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目的:探讨局灶节段性肾小球硬化(FSGS)患者入住肾科重症监护病房(RICU)的原因及其临床特征。方法:选取2009年7月至2012年12月南京军区南京总医院RICU收治的FSGS患者,回顾性分析其临床特征、既往治疗情况、并发症。结果:2009年7月至2012年12月共48例FSGS患者入住RICU,占所有RICU患者的2.95%,占肾病综合征(NS)患者的31.37%。感染、急性肾损伤(AKI)、电解质紊乱是入住RICU的FSGS患者常见并发症。初发初治患者以AKI的发生率高,接受激素或免疫抑制剂的患者感染发生率高。感染、单纯AKI、感染合并AKI患者分别有11、19、12例。31例次AKI患者中,12例次合并感染,19例次合并低血容量,4例患者为药源性因素所致AKI。结论:FSGS是RICU患者NS的主要病理类型之一,感染、AKI、电解质紊乱是RICU FSGS患者入住RICU的主要原因,三者常重叠存在;感染的发生与激素及免疫抑制剂的使用关系密切,FSGS发生AKI主要与低血容量、感染和药源性因素相关。
Objective: To investigate the causes and clinical features of patients with focal segmental glomerulosclerosis (FSGS) admitted to the renal intensive care unit (RICU). Methods: From July 2009 to December 2012, patients with FSGS who underwent RICU in Nanjing General Hospital of Nanjing Military Region were retrospectively analyzed. The clinical features, previous treatment and complications were retrospectively analyzed. Results: From July 2009 to December 2012, 48 patients with FSGS were admitted to RICU, accounting for 2.95% of all RICU patients and 31.37% of patients with nephrotic syndrome (NS). Infection, acute kidney injury (AKI), electrolyte disturbances are common complications of FSGS patients admitted to RICU. Patients with newly diagnosed primary disease have a high incidence of AKI, and those who receive hormone or immunosuppressive agents have a high incidence of infection. Infection, simple AKI, infection with AKI patients were 11,19,12 cases. Of the 31 patients with AKI, 12 were complicated with infection, 19 were complicated with hypovolemia, and 4 were AKI due to drug-induced factors. Conclusion: FSGS is one of the major pathological types of NS in patients with RICU. Infection, AKI and electrolyte imbalance are the main causes of RICU in patients with RICU FSGS, and often overlap. The incidence of infection is closely related to the use of hormones and immunosuppressive agents, AKI occurs in FSGS mainly associated with hypovolemia, infection and drug-induced factors.