急性肾功能衰竭患者经皮肾穿刺活检的临床意义

目的研究急性肾功能衰竭（ARF）患者的病理类型及病因分布，评价肾活检在肾脏病诊治中的作用与临床意义。方法对30例ARF患者具有肾穿刺活检适应证的病例，在B超介入定位下行经皮肾穿刺活检，并作光镜、免疫病理检查及结合临床特点进行分析。结果30例ARF患者肾穿刺均能成功取得肾小球，标本合格率为96．7％。病理分析显示：硬化性肾炎2例（6．67％）；原发性肾小球肾炎17例（56．67％），其中IgA肾病3例，肾小球轻微病变5例，膜性肾病2例，局灶节段性硬化性肾炎2例，毛细血管内增生性肾炎2例，新月体肾炎3例；继发性肾小球肾炎8例（26．62％），其中狼疮性肾炎6例，过敏性紫癜肾炎2例：另外，急性肾小管坏死2例（6．67％）；急性间质性肾炎1例（3．33％）。并发症主要有肉眼血尿2例，肾周血肿1例，未发生误穿其他脏器、感染及严重大出血等并发症。结论对急性肾功能衰竭患者行肾活检是可行的，有助于明确病因及病理类型，对指导治疗及判断预后均有非常重要的作用。     

成人肾病综合征并发急性肾功能衰竭临床及病理研究

目的探讨成人肾病综合征（NS）并发急性肾功能衰竭（ARF）临床、病理特点及转归。方法把84例成人NS并发ARF患者分成两组：老年组30例、非老年组54例,并对两组的临床、病理特点及转归进行回顾性对比分析。结果两组均男性多于女性,病因以原发性肾小球疾病为主。其中老年组以继发糖尿病肾病、恶性肿瘤为主,肾活检病理类型以膜性肾病、局灶节段性肾小球硬化为主,非老年组的肾活检病理类型多样;老年NS并发ARF发病率较高,为25．0％（30／120）,非老年发病率为7．15％（54／755）;老年组病死率高,治愈率低。结论成人NS并发ARF患者中,老年组病理类型以膜性肾病、局灶节段性肾小球硬化多见,发病率高,治愈率低,预后差;非老年组的肾活检病理类型多样,发病率较低,治愈率较高,预后较好。     

老年肾脏病的临床与病理特点——附121例报告

目的:总结老年肾脏病患者的临床与病理类型分布特点.方法:总结121例的肾穿刺活组织检查(活检)病理资料,分析不同临床表现[包括尿常规检查异常(有蛋白尿、血尿或管型细胞,但达不到肾病综合征诊断标准,亦无肾功能不全)、肾病综合征、肾功能不全]患者的病理类型.结果:121例的肾脏疾病病理分布以原发性肾小球病为主,其中前3位分别是系膜增生性肾炎、微小病变性肾小球肾炎、膜性肾小球肾炎.继发性肾小球疾病的主要病理类型为狼疮肾炎,其次是显微镜下多血管炎、肾淀粉样变.尿常规异常21例,肾病综合征61例,肾功能不全53例.尿常规检查异常患者以原发性肾小球疾病为主,占76%,病理类型前3位分别为系膜增生性肾小球肾炎、微小病变性肾小球肾炎,IgA肾病.老年肾病综合征以原发性为主,占84%,病理类型前3位为系膜增生性肾小球肾炎、膜性肾小球肾炎、微小病变性肾小球肾炎.急性肾功能不全患者以微小病变性肾小球肾炎为主(7例).慢性肾功能不全以原发性肾小球疾病为主,前3位依次为硬化性肾炎、系膜增生性肾小球肾炎和IgA肾病.结论:老年患者的肾小球疾病以原发性多见,病理类型以系膜增生性肾炎、微小病变性肾小球肾炎、膜性肾小球肾炎为主;在继发性肾小球疾病中则以狼疮肾炎为主,显微镜下血管炎次之.     

