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：分析入院前诊断与肾活检与肾活检后诊断的符合率,寻找误漏诊原因。结果：经肾活检证实68例ARF病例中20例（29．6％）存在病因误诊,包括急性肾小球肾炎（AGN）、急进性肾炎（RPGN）、 急性肾小管坏死（ATN）、膜增生性肾小球肾炎（MPGN）、原发性肾病综合征伴特发性急性肾功能衰竭（NS＋IARF）、狼疮肾炎（LN）、急性间 质性肾炎（AIN）、慢性肾炎急性发作等之间混淆。有30．9％（21／68）例改变了治疗方案,35．3％（24／68）部分改变了治疗方案,33．8％（23／68）按原方案治疗。结论：临床上有相当部分ARF的病因被误诊,在诊断困难时应及时肾活检,以免延误治疗。     

急性肾功能衰竭临床与病理类型分析

目的分析总结急性肾功能衰竭(ARF)病理类型与临床关联、治疗、转归情况,探讨ARF肾活检指征,提高ARF诊治水平.方法收集1998.7～2004.8我科ARF行肾活检患者的病理、临床资料、治疗以及转归情况.结果6年间肾活检ARF共261例,占同期ARF的38.7%(261/674).男性145例,女性116例;平均年龄(41.58±16.89)岁;Scr 444.24±366.19μmol/L,BUN(21.52±12.72)mmol/L.肾小管间质病变105例,占肾活检40.2%,占同期肾小管间质病变26.4%,47.6%的肾小管间质性ARF由药物引起,占首位,其中急性肾小管坏死(ATN)55例和急性间质性肾炎(AIN)30例,各占肾活检的21.1%和11.5%.肾小球小血管病变120例,占肾活检46.0%,占同期肾小球小血管病变88.9%,主要病变为新月体肾炎(CGN)58例和狼疮肾炎(LN)45例,分别占肾小球小血管病变的48.3%和37.5%,占ARF肾活检的22.2%和17.2%.肾病综合征伴肾前性ARF 36例,占13.8%.肾活检纠正诊断40例,占15.3%,主要是CGN误诊为其他类型的肾小球肾炎,AIN误诊为ATN,肾活检前后临床与病理符合率84.7%.31.8%行血液净化治疗,总治愈率达78.5%,肾小管间质病变治愈率82.9%,肾小球小血管病变68.3%.结论ARF中肾脏病理具有重要意义.CGN和LN是肾小球小血管病变ARF的主要病理类型.肾活检有助于鉴别AIN与非典型性ATN,两者治疗截然不同.早期肾活检可提高ARF诊断率、降低误诊率,及时治疗可改善或恢复肾功能.     

表现为急性肾衰竭的IgA肾病11例临床与病理分析

目的：探讨IgA肾病并发急性肾衰竭(ARF)的临床与病理特点。方法：回顾分析11例IgA肾病并发ARF的临床与病理资料。结果：(1)本组11例IgA肾病患者并发ARF，占我院同期IgA肾病的1．28％(11／860)；(2)本组患者7例患者以浮肿、少尿为首发症状，3例以反复肉眼血尿为主诉、1例以恶性高血压为主要症状，6例患者蛋白尿≥2．0g／d；(3)肾活检示系膜增生性肾炎7例、新月体肾炎1例、增生硬化性肾炎伴新月体形成1例，余2例为In肾病的基础上伴发急性肾小管间质性肾炎。(4)本组资料中8例患者行激素加MP／CTX冲击治疗，4例予以单纯对症处理；8例肾功能恢复正常，1例肾功能部分缓解，2例患者肾功能进展行维持性透析治疗，总有效率为81．8％。结论：IgA肾病并发ARF发生率不低，病理可表现为多种病理类型，病理改变轻，预后好，多数患者肾功能可以恢复正常。     

心脏术后低排综合征致急性肾功能衰竭的腹膜透析治疗

目的　探讨腹膜透析对心脏术后低排综合征 (LOS)致急性肾功能衰竭 (ARF)的疗效。方法　 2 4例心脏术后引起LOS合并多脏器功能衰竭 (MSOF)致ARF者 ,因不适合血液透析 (HD) ,于确诊后 2 4小时内进行腹膜透析 (PD)治疗。结果　 12例患者多脏器严重衰竭死亡 ,9例患者PD 3～30天内肾功能恢复 ,3例治疗后病情好转 ,自动出院。结论　心脏术后LOS致MOSF合并有ARF者 ,PD具有较好的治疗效果。     

