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医学免费论文:微小病变肾病综合征并发急性肾衰竭的临床病理特点
【摘要】目的 ：探讨微小病变肾病综合征（minimal change nephrotic syndrome，MCNS)并发特发性急性肾衰竭(idiopathic acute renal failure，IARF)的临床病理特点。方法 ：回顾性分析15例成人MCNS并发IARF（肾衰组)临床病理表现及转归情况，随机抽取成人MCNS无并发急性肾衰竭15例（非肾衰组)作对照。结果 ：肾衰组血肌酐为（307.7±168.6)μmol/L，少尿型占73.3%（11例)，急性肾衰竭好转率为86.7%(13例)。与非肾衰组相比，肾衰组水肿程度较重，收缩压水平较高(P <0.01)；肾衰组肾小管上皮细胞浊肿和肾小管上皮细胞扁平化发生率较高（P <0.01)，肾小管腔内蛋白管型的发生率较高(P <0.05)；肾病综合征的缓解时间和平均住院时间较长（P <0.01)。结论：成人原发性MCNS并发IARF患者临床上水肿程度较重和收缩压水平较高，病理表现主要为急性肾小管损伤，肾功能损伤多呈可逆性质，预后好。
【关键词】 微小病变肾病 肾病综合征 急性肾衰竭
Clinical and pathological features of minimal change nephrotic syndrome complicated with acute renal failure
YOU Xiaohan，ZHOU Ying，HUANG Chaoxing医.学全.在.线网站www.lindalemus.com.
Department of Nephrology，the First Affiliated Hospital of Wenzhou Medical College，Wenzhou，325000
Abstract: Objective: To explore the clinical and pathological characteristics of minimal change nephrotic syndrome （MCNS) complicated with idiopathic acute renal failure （IARF). Methods:Fifteen patients with adult-onset MCNS complicated with IARF （ARF group) were compared with 15 patients with MCNS without ARF （non-ARF group) who were randomly selected. The clinical manifestation，pathological data and outcome were analyzed retrospectively. Results: In ARF group the average serum creatinine level was （307.7±168.6 )μmol/L. 11 cases manifested oliguria ARF （73.3%) and recovery of renal function （86.7%) in ARF group was found in 13 case. The systolic blood pressure was higher and the degree of edema was more serious in the ARF group （P <0.01). The incidence of vacuolar degeneration in tubular epithelium and flattened tubular epithelium was higher in the ARF group （P <0.01). The incidence of proteinaceous casts was higher in the ARF group （P <0.05). The remission time of nephrotic syndrome as well as the hospitalization time （P <0.05)was longer in the ARF group. Conclusion: IARF usually occurs in nephrotic patients with higher blood pressure and more serious edema. The main histopathologic change is acute tubule injury.Recovery of renal function occurs in most cases. The prognosis is good.
Key words: minimal change disease；nephritic syndrome；acute renal failure
1966年Chamberlain首次报道原发性肾病综合征（nephritic syndrome，NS)患者并发原因不明的急性肾衰竭（acute renal failure，ARF)，即特发性急性肾衰竭(idiopathic acute renal failure，IARF)。微小病变肾病（minimal change dieases，MCD)是原发性NS的常见病理类型之一，现已明确IARF最好发于微小病变肾病综合征（minimal change nephrotic syndrome，MCNS)，但其发生机制至今不明。我们回顾性分析了1993年7月-2008年5月我院成人MCNS并发IARF 15例临床病理特点及转归情况，探讨成人MCNS并发IARF的临床病理特点及其发生机制。
1 对象和方法