超声引导下经皮肾穿刺活检的临床意义

目的探讨灰阶B超引导下对肾脏疾病患者进行经皮肾组织穿刺活检的临床价值。方法采用GE200Pro黑白超声仪、穿刺探头、自动活检枪及组织切割针对肾下极进行穿刺,穿刺组织分别送光镜、电镜及免疫学检查。结果36例患者利用组织切割针进行肾穿刺,取出组织44条,电镜共检出452个肾小球送病理学检查,检出弥漫系膜增生性肾小球肾炎17例,IgA肾病8例,糖尿病肾病伴乙型肝炎相关肾炎1例,狼疮性肾炎2例,糖尿病肾病3例,局灶系膜增生性肾小球肾炎2例,肾小球轻微病变3例。结论经皮肾穿刺活检,对了解肾脏疾病的病理类型,指导临床治疗及判断疾病预后具有十分重要的意义。该方法操作简便、成功率高、并发症少,值得推广。     

江苏省泰州地区334例经皮肾穿刺活检临床病理分析

目的探讨泰州地区肾活检患者的临床及病理特点,以及2者之间的关系。方法回顾性分析江苏省泰州地区近4年因肾脏疾病行经皮肾穿刺组织活检患者的年龄、病因、临床特点和病理类型,并探讨其临床特点和病理类型之间的关系。结果本组患者中,男性占53.3%,女性占46.7%;平均年龄:男(39.1±18.1)岁、女(40.8±13.3)岁。原发性肾小球肾炎(PGD)主要临床表现为慢性肾小球肾炎占62.7%。PGD常见病理类型依次为系膜增生性肾小球肾炎(MsPGN)36.4%I、gA肾病29.8%、FSGS11.0%。继发性肾小球肾炎最常见的病理类型是狼疮性肾炎37.7%。结论本地区肾活检患者青壮年多见,以原发性肾脏疾病最常见,常见的病理类型依次为MsPGN、IgA肾病、FSGS。继发性肾小球疾病以狼疮性肾炎、紫癜性肾炎和高血压肾病居前3位。     

彩超引导下经皮肾穿刺活检的临床意义

目的 探讨在彩超引导下对肾脏疾病患者进行经皮肾组织穿刺活检的临床价值。方法 采用PHILIPS非凡彩超诊断仪穿刺架自动活检枪及组织切割针对肾下极进行穿刺，穿刺组织分别送电镜、光镜及免疫学检查。结果 32例患者利用组织切割针进行肾穿刺，取出组织42条，电镜共检出466个肾小球，送病理学检查，检出弥漫性系膜增生性肾小球肾炎16例，IgA肾病6例，轻度系膜增生型IgM肾病5例，狼疮性肾炎2例，紫癜性肾炎1例，局灶增生性肾小球肾炎1例，轻度系膜增生型IgA肾病伴高血压肾脏损害1例。结论 经皮肾穿刺活检，对了解肾脏疾病的病理类型，指导临床治疗及判断预后有十分重要的意义，方法操作简便，成功率高，并发症少，值得推广。     

