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目的探讨急性肾功能衰竭(ARF)患者的肾脏病理改变。方法对212例ARF患者的临床资料进行回顾性分析。结果肾小管、肾小管间质病变占74.4%,肾小球疾病占22.6%。流行性出血热(EHF)患者中急性小管间质肾病(ATIN)占99.3%、急性肾小管坏死(ATN)占0.7%;药物、感染、挤压综合征、出血、肺癌、多发性骨髓瘤和原因不明21例,其中ATN17例(80.9%),急性间质性肾炎(AIN)3例(14.3%),ATIN1例(4.8%);肾小球疾病48例,其中新月体肾炎17例,余31例为基本病变伴ATN5例,ATIN26例。治愈189例(89.2%),好转10例(4.7%),无效13例(6.1%)。误诊和诊断不明确29例(13.7%)均得到了确诊,更改了治疗方法。结论EHF和肾小球疾病(除新月体肾炎外)多为ATIN,药物、中毒、挤压综合征、出血为ATN;疗效与原发病相关;ARF确诊困难时应尽早肾活检。
Objective To investigate the renal pathological changes in patients with acute renal failure (ARF). Methods The clinical data of 212 ARF patients were retrospectively analyzed. Results tubules, tubulointerstitial lesions accounted for 74.4%, glomerular diseases accounted for 22.6%. Atypical tubulointerstitial nephropathy (ATIN) accounted for 99.3% and acute tubular necrosis (ATN) accounted for 0.7% in patients with epidemic hemorrhagic fever (EHF). Drugs, infections, crush syndromes, hemorrhage, lung cancer, multiple myeloma and The cause of unknown 21 cases, including ATN in 17 cases (80.9%), acute interstitial nephritis (AIN) in 3 cases (14.3%), ATIN in 1 case (4.8%); glomerular disease in 48 cases, including crescentic nephritis in 17 cases, The remaining 31 cases were basic lesion with ATN in 5 cases and ATIN in 26 cases. 189 cases (89.2%) were cured, 10 cases (4.7%) improved and 13 cases (6.1%) ineffective. Twenty-nine cases (13.7%) were misdiagnosed and diagnosed incorrectly. All of them were confirmed and the treatment was changed. Conclusion EHF and glomerular diseases (except crescentic glomerulonephritis) are mostly ATIN, drug, poisoning and crush syndrome, and the bleeding is ATN. The curative effect is related to the primary disease; renal biopsy should be done as soon as possible when the diagnosis of ARF is difficult.