3例,急性肾衰4例,慢性肾衰1例;⑤6例行肾活检病理改变分别为:毛细血管内增生性病变(2例),膜增生样病变(3例),轻度系膜增生性病变1例;免疫荧光可见较多免疫复合物沉积,尤其是补体C1q沉积;2例小B细胞淋巴瘤患者伴间质淋巴瘤细胞浸润.结论:NHL肾脏损害从轻度尿检异常至急性肾衰不等,肾脏病理多为急性增殖性病变;肾外损害除了发热、贫血等表现外,多数患者还有皮疹,低补体血症,甚至自身抗体和ANCA阳性,类似系统红斑狼疮和系统性血管炎,临床需注意鉴别.     

急性肾功能衰竭诊断治疗最新进展

急性肾功能衰竭 (急性肾衰 )是以迅速的 (逐日或逐周 )肾小球滤过率下降和血肌酐及尿素氮上升为特点的一个临床综合征。起病初期临床表现常常不明显 ,有赖于密切观察肾功能动态改变而得以诊断。少尿 (尿量少于 40 0ｍｌ/ｄ)或无尿 ,仅出现于约半数病人 ,而且常出现于致病因素 (如低灌注、肾毒性药物 )作用 1～ 2天之后 ,或肾小球源性急性肾衰(如急进性肾炎 )起病的数周后 ,失却了早期、预防性治疗的时机 ,临床工作中一定要注意纠正以少 (无 )尿作为发现 (或考虑诊断 )急性肾衰综合征错误指征。急性肾衰可见于临床各科病人 (内、外、妇产、儿…     

利福霉素类致急性肾功能衰竭的早期诊断与治疗(附3例报告)

利福霉素类致急性肾衰并非罕见,本文分析报告3例,结合文献提出早期诊断的重要性。老年、糖尿病、间歇用药与间断后再用药的病人,尤须注意。急性肾损害最先出现尿改变,在用药前与用药中应多次作尿常规与肾功能检查。正确的治疗方法是停药,采用肾衰综合治疗,重症可用床旁血液透析与激素治疗,预后良好。肾功恢复后不宜再次用利福霉素类药物,也不宜用激惹试验来证实诊断。     

立其丁加多巴胺治疗急性肾功能衰竭

我们试用立其丁加多巴胺治疗急性肾功能衰竭少尿期10例,取得较好疗效。1.一般资料:男6例,女4例,年龄30～50岁,其中2例持续无尿达1周。10例病人入院时少尿或无尿均超过2天,血压偏高,伴有急性肾衰的临床症状,血尿素氮进行性升高,单纯利尿治疗无     

抗肾小球基膜抗体疾病的临床流行病学分析(附14例报告)

目的通过对抗肾小球基膜抗体疾病(抗-GBM疾病)病例的回顾性分析,为我国抗-GBM疾病的流行病学、临床及病理表现特征、治疗现状及预后等方面提供更多资料.方法回顾性分析本所肾脏病临床中心在1980～2000年间14例经肾活检证实诊断为抗肾小球基膜抗体疾病患者的临床病理资料.结果该14例抗-GBM疾病患者占全部自体肾肾活检病例的0.14%,占新月体肾炎的9.1%.14例患者中男性13例,女性1例,平均起病年龄为(26.7±8.1)岁,大多患者在冬春季节起病,10例于发病前一月内有呼吸道感染史.14例患者均在起病时或短期内出现急进性肾功能衰竭,13例需肾脏替代治疗;8例病程中出现咯血,其中6例以咯血起病;全部病例均伴有不同程度的贫血;1例患者伴有中枢神经系统受累.肾脏受累主要表现为肉眼血尿(8/14)、少尿(10/14)或无尿性肾功能衰竭(3/14).起病时血清学检查抗-GBM抗体(间接免疫荧光法)阳性者13例(另一例在病程后期出现阳性),血清C3水平均正常,抗核抗体、抗双链DNA抗体及抗中性粒细胞胞浆抗体均阴性.病理上均出现大量新月体形成,其中13/14表现为新月体肾炎(新月体比例＞50%),8/14表现为100%的新月体肾炎,4例出现明显血管袢坏死改变.免疫荧光检查均有沿毛细血管袢基膜弥漫沉积的线状免疫复合物,均为IgG类抗体介导的免疫沉积物,1例同时伴有IgA的沉积.2例重复肾活检提示在短期内细胞性新月体即转化为纤维细胞性新月体和纤维素性新月体,并且出现肾小球全球硬化及小管间质的慢性化改变.早期应用血浆置换疗法及甲基强的松龙冲击治疗能有效缓解肺出血,并可能改善肾功能衰竭.随访表明,全部患者均需采取长期肾脏替代治疗,2例肺部出血反复发作,对再次甲基强的松龙冲击治疗仍有良好反应.结论本文报道的14例抗-GBM疾病患者初步反映了中国人抗-GBM疾病的临床流行病学特征.     