慢性肾小球肾炎患者恶性高血压的临床特点和预后

目的了解慢性肾小球肾炎患者出现的恶性高血压(MHT)的临床特点及其对肾脏疾病预后的影响。方法分析我科1990～2002年4月收治的肾脏病伴发MHT患者的临床和病理资料。用多元回归进行预后相关因素分析。结果符合诊断的共38例,男女比例3.75∶1;平均年龄(29.5±7.7)岁,皆为慢性肾小球肾炎患者,病因以IgA肾病最多见。这组患者的高血压知晓率75.7%,长期治疗率13.5%,控制率5.4%。其中6例发生急性肾衰竭,16例发生慢性肾衰竭基础上的急性肾衰竭,13例为慢性肾衰竭,3例肾功能正常。经过积极抗高血压治疗后,41.7%患者肾功能好转,需透析者中20%脱离透析。1年肾存活率55%。高血压家族史、最高收缩压(SBP)和舒张压(DBP)水平以及肾脏慢性病变积分是影响短期肾功能好转的不良指标。最高血肌酐水平和肾脏慢性病变积分是决定1年肾脏存活的重要指标。结论在年轻肾小球肾炎患者中发生MHT并不少见,严重影响肾脏预后。经过积极降压治疗部分患者可好转。最高血肌酐水平和肾脏慢性病变积分是决定1年肾脏存活的重要指标。肾性高血压治疗率和血压控制率低可能是这组患者容易发生MHT并导致肾功能快速恶化的重要原因。     

各种肾脏疾病C_3b受体的意义

各类肾脏疾病病人以临床和病理学观察对C_3b受体分布状态进行了研究:慢性增殖性肾小球肾炎(CPGN)43例,急性链球菌感染后肾小球肾炎(AGN)9例,膜增殖性肾小球肾炎6例,膜性肾病(MN)2例。另外,6例系统性红斑狼疮,和2例急性肾功能衰竭(ARF)也研究了,6例健康肾作对照。结果如下:     

影响特发性膜性肾病患者预后的危险因素分析

目的:了解特发性膜性肾病(idiopathic membranous nephropathy,IMN)患者预后的影响因素,为患者预后评估提供理论依据。方法:2013年03月~2016年09月期间,调查我院收治的91例特发性膜性肾病患者,根据患者预后分为临床缓解组(62例)、肾功能进展组(29例),肾功能进展定义为e GFR下降30%或发生终末期肾病。比较两组患者基本情况、检验指标、肾脏活检结果、肾脏病理半定量积分、肾脏活动性与慢性化指标积分、病理分期、肾小管间质损害、FSGS病变情况的统计学差异。结果:肾功能进展组24 h尿蛋白定量、血肌酐、血三酰甘油、血尿酸等检验指标明显高于临床缓解组(P0.05);两组肾小球硬化比率、肾脏病理半定量积分、肾脏活动性与慢性化指标积分的差异有统计学意义(P0.05),肾功能进展组各项指标均差于临床缓解组;两组IMN病理分期、肾小管间质损害、FSGS病变比较差异有统计学意义(P0.05),肾功能进展组各项指标均差于临床缓解组;7个因素(年龄、高血压病史、24 h尿蛋白、血肌酐、Katafuchi积分、IMN病理分期、肾小管间质损害)对IMN患者预后影响明显。结论:影响特发性膜性肾病患者预后的因素主要包括:IMN病理分期、血肌酐、小管间质损害、24 h尿蛋白、高血压病史、Katafuchi积分、年龄。     

IgA肾病合并急性肾衰竭的临床与病理分析

目的：探讨IgA肾病合并急性肾衰竭（ARF）的临床与病理特点。方法：1992年～2006年经肾活检确诊IgA肾病合并ARF 20例患者的临床与病理资料进行回顾性分析。根据不同病理选择治疗方案并进行随访。结果：本组20例IgA肾病合并ARF,占活检IgA肾病的3.8%（20/527）。其中急性肾炎综合征4例,急性肾炎综合征合并肾病综合征5例,以浮肿、少尿为主8例,以恶性高血压为主3例。病理改变上系膜增生性肾炎5例,新月体肾炎8例,增生硬化性肾炎伴新月体肾炎3例、轻度系膜增生性肾炎合并急性肾小管间质肾炎4例。14例肾功能恢复正常,4例部分缓解,2例无效性透析治疗后行肾移植。结论：IgA肾病合并急性肾衰竭发生率达3.8%,高于目前文献报道。临床表现多样化,病理表现为多种病理类型。病理轻则预后好,新月体肾炎诊断治疗及时预后好,多数患者肾功能可以恢复正常。因此早期及时肾活检对IgA肾病指导治疗、判断预后有非常重要的价值。     