2型糖尿病合并肾损害177例临床病理分析

目的分析2型糖尿病(T2DM)合并肾损害的临床病理特点,探讨肾穿刺活检在诊断T2DM合并肾损害时的重要性。方法回顾性分析177例T2DM合并肾损害患者的临床资料及肾穿刺活检的病理资料。结果 177例2型糖尿病合并肾损害患者占同期全部肾穿刺活检患者的6.7%(177/2653),其中女性56例,男性121例。患者年龄24~76岁,平均年龄53.4岁。病理诊断糖尿病肾病(DN)62例,非糖尿病肾病(NDRD)106例,DN合并NDRD 9例。62例DN中,I型DN 2例,IIa型5例,IIb型8例,Ⅲ型41例,Ⅳ型6例。106例NDRD中,Ig A肾病27例,膜性肾病24例,系膜增生性肾小球肾炎21例,高血压肾损伤7例,肾小管间质性炎6例,局灶节段性肾小球硬化症(FSGS)和局灶增生硬化性肾小球肾炎各5例,ANCA相关性血管炎性肾损伤4例,增生硬化性肾小球肾炎3例,淀粉样变性肾病、膜增生性肾小球肾炎、过敏性紫癜性肾炎和新月体性肾小球肾炎各1例。9例DN合并NDRD中,Ⅲ型DN+Ig A肾病、IIa型DN+膜性肾病和Ⅲ型DN+局灶增生性肾小球肾炎各2例,Ⅲ型DN+系膜增生性肾小球肾炎、Ⅲ型DN+ANCA相关性血管炎性肾损伤和IIb型DN+Ⅳ型狼疮性肾炎各1例。结论 T2DM合并肾损害可以是DN也可以是NDRD,还可以是DN合并NDRD,不同的病理类型在临床治疗和预后上有很大的差异。肾穿刺活检可以从组织学上明确诊断,为治疗和判断预后提供依据。     

70例肾小球疾病肾穿刺活检结果分析

目的分析70例肾小球疾病肾穿刺活检结果,了解肾小球疾病病理类型。方法将2018年1月至2019年4月我院进行肾穿刺活检的70例肾小球疾病患者作为研究对象,所取标本均进行光镜检查、免疫荧光检查和电镜检查,结合其临床资料、实验室和病理检查结果,分析肾小球疾病临床及病理类型。结果 70例肾小球疾病患者中,原发性肾小球疾病53例(75.71%),继发性肾小球疾病17例(24.29%),无遗传性肾小球疾病。原发性肾小球疾病病理分型中IgA肾病占比最高(41.51%),其次为膜性肾病(30.19%)。原发性肾小球疾病临床分型不同,其病理分型也存在差异。继发性肾小球疾病中结缔组织疾病肾损害和血管性疾病肾损害占比最高(均为35.29%),其中狼疮性肾病发生率最高(35.29%),其次为过敏性紫癜性肾炎(23.53%)。原发性肾小球疾病患者性别与继发性肾小球疾病患者存在差异(P0.05),年龄分布与继发性肾小球疾病患者无显著差异(P0.05)。结论肾穿刺活检结果显示肾小球疾病以原发性为主,原发性肾小球疾病男性较为多见,其病理分型包括IgA肾病、膜性肾病等,而继发性肾小球疾病女性较为多见,其病理类型以狼疮性肾病、过敏性紫癜性肾炎为主。     

自动同步负压活检装置用于肾活检的护理

经皮肾穿刺活体组织检查（简称肾活检）是诊断各种慢性肾小球疾病的重要手段，对了解肾脏疾病的病理类型、指导临床治疗、判断疾病预后都具有十分重要的意义 。我科2001年1月-2005年8月采用自动同步负压活检装置（专利号：971072078）对224例。肾病病人进行了肾活检，现介绍如下。1对象与方法1．1研究对象224例中，男124例，女100例；年龄14岁～18岁（31．1岁±1．6岁）；肾病综合征70例，慢性肾小球肾炎60例，狼疮性肾炎38例，隐匿性肾小球肾炎13例，IgA肾病13例，急性肾功能不全8例，慢性肾功能不全8例，过敏性紫癜性肾炎6例，乙肝相关性肾炎6例，结缔组织病2例。     

B超对肾病病理分型的诊断价值

为探讨肾炎超声图象与病理类型的关系,在无创性检查方面寻求确定肾炎病理类型的路子,我们立题对60例原发性肾小球肾病患者B超切面象与病理进行了研究及对比分析。超声图象主要分析肾脏大小(长径×宽径×厚径),肾实质回声强度、皮髓质分界。肾被膜轮廓线是否完整。60例均经肾穿刺活检确诊病理类型。结果显示:3例轻微肾小球病变与25例系膜增生性肾小球肾炎的超声图象均正常,11例硬化型肾炎,     