心脏术后急性肾功能衰竭21例治疗效果分析

目的探讨心脏术后急性肾功能衰竭的治疗方法。方法回顾性分析广西梧州市红十字会医院心脏手术患者538例中术后发生急性肾功能衰竭21例的临床资料。其中,法洛四联症4例,感染性心内膜炎并主动脉瓣关闭不全7例,风湿性心脏病瓣膜置换10例。出现少尿型肾功能衰竭17例,非少尿型肾功能衰竭4例;非少尿型肾功能衰竭4例患者采取合理输液治疗,少尿型肾功能衰竭17例中4例采用腹膜透析及13例采用血液透析治疗。结果21例中14例治愈,7例死亡患者为少尿型肾功能衰竭合并有多脏器功能衰竭院内死亡,6例主要死亡原因为肾功能衰竭合并心力衰竭和肺部感染呼吸衰竭死亡,1例合并真菌性败血症。7例死亡患者中1例为法洛四联症患者、2例为感染性心内膜炎瓣膜置换术患者、4例为风湿性心脏病瓣膜置换术患者。结论心脏术后急性肾功能衰竭要早期发现、及时处理,加强利尿等方法无效时,及时进行腹膜透析或血液透析。     

Rifampicin-induced immune thrombocytopenia

Rifampicin-induced thrombocytopenia is reported in three patients with pulmonary tuberculosis. All three patients gave a definite history of having had prior exposure to rifampicin. Immunological studies in all three patients showed the presence of antiplatelet antibodies, resulting in thrombocytopenia. Moreover, binding of these antibodies to the platelet membrane was more avid in the presence of rifampicin, thereby implicating the drug. The avidity of the rifampicin-dependent antibodies was demonstrated by platelet aggregation inhibition test, and estimation of the rifampicin-dependent antibody was done by studying the platelet-associated immunoglobulin [PAlgG] by ELISA which was also used to quantitate antiplatelet antibodies. Immunofluorescence test was also performed to detect antiplatelet antibodies.     

两种评价急性肾衰竭患者预后及肾脏转归积分模型的比较

目的　比较急性生理和平素健康评估Ⅱ (APACHEⅡ )与急性肾小管坏死 个体严重程度指数 (ATN ISI)两种积分模型对急性肾衰竭 (ARF)患者的预后和肾脏转归的预示效果。方法　回顾性分析了近 1 0年的 42 2例ARF患者资料 ,比较两种积分模型对患者病死率及肾脏转归的预测效果 ,并采用两种积分评定方式对ARF发生 30、45、60d后的肾脏转归进行了判别分析。结果　随着两种模型积分值的增加 ,患者的病死率升高 ,当ATN ISI积分≥ 0 85、APACHEⅡ积分≥ 35时病死率为 1 0 0 % ;APACHEⅡ和ATN ISI模型的ROC曲线下的面积分别为 0 81 7± 0 0 2 1和 0 880± 0 0 1 8,表明两种模型对ARF患者病死率的判别均有意义。对肾脏转归的判别 ,ATN ISI在各评定时间的判别符合率均高于APACHEⅡ ;ATN ISI积分≥ 0 75时 ,均需依赖透析治疗 ;<0 75但≥ 0 58时 ,肾功能未恢复正常 ;肾功能完全恢复者积分值均在 0 58以内。APACHEⅡ积分≥ 2 6时 ,均需依赖透析治疗 ;<2 6时 ,肾功能完全恢复和肾功能不全病人之间无明显积分界限 ;但≤ 2 2时 ,上述二者所占比例分别为 80 4%和1 9 6 %。结论　两种积分模型对ARF患者的病死率及肾脏转归均有较好的预示效果 ,但ATN ISI积分模型对肾脏转归的预示价值更优于APACHEⅡ。     

Acute renal insufficiency caused by drugs or iodinated contrast media. Results of a prospective and multicenter study in south Tunisia