应用O型管道开展家庭腹膜透析的疗效观察

我院肾内科从1993年8月至1996年8月,应用O型管道装置在海南开展家庭腹透治疗慢性肾功能衰竭。 临床资料 本组30例患者男20例,女10例,年龄最小23岁,最大68岁,平均46.16岁。原发病为慢性肾小球肾炎23例,高血压性肾病3例,狼疮性肾炎、多囊肾、急进性肾炎(发展成慢性肾衰)、移植肾慢性排异各1例。操作方法按常规[叶任高.肾功能衰竭与腹膜透析疗法.济南:山东科技出版社,1994 215～250.]。接着培训病人熟练地掌握腹透的技术,透析中心帮助和指导病人建立家庭腹透室。     

肾脏病合并睡眠呼吸暂停综合征18例分析

目的 探讨肾脏病与睡眠呼吸暂停综合征(SAS)的关系及临床意义。方法 对1997年1月～2002年1月肾脏病人228例中，合并SAS的18例病人进行回顾性分析，探讨二者的关系。结果 228例肾脏病人中合并SAS18例，分别表现为无症状性蛋白尿3例、肾病综合征1例，糖尿病肾病1例、慢性肾小球肾炎2例、高血压肾损害2例、终末期肾病7例、肾小管功能障碍2例。13例病人给予药物和/或经界面罩持续气道正压通气(CPRP)治疗，SAS改善后，除终末期肾病病人外，余患者肾脏病均不同程度好转。7例慢性肾功能衰竭病人中2例死亡，2例改行腹膜透析后SAS好转，3例肾移植后SAS消失。结论 SAS可导致或加重肾脏损害，临床可表现为肾小球和/或肾小管损伤。终末期肾病病人易于合并SAS，SAS可严重影响此类病人生存质量、生存率。SAS与肾脏病可相互影响形成恶性循环，需引起临床警惕。     

Acute renal failure in chronic kidney disease--clinical and pathological analysis of 104 cases

BACKGROUND: Acute renal failure in chronic kidney disease (A/C) constitutes an important part of acute renal failure (ARF), but until now there has been no research focusing on this entity. PATIENTS AND METHODS: Clinical data were collected from all patients diagnosed as A/C by clinical materials and renal biopsy over a 12-year period (January 1990 - December 2001) in the renal department of a teaching hospital, and the incidence, etiology, pathological and clinical features of A/C, and factors predicting prognosis were studied. RESULTS: Altogether, 104 patients of A/C were identified, which accounted for 35.5% of biopsied acute renal failure cases during the same period. Drug-induced acute renal interstitial/tubular-interstitial disease, prerenal ARF and flare-up of lupus nephritis were the most common causes of ARF in A/C patients. More than one third of A/C were associated with drugs, which occurred more commonly in older patients. After an average hospitalization of 28.5 days, about 39 patients required dialysis, 23 patients became dialysis-independent. The mortality was 1.9%. Furthermore, serum creatinine (Scr) returned to normal level (< 133 micromol/l) in 46.2% of all patients; Scr decreased by 15%, yet not normal in 26.0%. Multivariate logistic regression analysis indicated that hypertension, requirement of dialysis therapy and high Scr level were independent predictors of poor renal outcome. CONCLUSION: A/C constitutes an important part of ARF, and drug-induced ARF is prominent in China. Because early diagnosis and correct treatment may obviously affect prognosis, enough attention should be paid to this entity.     

Role of RAS inhibitor in the treatment of lupus nephritis with thrombotic microangiopathy