肾活检在急性肾功能衰竭诊治中的意义

目的　探讨急性肾功能衰竭 (ARF)误诊原因及肾活检在ARF诊治中的意义。方法　分析临床诊断与病理诊断的符合率及误诊原因 ,总结肾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　 78例ARF中临床与病理诊断符合者 5 2例 (6 6 .7% ) ;肾活检前病因诊断错误或病因不明者 2 6例(33.3% ) ;肾活检后 2 6例 (33.3% )的治疗方案被更改。结论　对急性肾功能衰竭患者临床病因诊断有困难者 ,应及时行肾活检 ,以明确诊断、指导治疗与判断预后     

Acute renal failure

ARF is a common clinical problem associated with significant morbidity and mortality. Therefore, rapid and accurate diagnosis is imperative. Initial diagnostic strategies should be directed toward distinguishing among prerenal, renal, and postrenal causes of ARF. This can be done by the use of urinary diagnostic indices in concert with radiologic investigation, renal biopsy, and hemodynamic monitoring when appropriate. Treatment of established ARF should be directed toward maintaining fluid and electrolyte homeostasis and controlling complications resulting from retained nitrogenous waste products. This may necessitate the aggressive use of dialysis. As yet, there is no proven means to prevent ARF or alter the course of ARF once it is established.     

Peak value of blood myoglobin predicts acute renal failure induced by rhabdomyolysis

PurposeAcute renal failure (ARF) is the most important complication of rhabdomyolysis. Serial measurements of blood myoglobin might be useful for predicting rhabdomyolysis-induced ARF.MethodsThirty patients with rhabdomyolysis were examined. The causes of rhabdomyolysis were trauma, burns, and ischemia, among others. Serial blood myoglobin levels were measured by immunochromatography, and the peak value was determined. The relationship between blood myoglobin levels and the incidence of ARF was evaluated.ResultsThe median peak blood myoglobin level was 3335 ng/mL. Acute renal failure occurred in 12 patients (40%). Nine patients (30%) underwent renal replacement therapy. Peak creatine kinase and peak blood myoglobin levels in the ARF group were significantly higher than those in the non-ARF group. Three patients in the ARF group were treated with renal replacement therapy before occurrence of uremia because of extremely high levels of blood myoglobin (>10 000 ng/mL). Receiver operating characteristic analysis showed that the area under the curve for blood myoglobin that predicted ARF was 0.88, and the best cutoff value for blood myoglobin was 3865 ng/mL.ConclusionsThe peak value for blood myoglobin might be a good predictor of rhabdomyolysis-induced ARF. Early renal protective therapies should be considered for patients with rhabdomyolysis at high risk of ARF.     

SLE with diffuse alveolar hemorrhage,microangiopathic hemolytic anemia and acute renal failure

In SLE patients with diffuse alveolar hemorrhage (DAH) and acute renal failure (ARF), the most common associated renal injury is proliferative lupus nephritis. We report a case of a young SLE patient with DAH and ARF who was successfully treated with a course of therapeutic plasma exchange (TPE) plus pulse IV cyclophosphamide. Kidney biopsy revealed an alternative diagnosis. J. Clin. Apheresis 27:263–264, 2012. © 2012 Wiley Periodicals, Inc.     

