123例慢性肾脏病基础上急性肾衰竭临床分析

目的了解慢性肾脏病基础上急性肾衰竭（A／C）发病情况及临床特点。方法回顾性分析本科1995年1月至2008年12月临床诊断慢性肾脏病基础上急性肾衰竭（ARF）病例发病率、病因、与基础肾脏病关系及预后影响因素。结果123例符合选择标准，占同期急性肾衰竭病例数65．5％；A／C常见病因分别为药物性（主要为抗生素、NSAIDs和ACEI）56例、肾前性因素31例、狼疮性肾炎活动8例，其中药物性最常见，超过1／3；糖尿病肾病（DN）患者是发生A／C的主要人群，123例中有43例（占35．0％）；63例需血液透析，28例患者血肌酐恢复到原有水平，38例转为维持性透析，病死率3．3％；多因素回归分析示老年患者、高血压、需要接受血液透析、糖尿病，提示预后不良。结论A／C是急性肾衰竭主要病因，药物性最常见。A／C治疗关键在于预防。应重视糖尿病肾病诊治。

Clinical analysis acute renal failure from chronic kidney disease in 123 cases

Objective To study the etiology and clincal features of acute renal failure in chronic kidney disease (A/C). Methods Clinical data were collected from all patients diagnosed as A/C by clinical materials over a 13 - year period (January 1995 - December 2008 ) in the renal department of the Third People's Hospital of Wenzhou, and the incidence, etiology, the relationship between A/C and known basal kidney disease and factors predicting prognosis were studied. Result 123 patients of A/ C were identified, which accounted for 65.5% of acute renal failure cases during the same period. The most common causes of ARF in A/C patients were drug -induced (mostly antibiotics, nonsteroidal anti -inflammatory drugs, ACEI) acute renal disease (56 cases), prerenal ARF( 31 cases) and flare - up of lupus nephritis ( 8 cases). More than one third of A/C were associated with drugs. besides A/C occurred more commonly in diabetic nephropathy patients, which accounted for 43 cases. During hospital stay,about 63 patients required dialysis, 38 patients became dialysis -independent. The mortality was 3.25%. Furthermore, serum creatinine (Scr) returned normal in 28 patients. Multivariate logistic regression analysis indicated that age, hypertension and requirement of dialysis therapy and DM were independent predictors of poor renal outcome. Conclusions A/C constitutes an important part of ARF, and drug - induced ARF is prominent. For patients with known basal kidney disease, prevention is important. More attention should be paid to diabetic nephropathy.