In order to determine the frequency of acute renal failure (ARF) induced by drugs, to identify the agents responsible for it and to define its semiological characteristics, a prospective study was carried out between 1 October 1987 and 30 September 1988, in Sfax and southern Tunisia. Three Departments of Medicine and one Hemodialysis Center participated in this study. Twelve cases of drug-induced ARF were identified among the 73 cases of ARF reported, i.e., a frequency of 16%. Anti-inflammatory non-steroidal drugs (AINS) were implicated in 5 cases and antibiotics in 2. Symptoms of hypersensitivity were observed in 4 patients, 2/3 without oliguria. Renal insufficiency was usually marked: plasma creatinine was 523 +/- 425 mumol/l; proteinuria greater than 1 g/24 h was seen in 2 patients. Hypovolemia and/or hypotension (6 cases) and diabetes mellitus (4 patients) were found to favor ARF. Renal function returned to normal in 9 patients, whereas mild renal failure persisted in the remaining 3 patients. Drug-induced ARF occurs often. AINS are the most frequently incriminated agents and hypersensitivity symptoms without oliguria are the most common manifestations. Drug-induced ARF can be prevented by close monitoring of high-risk patients, i.e., those taking AINS.     

A prospective, multicenter study of the epidemiology, management, and outcome of severe acute renal failure in a "closed" ICU system

The safety and effectiveness of "closed" intensive care units (ICUs) are highly controversial. The epidemiology and outcome of acute renal failure (ARF) requiring replacement therapy (severe ARF) within a "closed" ICU system are unknown. Accordingly, we performed a prospective 3-mo multicenter observational study of all Nephrology Units and ICUs in the State of Victoria (all "closed" ICUs), Australia, and focused on the epidemiology, treatment, and outcome of patients with severe ARF. We collected demographic, clinical, and outcome data using standardized case report forms. Nineteen ward patients and 116 adult ICU patients had severe ARF (13.4 cases/100, 000 adults/yr). Among the ICU patients with severe ARF, 37 had impaired baseline renal function, 91 needed ventilation, and 95 needed vasoactive drugs. Intensivists controlled patient care in all cases. Continuous renal replacement therapy (CRRT) was used in 111 of the ICU patients. Nephrological opinion was sought in only 30 cases. Predicted mortality was 59.6%. Actual mortality was 49.2%. Only 11 ICU survivors were dialysis dependent at hospital discharge. In the state of Victoria, Australia, intensivists manage severe ARF within a "closed" ICU system. Renal replacement is typically continuous and outcomes compare favorably with those predicted by illness severity scores. Our findings support the safety and efficacy of a "closed" ICU model of care.     

Hemorrhagic cardiac tamponade in critically ill patients with acute renal failure

PURPOSE: The purpose of this study was to report the development, management, and follow up of tamponading uremic pericardial effusion in critically ill patients with acute renal failure. SETTING: The setting for this study was an adult, 24-bed tertiary multidisciplinary intensive care unit (ICU) of a university hospital. PATIENTS: The subjects were 5 critically ill patients with multiple organ failure including acute renal failure (ARF) that was slow to resolve. RESULTS: Renal involvement was attributed to renal hypoperfusion, sepsis and myoglobinuria. Continuous veno-venous hemofiltration (CVVH) was instituted early during hospitalization in 4 cases and lasted for 35 to 48 days; renal replacement therapy was not used in 1 case. Tamponade developed late in the course of ARF, after CVVH was discontinued in the 4 cases and was effectively managed with percutaneous pericardiocentesis under echocardiography and continuous catheter drainage of the pericardial sac for 48 to 72 hours. Hemorrhagic fluid (Hb 2.2-5.9 g/dL) with lymphocyte predominance was detected. Transient constrictive-like pericarditis findings were present in all patients after the procedure. All patients were discharged from the hospital in a good condition with normal serum and creatinine levels; 1-year follow up showed a normal echocardiogram. CONCLUSION: Awareness for the possibility of hemorrhagic pericarditis and cardiac tamponade is needed in ICU patients with ARF slow to resolve. Transient constrictive-like pericarditis may present after pericardiocentesis.     

Immune hemolytic anemia and renal failure associated with rifampicin-dependent antibodies with anti-I specificity

Summary A 50-year-old woman with primary biliary cirrhosis developed immune hemolytic anemia and renal failure while receiving rifampicin for the treatment of refractory pruritus. Serological studies revealed the presence of rifampicin-dependent antibodies of the IgM class that, when tested against a wide panel of erythrocytes, had anti-I specificity. Subsequently, rifampicin was withdrawn and prednisone treatment instituted, this resulting in a rapid resolution of the hemolysis, whereas hemodialysis was required for recovery of the renal function. A role is suggested for the anti-I specificity of the antibodies in the development of renal failure associated with rifampicin therapy.This work was partially supported by grant FISS 90/0486 from theMinisterio de Sanidad y Consumo of Spain     

A case of exercise-induced acute renal failure in a patient with idiopathic renal hypouricemia developed during antihypertensive therapy with losartan and trichlormethiazide.