横纹肌溶解综合征致急性肾衰竭23例诊治分析

目的 :总结横纹肌溶解综合征 (RM)合并急性肾衰竭 (RM ARF)的发生率以及治疗效果和临床转归。方法 :2 3例 RM ARF患者中男 17例 ,女 6例 ;平均年龄 (38.0 0± 17.13)岁。所有患者均检测血清肌酶、血肌红蛋白 (Mb)、白蛋白 (Alb)以及血生化指标检测 ,包括电解质、肝功能、肾功能、血尿酸 (UA)、血红蛋白(Hb)、血气分析等。3例患者行肾活检术 ,并做肾小管 Mb免疫组织化学 En Vision法检测。结果 :RM ARF发生率占同期 ARF的 5 .96 % (2 3/ 386 ) ,占急性小管间质病变的 9.75 % (2 3/ 2 36 )。血肌酸磷酸激酶 (CPK)78.2 6 %升高 (>16 .6 7μmol· s- 1 · L- 1 ) ,血 P3+ 、U A、K+ 分别为 78.2 6 %、95 .6 5 %、86 .96 %升高 ,血 Ca2 +86 .96 %下降 ,代谢性酸中毒 91.30 % ,高分解代谢 82 .6 1%。 3例肾脏病理显示急性肾小管坏死 (ATN) ,肾小管Mb免疫组织化学全部阳性。 8例患者有肌肉损伤 ,但未行肌电图检查和肌肉活检。 18例行血液净化 ,其中 5例血液透析 (HD) ,7例腹膜透析 (CAPD) ,6例连续性静静脉血液滤过 (CVVH)。经综合治疗 ,RM ARF病死率34.78% ,存活率 6 5 .2 2 % ,其中 12例肾功能完全恢复正常。结论 :RM大多为非创伤性 ;血清肌酶和血生化检测可提高 RM ARF诊断率 ;肾脏病理活检有助于确诊 RM AR     

Transpyloric enteral nutrition in the critically ill child with renal failure

Objective To study the efficacy and tolerance of transpyloric enteral nutrition (TEN) in the critically ill child with acute renal failure (ARF).Design Prospective observational study.Setting Paediatric intensive care unit.Patients Critically ill children with ARF who received TEN were included in the study. They were compared with the remaining 473 critically ill children receiving TEN in this period. Tolerance of nutrition and gastrointestinal complications were assessed.Intervention Transpyloric enteral nutrition.Measurements and results Fifty-three critically ill children with ARF aged between 3 days and 17 years received TEN. Children with ARF more frequently received parenteral nutrition before TEN (56.6%) than the other patients (17.5%). The incidence of shock, hepatic alterations and mortality was significantly higher in patients with ARF than in the remaining children. In children with ARF the mean duration of the TEN was 16.5 ± 27.3 days and the maximum caloric intake was 77 ± 26.7 kcal/kg/day. Thirteen patients (24.5%) presented gastrointestinal complications, 9 (17%) abdominal distension and/or excessive gastric residue, 5 (9.4%) diarrhoea, 1 necrotising enterocolitis and 1 duodenal perforation. The frequency of gastrointestinal complications was significantly higher in children with ARF. TEN was definitive suspended in five patients due to gastrointestinal complications. Four of these patients were treated with continuous renal replacement therapy. Thirty percent of patients died during TEN. In only one patient was the death related to complications of the nutrition.Conclusions Critically ill children with ARF tolerate TEN, although the incidence of gastrointestinal complications is higher than in other critically ill children.     

Survivors of acute renal failure who do not recover renal function

Overall survival in 1095 with severe acute renal failure (ARF) between 1984 and 1995 was 59.5%. Of these, 107 (16.2%) remained dependent on long-term dialysis. The frequency of end-stage renal failure (ESRF) in survivors of ARF varied between 3% and 41% according to the cause of ARF, being highest in those with acute renal parenchymal disease (in whom survival was also among the highest at 84%) and lowest in ARF due to obstetrics and trauma. Patients failing to regain adequate renal function did not appear to differ on clinical grounds from survivors who became dialysis-independent. Survival in those requiring long-term dialysis was less good than for other patients with ESRF, partly due to excess mortality in those for whom vascular disease or surgery was the precipitating cause of ARF. Six patients recovered sufficient renal function to become independent of dialysis after 3-18 months on regular dialysis therapy (6-21 months after onset of ARF). ESRF resulting from ARF is more frequent than previously reported. This increase may be due to a changing case-mix, increasing age of patients (and hence reduced capacity for renal recovery), and an increase in aggressive surgery for patients with advanced vascular disease. This presents a significant and increasing problem, with implications for both clinical management and the provision of dialysis services.      