Objective To investigate whether RAS inhibitors can improve renal function in the treatment of lupus nephritis (LN) with thrombotic microangiopathy (TMA). Methods A total of 15 LN patients with TMA proven by renal pathology, from January 2000 to December 2013 in PUMCH, were included. The serum creatinine (Scr) and blood pressure (BP) before and after using RAS inhibitors were analyzed. Results (1)Male/female ratio was 1∶14. All of the patients had renal dysfunction, and median peak value of Scr was 396 μmol/L (160～643 μmol/L). 5 cases (33.3%) required acute dialysis during hospitalization. Hypertension occurred in 15 patients, while 6 cases (40.0%) were diagnosed malignant hypertension. (2) Anemia and thrombocytopenia occurred in 15 and 14 cases, respectively. Three cases (20.0%) were diagnosed MAHA definitely and 5 cases (33.3%) were diagnosed MAHA probably. (3) Renal biopsy showed class Ⅱ in 1 case, Ⅲ in 4 cases, Ⅳ-(G) in 2 cases, IV(S) in 5 cases and IV+V in 3 cases. Active lesions were predominant in both glomeruli and renal vasculopathy. (4) All the patients received steroid and immunosuppressive therapy, of whom 9 cases were given steroid pulse therapy. Thirteen cases received cyclophosphamide, and the rest 2 cases received cyclophosphamide and mycophenolate. After steroid pulse therapy, there were only 5 patients (55.6%) who got decreased Scr. In 13 patients (86.7%), hypertension was ameliorated and Scr decreased within one week after implementing RAS inhibitors, which fell medianly 15.8% and 17.0%, respectively. (5) Eleven of the 15 patients were followed from 8 to 135 months (median 32 months), and the other 4 patients were lost. Five cases who was on dialysis during hospitalization became independent of renal replacement therapy, while the other cases also got improved renal function. Conclusions Patients of LN with TMA who develop AKI and refractory hypertension should be treated with RAS inhibitors. Improved renal survival and successful discontinuation of dialysis are possible benefits when RAS inhibitors are used to treat LN with TMA.     

Acute renal failure due to intrinsic renal diseases: review of 1122 cases

In this study we have analyzed incidence, causes and clinical course of ARF due to primary intrarenal disease other than acute tubular necrosis. Thousand hundred and twenty two cases of ARF of diverse etiology were studied over a period of 16 years; July 1984 to Dec, 1999. Surgical ARF 231 (20.6%) were not included in the present study. Intrinsic renal diseases were responsible for ARF in 891 (79.4%) of cases. The most common intrinsic renal diseases 705 (79.4%) causing ARF were ischemic/toxic acute tubular necrosis, but not included in this study. Acute renal failure was related to acute glomerulonephritis (9.3%), acute interstitial nephritis (7%), and renal cortical necrosis in (4.6%) of cases. Therefore intrinsic renal diseases other than ATN were the causative factor for acute renal failure in 186 (20.8%) patients in our study. Crescentic (51.8%) and endocapillary proliferative glomerulonephritis (34.9%), were the main glomerular diseases responsible for ARF and 75.9% of GN was related to infectious etiology. Fifty three percent of acute interstitial nephritis was drug induced and in 25 (40%) patients it was related to an infectious etiology. Renal cortical necrosis due to HUS was observed in 16 (39%) children and majority (76.47%) of the cases had a diarrhoeal prodrome. Obstetrical complications were the main causes (61%) of cortical necrosis in adults with acute renal failure. Thus, intrinsic renal diseases other than ATN were responsible for ARF in 186 (20.8%) cases. Post-infectious glomerulonephritis, acute interstitial nephritis and renal cortical necrosis (complicating HUS in children and obstetrical complications in adult) are the main causes of acute renal failure in our study. Both acute GN and interstitial nephritis had excellent prognosis, however renal cortical necrosis was associated with a very high mortality.     

原发性IgA肾病中的微血管损害

目的 了解原发性IgA肾病中微血管损害及新月体形成(V/C)的临床、病理特点。方法 以2004年确诊并行肾穿刺活检证实的87例伴V/C损害的原发性IgA肾病与同期135例不伴V/C损害的原发性IgA肾病以及伴有V/C的狼疮肾炎患者的临床、病理资料进行比较。结果 原发性IgA肾病中较常发生V/C损害,发生率为39.19%;而V/C损害受累小球数占肾小球总数的(14.08±12.75)%。37.9%伴V/C损害的IgA肾病患者血清肌酐升高。血压、尿蛋白等临床指标在有与无V/C损害的两组IgA肾病间均无显著性差异。原发性IgA肾病患者的球性硬化发生率(135例/222例,64.86%)、球性硬化数与肾小球总数的比率[(26.98±24.68)%]均显著高于LN组[30例/73例,40.00%,(16.18±18.80)%]。结论 原发性IgA肾病中V/C损害发生率较高,出现常缺乏明显临床表现,并可能导致肾单位的缓慢、持续性、“非显性”丢失, 最终进展至终末期肾衰。     

