原发性肾病综合征并发急性肾衰竭患者临床病因与病理分析

目的 探讨原发性肾病综合征(PNS)合并急性肾衰竭(ARF)的临床病因及病理特点。方法 对26例原发性肾病综合征合并急性肾衰竭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衰竭的发生率为4．2％，其诱因为血流动力学改变9例，感染5例，药物中毒4例，肾静脉血栓形成1例，余7例无明显诱因。肾脏病理检查肾小球以轻微改变为主，其中微小病变型10例，轻度系膜增生型9例，两者合计为73．1％；22例患者肾小管间质表现为广泛而显著的水肿，肾小管上皮细胞肿胀、空泡变性和灶性坏死，4例肾间质内可见淋巴细胞和单核细胞以及多少不等的嗜酸粒细胞弥漫性浸润。所有患者均经强的松、利尿剂及消除诱因等治疗，其中7例进行血液透析治疗，所有患者肾功能均恢复正常。结论 原发性肾病综合征并发急性肾衰竭临床并不少见，多发生于肾小球轻微改变者，尽早明确原发性肾病综合征并发急性肾衰竭以及诱发因素，并给予相应治疗，患者一般预后良好，肾功能可恢复正常。

Clinical etiology and pathological analysis of acute renal failure in primary nephritic syndrome

Objective To explore the clinical etiology and pathological characteristics of primary nephritic syndrome (PNS) complicated with acute renal failure (ARF).Methods The clinical and pathological data of 26 cases with PNS complicated with ARF were analyzed retrospectively.Results The incidence of PNS complicated with ARF was 4.2%.ARF was caused by hemodynamics in 9 of 26 cases,by infections in 5,by drugs and renal vein thrombosis in 4 and 1 respectively.In addition,the causes of ARF in 7 cases could not be determined.Pathological examination showed mild abnormal glomeruli,including minimal change disease (10 cases),mild mesangial proliferative glomerulonephritis (9 cases),accounting for 73.1% of pathological classification.There were diffuse interstitial edema with tubular epithelial cell swelling,vacuolation and patchy necrosis in 22 cases, diffuse interstitial infiltration of monocyte,lymphocyte and more or less eosinophil in 4 cases.The renal function in each case recovered after being treated with diuretics,prednisone,hemodialysis and eliminating cause.Conclusions ARF in PNS commonly occurs in patients with near normal glomeruli,whose incidence is not rare. Its causes and diagnosis should be determined as soon as possible.The renal function was reversible after appropriate treatment.