原发性肾病综合征并发急性肾损伤48例临床病理分析

目的探讨原发性肾病综合征合并急性肾损伤的临床及病理特点,提高此类并发症的防治水平。方法对我院原发性肾病综合征合并急性肾损伤患者的临床和病理改变进行回顾性分析。结果原发性肾病综合征合并急性肾损伤的临床特征表现为大量蛋白尿、高度水肿,常合并胸腹腔积液。肾脏病理类型:系膜增生性肾小球肾炎、肾小球微小病变及IgA肾病多见。其中系膜增生性肾小球肾炎22例,占46%;微小病变型10例,IgA肾病9例。所有患者均依据病理分型给予激素和(或)细胞毒药物,同时行利尿、控制感染、抗凝等综合治疗,其中5例进行血液透析治疗,肾损伤大多好转,但增生硬化型肾炎等预后较差。结论原发性肾病综合征并发急性肾损伤临床并不少见,多发生于系膜增生性肾小球肾炎、肾小球微小病变及IgA肾病,尽早明确病理诊断和去除诱因,并予相应治疗,大多患者预后良好,肾功能可恢复正常。

Analysis of Clinical Pathologic Feature of Primary Nephrotic Syndrome Complicated with Acute Kidney Injury of 48 Cases

Objective To investigate the clinical manifestation,pathologic feature of primary nephrotic syndrome (PNS) complicated with acute kidney injury(AKI) and improve the prevention and treatment of such complications. Methods Data of 48 cases PNS complicated with AKI were reviewed. Results The clinical manifestations of All the AKI cases caused by PNS were amount urinary protein,severe edema. Most of them complicated with pleural effusion. The type of renal pathology was mesangioproliferative glomerulonephritis,minimal change glomerulopathy and IgA nephropathy,which mesangial proliferative glomerulonephritis in 22 cases, 46% ;10 cases of minimal change disease,IgA nephropathy in 9 patients. All patients were given according to pathological type hormone and(or) cytotoxic drugs,while the line diuretic,infection control,anticoagulation,comprehensive treatment,including 5 patients on hemodialysis treatment and kidney damage were mostly better,but sclerosis type nephritis had poor prognosis. Conclusion PNS complicated with AKI are not uncommon. Most of them occur in mesangial proliferative glomerulonephritis,minimal change disease and IgA glomerular nephropathy. Most patients with good prognosis,renal function return to normal.