Exercise-induced acute renal failure (ARF) developed in a 45-year-old man during antihypertensive therapy with losartan and trichlormethiazide. The antihypertensive therapy was stopped and marked hypouricemia became apparent during improvement of his renal function. The daily urinary excretion of uric acid was normal and an increased fractional excretion of uric acid was observed. Renal biopsy revealed that the kidney was recovering from acute tubular necrosis with interstitial fibrosis. Based on the results of pyrazinamide and benzbromarone tests, we classified this case as one of presecretory reabsorption defect of uric acid. Antihypertesive therapy with benidipine and candesartan was initiated, and the patient has not had any ARF episodes since. Because idiopathic renal hypouricemia can be associated with exercise-induced ARF and chronic renal dysfunction, careful antihypertensive therapy and follow-up evaluation of renal function might be necessary for hypertensive patients with idiopathic renal hypouricemia.     

急性肾功能衰竭误漏诊原因分析及肾活检的意义

目的 探讨急性肾功能衰竭（ＡＲＦ）误漏诊原因,提高ＡＲＦ诊断水平。方法 分析入院前诊断与最终诊断的事率寻找误漏诊原因,总结 活检后诊断和治疗的修正率及早期治疗对预后的影响。结果 １１１例ＡＲ守前确诊断ＡＲＦ者７５例（６７．６％）;１６例（１４．４％）误诊为慢性肾功能衰竭（ＣＲＦ）;２０例（１８．０％）误漏诊为肾脏肿瘤、泌尿系统结石、血尿／蛋白尿原因待查等其他两列肾活检病理检查纠正了１５例（２１．７     

急性肾衰患者尿液和肾组织中表皮生长因子的检测及动态变化的意义

本文应用放射免疫方法首次对6例恢复期急性肾衰(ARF)患者尿中EGF进行了动态观察,并与肾组织中EGF进行了比较。发现随着尿中EGF含量的不断增加,Scr水平逐渐下降,而且肾衰指数和钠滤过分数也里类似的变化。恢复期ARF患者肾组织中EGF含量普遍增加,在伴肾小管上皮细胞再生表现者增加的更为明显,并与尿中EGF的变化平行。以上结果表明,ARF患者尿中EGF含量变化,在一定程度上间接地反映了肾脏中EGF的含量和患者肾小管的修复状态,以及肾功能的恢复情况。     

Characteristics of acute renal failure in elderly patients admitted to a small town hospital

We studied the features of acute renal failure (ARF) in elderly patients treated in a hospital, without an intensive care unit, to identify etiological factors and establish adequate preventive measures and treatment. During twelve consecutive months we studied prospectively 99 patients with ARF diagnosed by conventional criteria, an incidence of 1,238 cases per million per year. ARF affected 1.78% of patients admitted to hospital. We analyzed age, sex, serum creatinine, diuresis, etiology, type of ARF, preexisting chronic diseases, treatment, complications and outcome. Preexisting chronic diseases were common, the most frequent being hypertension (54%) and diabetes (39%). Previous treatments for cardiovascular diseases were frequent (angiotensin-renin system blockade 35.4%, diuretics 50.5%). 79% of ARF arose in hospital, 21% outside hospital. ARF was pre-renal in 60%, renal in 31% and post-renal in 9%. 34.7% were caused by volume depletion, 23.4% by low cardiac output and 23.4% by infection. 44.4% of ARF patients had oliguria or anuria latrogenic factors contributed to the ethiology of ARF in 35.3% of patients. Hospital stay was doubled by ARF the presence of ARF and the mortality was 36.4%. The rate was higher in ARF arising in hospital than in ARF acquired before admission. Factors that had a significant influence on the mortality rate were comorbid conditions, oliguroanuria, ARF of renal origin and serum albumin. We conclude that ARF has a high incidence, morbidity and mortality in this elderly population. Volume depletion, associated cardiovascular pathology and pharmacological treatment are important etiological factors in those with ARF outside hospital. Adequate treatment of ARF and avoidance of nephrotoxic medications are necessary in hospital.