50例急性肾衰竭患者尿沉渣镜检与肾活检病理对比分析

目的探讨尿沉渣谱是否能反映急性肾衰竭患者肾脏病理损伤。方法50例急性肾衰竭患者以肾活检病理为评估金标准。取肾活检日晨尿，由专人双盲用相差显微镜检测。根据肾脏病理结果将患者分为3组：以肾小球增殖性病变为主、非增殖性病变为主和小管间质病变为主。尿沉渣所见包括红细胞、有核细胞和各种管型，也分为3类沉渣谱：Ⅰ类以变形红细胞和红细胞管型为主的多种细胞、多种管型，伴蛋白尿；Ⅱ类呈少细胞、细颗粒或透明管型中镶嵌有核细胞，伴大量尿蛋白；Ⅲ类少细胞、透明管型为主或其中嵌入几个有核细胞，蛋白量少。比较不同病理改变的尿沉渣特点。结果肾小球增殖性病变为主33例中30例（91％）为Ⅰ类尿沉渣谱；肾小球非增殖性病变为主9例中8例为Ⅱ类尿沉渣谱；小管间质病变为主8例中5例为Ⅲ类尿沉渣谱。结论尿沉渣分析能在一定程度上反映肾损伤的部位和严重性，这项无创、经济、方便的检查方法值得临床重视与应用。

Comparison of cytodiagnositc urinalysis and renal pathology in 50 patients with acute renal failure

Objective To investigate the utility of cytodiagnostic urinalysis in detecting renal pathological changes in acute renal failure.Methods Fresh morning urine specimens of 50 patients with acute renal failure(ARF)were collected at the day of renal biopsy.The pathological diagnosis was made by light microscopy,immunofluorescence and electron microscopy. They were roughly classified into proliferative glomerular disease,non-proliferative glomerular disease and tubulointerstitial lesions.Urinary sediment was examined by two experts with phase- contrast microscopy,who did not know the pathological result and clinical information.Formed elements in the urine sediment included erythrocytes,all kinds of karyotes and casts.The cytodiagnostic urinalysis was classified into 3 types.Type 1:dysmorphic erythrocytes,erythrocytic cast,phagocyte(engulf erythrocytes),monocyte or coenocyte,with or without large amount of proteinuria.Type 2:hyline and granular casts with karyotes,few erythrocytes or karyotes,large amount of proteinuria.Type 3:byline and granular casts with karyotes,less proteinuria.Results In 33 patiens with proliferative glomernlar disease,cytodiagnostic urinalysis of type 1 was found in 30 cases(91%).Eight of 9 cases of non-proliferative glomerular disease presented cytodiagnostic urinalysis of type 2.Cytodiagnostic urinalysis of type 3 was found in 5 of 8 cases of tubulointerstitial lesions.Conclusion Cytodiagnostic urinalysis combined with proteinuria quantification is a non-invasive,cheap,convenient method to reflex the severity and region of renal injury in ARF.