Clinicopathology of childhood-onset renal systemic lupus erythematosus

AIMS: To determine the clinicolaboratory renal manifestations; glomerular, extra-glomerular histopathologic lesions; renal tubular dysfunction (RTD) frequency and outcome of a short-term renal follow up in Nigerian children with systemic lupus erythematosus (SLE). METHODS: A non-randomized prospective study of consecutive cases of childhood-onset SLE with nephropathy was conducted. Baseline/follow-up clinicolaboratory data were collected. Each patient was followed up for 12 months. RESULTS: Seven of the 11 children studied were girls. The median age at diagnosis was 11.0 years. Median diagnosis time interval (1.9 years) and median time of renal disease onset (1.0 year) were similar. Hypertension, nephrotic syndrome and acute renal failure (ARF) occurred in 45.5%, 54.5% and 63.7% of the patients, respectively. The glomerular lesions were non-proliferative lupus nephritis (LN) in 9.0% (class II LN); focal (class III LN) and diffuse (class IV LN) proliferative LN (PLN) in 27.0% and 64.0%, respectively. Tubulointerstitial nephritis (TIN, 91.0%) and RTD (64.0%) were common. ARF (P = 0.033) and RTD (P = 0.015) were significantly associated with severe TIN. Complete renal remission rate at end-point was 71.4%. Relapse and renal survival rates were 14.3% and 86.0%, respectively. RTD was persistent in 43.0%. CONCLUSION: Renal function disorders, diffuse PLN and extra-glomerular lesions were frequent. Significant association of ARF and RTD with severe TIN in this series suggests the need for early renal tubular function (RTF) assessment in our SLE patients. Deranged RTF may be marker of severe TIN in SLE warranting early confirmatory renal biopsy and aggressive interventional treatment.     

68例狼疮肾炎的肾小管间质病变探讨

目的探讨肾小管间质病变（ＴＩＬ）在狼疮肾炎（ＬＮ）的意义。方法分析了６８例ＬＮ资料，并对其中４２例作了较长期的随访。结果ＬＮ的ＴＩＬ发生率为７５％，ＴＩＬ明显者，肾小管功能显著下降，血肌酐、尿蛋白水平明显增加（Ｐ＜００１），肾小管间质与肾小球急、慢性病理改变之间均显著相关（Ｐ＜００１），同时，存在明显ＴＩＬ者，其生存率及肾存活率有下降趋势。结论ＴＩＬ与肾小球病变呈平行的正相关关系，且对ＬＮ预后有一定的影响。     

血清半胱氨酸蛋白酶抑制剂C在急性肾衰早期诊断中的价值

目的 探讨半胱氨酸蛋白酶抑制剂C（cystatin C）在早期预测和诊断急性肾衰竭（ARF）中是否优于血清肌酐（Scr）。方法 前瞻性收集我院103例重症监护室危重患者资料，每例患者每天采集血标本。同时应用酶法测Scr水平；用颗粒增强透射免疫比浊法（PETIA）检测血清cystatin C水平；用Cockroft-Gauh公式估算肾小球滤过率（eGFR）。ARF运用ADQI的RIFLE标准进行诊断（R：Scr升高≥50％基础值，I：Scr升高≥100％基础值，F：Scr升高≥200％基础值，L：肾功能丧失；E：终末期肾脏病ESRD）；同时ARF也按cystatin C升高≥50％、≥100％和≥200％的标准进行诊断。结果 27（26．2％）例患者发生不同程度ARF，其中15例经历R标准，18例经历I标准，9例经历F标准，3例经历LE标准。其余76例没有发生ARF的患者作为对照组。ARF患者的cystatinC较非ARF患者显著升高（P〈0．01），ARF患者的cystatin C与Scr（r=0．747，P〈0．01）、（cystatinC）^-1与eGFR（R=0．815，P〈0．01）呈明显线性相关。分别按照cystatin C和Scr两种方法诊断ARF，不同程度ARF诊断的中位时间是：R标准的15例患者分别为2d（1～4d）和3d（2～6d）（P=0．011）；Ⅰ标准18例患者分别为4d（1～8d）和5．5d（2～10d）（P=0．006）；F标准的9例患者分别为5d（3～lld）和6d（3～13d）（P=0．02）。ROC分析证实cystatinC在ARF诊断中的准确性高，曲线下面积为0．995，95％可信区间为0．984～1．006（P〈0．001）。当以cystatin C升高≥50％时作为ARF的诊断截点时，cystatin C在ARF诊断中的敏感性和特异性分别为93％和96％。结论 cystatin C可以作为急性肾衰竭的诊断指标：cystatin C在ARF的诊断时间上较Scr更早，可作为ARF的早期预测指标之一。     