急性肾功能衰竭预后危险因素研究

目的 探讨影响急性肾功能衰竭（ARF）患者肾功能恢复率、病死率的危险因素，以指导诊疗，改善预后。方法 通过Logistic回归等方法回顾性分析44例ARF患者的多系统器官功能衰竭（MSOF）发生率，比较高、低分解代谢、伴否MSOF的ARF患者其肾功能恢复率及病死率。结果 高、低分解代谢型ARF患者肾功能恢复率、病死率差异均有显著性（P〈0．01、P〈0．05）。伴否MSOF的ARF患者问其肾功能恢复率，病死率差异均有显著性（均为P〈0．01）。脏器衰竭数目与肾功能恢复率呈显著负相关（r=-0．517，P〈0．01），与病死率呈显著正相关（r=0．78，P〈0．01）。低分解代谢型ARF患者肾功能恢复率是高分解代谢型的13．7倍，不伴MSOF的ARF患者肾功能恢复率是伴MSOF者的27倍，伴MSOF的ARF患者其病死率是不伴MSOF者的68．7倍。结论 对ARF患者应积极寻找并去除导致高分解代谢的原发病因，治疗选药时避免使用损害肾外脏器药物，力争不伴发或少伴发MSOF，这对改善ARF预后有利。     

Outbreak of acute renal failure due to cefodizime-vancomycin association in a heart surgery unit

OBJECTIVE: To describe an outbreak of acute renal failure (ARF) occurring in a group of patients undergoing open-heart surgery, simultaneously to a change in perioperative antibiotic prophylaxis. DESIGN: Case series. SETTING: A nine-bed heart surgery intensive care unit, serving a 1,300-bed University teaching hospital. PATIENTS: Thirty-two patients undergoing open-heart surgery during an 11-day period, when the preoperative surgical prophylaxis protocol had been changed from the usual antibiotic association of ceftriaxone + vancomycin to cefodizime + vancomycin. RESULTS: ARF occurred in 16 of the 32 (50%) patients exposed to the new antibiotic prophylaxis regimen; seven patients had oliguric ARF, and nine patients had an increase in serum creatinine (SCr) levels >50% over 24-48 h. In the seven patients with oliguric ARF, SCr increased from a median preoperative level of 88 micromol/l (80-115 micromol/l) to a peak value of 725 micromol/l (521-857 micromol/l) in 5 days (4-6). Eight patients out of the sixteen with ARF (50%) were diabetics, as opposed to none of the 16 patients not experiencing ARF. Renal biopsy (three patients) showed tubular dilation and necrosis, interstitial edema, and lymphomononuclear infiltrate of moderate degree. Only one patient required hemodialysis, and all recovered renal function. No other cases of unexplained ARF occurred in the unit after the original prophylaxis protocol was resumed. CONCLUSION: The simultaneous infusion of cefodizime and vancomycin may involve a high risk of substantial renal function derangement, especially in diabetics.     

Enzyme clearance in intermittent hemofiltration in patients with acute renal failure

AIM: To characterize elimination of some enzymes in intermittent hemofiltration (HF) in patients with acute renal failure (ARF). MATERIAL AND METHODS: 22 patients with oliguric ARF have undergone 52 procedures of intermittent HF. Before the procedure and after it the activity of enzymes (AA, AP, ACE, LAP, GGT, GDG, AlAT, AsAT, CPG, LDG) was measured in the samples of plasma and filtrate. RESULTS: Besides ACE and AlAT, all the enzymes concentrations were elevated in all the patients. HF did not change significantly the enzymes activity. Most of the enzymes were eliminated from the blood. In some samples the enzymes activity was low or absent. CONCLUSION: Further studies are necessary to answer questions aroused by the findings.