急性肾衰竭临床与病理分析

目的探讨急性肾衰竭的病因、临床与病理特点、治疗及转归。方法回顾性分析1988年1月～2003年10月诊治的急性肾衰竭80例病历资料。结果80例中肾性肾衰63例(78.8%),以肾小球疾病47例(58.8%)居首位;肾前性肾衰15 例(18.8%);肾后性肾衰2例(2.5%)。23例行肾活检,病理改变以系膜增殖性肾小球肾炎9例(39.1%)最多见,膜增殖性肾小球肾炎和新月体肾炎各4例(17.4%),毛细血管内增殖性肾炎3例(13%),增生硬化性肾小球肾炎2例(8 7%),轻微病变1 例(1.3%)。根据不同病因和病理改变特点,予补液、泼尼松口服、甲泼尼龙和环磷酰胺冲击、透析及利尿降压等治疗,治愈31 例(38.8%),好转27例(33.8%),自动出院10例(12.5%),住院期间和放弃治疗中共死亡21例(26 3%)。1996～2003年病死率(9 4%)明显低于1988～1995年(37 5%)(x2=7 85 P<0.01)。结论急性肾衰竭的治疗关键在于早期明确病因,及时对因治疗。肾活检在肾性肾衰的诊断、治疗和预后估计中起重要作用。适时透析治疗是急性肾衰竭枪救成功的关键。

Clinical and Pathological Analysis of Acute Renal Failure in Children

Objective To study the etiology, clinical and pathological characteristics, therapy and prognosis of acute renal failure (ARF). Methods The literature of 80 treated children with ARF from 1988. 1 to 2003.10 was reviewed. Results Sixty three cases (78.8%)suffered from mtrarenal ARF;47 glomerulonephritls (58. 8%); 15(18. 8%)prerenal ARF;2(2 5%)postrenal obstructive ARF. Twenty three cases with renal biopsy,9(39. 1%)MsPGN;4 (17. 4% ) MPGN; 4 (17. 4%) crescentic glomerulonephntis; 3 (13% ) endocapillary glomerulonephritls;2(8 7% )proliferative and sclerosing glomerulonephritis; 1(1. 3% )minimal changes. According to the different etiologic and pathological characteristics,different therapies were applied,infusion,oral prednisone ,and intravenous pulses of methylprednisone and cyclosphosphamide ,dialysis, or diuretic therapy and lowering blood. Thirty one (38. 8% )cases recov-ered;27(33 8% )cases improved; 10( 12.5% ) cases gave up treatments;21 (26 3% )died. The mortality of ARF from 1996 to 2003 was significantly lower than that from 1988 to 1995(x2 = 7.85 P<0.01).Conclusions The crucial treatment of ARF is to clarify its etiology in early stage. The renal biopsy plays an important role in the diagnasis, therapy and prognosis of ARF. The timely dialysis therapy is the key to successful emergency treatment of ARF