Retrospective analysis on Chinese patients diagnosed with acute renal failure hospitalized during the last decade (1994-2003)

OBJECTIVES: To investigate the epidemiology, diagnosis and prognosis of acute renal failure (ARF) in hospitalized Chinese during the last decade. METHODS: The diagnosis of patients with ARF in Peking University Third Hospital from January 1994 to December 2003 was reconfirmed and the data of epidemiology, etiology and prognosis were analyzed. RESULTS: Only 209 discharged cases were diagnosed with ARF and all were reconfirmed. Two peak occurrences were found at ages of 35-45 and 60-80 with a male predominance of approximately 59.7%. Patients diagnosed with ARF accounted for 1.19 per thousand of the admissions in the same period and increased significantly in the last 5 years (p = 0.038). The creatinine level at diagnosis was 345.8 +/- 122.6 micromol/l and had no significant change (p > 0.05). The percent of hospital-acquired ARF (HA-ARF) demonstrated a significant increase in 1999-2003 compared to 1994-1998 (p = 0.008). Intrarenal ARF accounted for 73.69% and was multifactorial, with drugs, infections and operations as leading causes. Renal biopsy was performed in 37.32% (78/209) with 53.84% (42/78) having acute interstitial nephritis. Maintenance dialysis was discontinued in 46.41% because their renal function completely or partially recovered. The overall mortality was 37.91% without improvement over time. The mortality was 6.25% for patients in nephrology department, but 65.51% in ICU (p < 0.001), and was 21.6% for patients in community-acquired ARF (CA-ARF), but 63.1% in HA-ARF (p < 0.001). CONCLUSIONS: During the past 10 years, the number of patients diagnosed with ARF has been rising in hospitalized Chinese. HA-ARF was the major source, and infections, drugs and operations were the leading causes. The diagnosis and prognosis of acute renal failure did not improve much in this population over the decade studied.     

中医疗法联合血液净化在急性肾功能衰竭患者中的应用效果

目的 探讨中医联合血液净化疗法对急性肾功能衰竭(ARF)患者的疗效.方法 选取于本院就诊的ARF患者86例,随机数字表法分为观察组和对照组,每组43例.两组患者均接受血液净化疗法治疗.观察组在此基础上给予中药治疗.统计两组治疗前、治疗后3 d内24 h尿量(UV)、尿素氮(BUN)、血肌酐(Scr)水平;BUN和Scr治疗后恢复正常时间以及尿蛋白转阴时间,并进行疗效评价.结果 观察组和对照组治疗总有效率分别为93.02%(40/43)和81.39%(25/43),两组比较差异存在统计学意义(P<0.05).肾毒性急性肾衰患者和缺血性急性肾衰患者总有效率分别为92.85%(26/28)和93.33%(14/15),两组比较差异无统计学意义(P>0.05).治疗前两组24 h UV比较差异无统计学意义(P>0.05),治疗1 d、2 d和3 d两组24 h UV比较差异无统计学意义(P>0.05).观察组尿蛋白转阴时间、Scr恢复正常时间和BUN恢复正常均显著低于对照组(P<0.05).结论 中医联合血液透析治疗ARF疗效显著,能缩短肾功能恢复时间,值得临床推荐.     

Short-term niflumic-acid-induced acute renal failure in children

Several reports emphasize the adverse effects of non-steroidalanti-inflammatory drugs (NSAIDs) on renal function. We haveobserved over the last 10 years seven cases of acute renal failure(ARF) due to immune interstitial nephritis in children. A recommendedoral or rectal dose of niflumic acid was prescribed for ear-nose-throatdisorders, Length of exposure was 1–5 days. Clinical symptoms (oedema, oliguria or anuria) appeared between3 and 6 days. Three patients had previously received the drug.Hypersensitivity signs (fever, skin rash, eosinophilia, and/orincreased IgE) were present in all cases, leukocyturia in fivecases, and haematuria in six cases. Renal biopsy showed interstitiallesions with lymphocyte, eosinophil, and plasma cell infiltrateswithout tubular cell necrosis. Glomeruli were normal on light-microscopy,except in one patient. Electron-microscopy showed extensivepodocyte fusion in two patients, who had clinical and laboratoryevidence of nephrotic syndrome (NS). ARF rapidly disappeared after NSAID withdrawal, except in twopatients whose renal failure was irreversible despite methylprednisolonebolus. ARF is very rare in children treated with niflumic acid.When ARF occurs, different pathophysiological mechanisms areinvolved but the most common is immunological.