原发性肾病综合征合并急性肾衰竭43例临床病理分析

目的研究分析原发性肾病综合征合并急性肾衰竭的临床及病理特点，提高此类并发症的防治水平。方法自2004年6月至2006年6月在我科住院确诊的43例原发性肾病综合征（PNS）合并急性肾衰竭（ARF）病例（ARF组）和同期住院的肾功能正常的原发性肾病综合征43例（对照组）。对两组病人的临床表现及病理特点进行对比分析。结果ARF组病人血压（收缩压、舒张压）、血浆自蛋白浓度、血肌酐浓度、血尿素氮浓度与对照组比较有显著性差异（P〈0.05）。病理分析ARF组中、重度系膜增殖性肾小球肾炎发生率比对照组明显增高，（P〈0.01）；ARF组膜增生性肾小球肾炎多于对照组（P〈0.05）；肾间质改变较对照组显著增多（P〈0.01）。ARF组D-二聚体阳性率较对照组增多（P〈0.05）；血浆纤维蛋白定量也较对照组显著增高（P〈0.01）。结论PNS合并ARF病人肾小球病理改变较重多伴肾间质病变、高凝状态、血栓形成及血浆自蛋白浓度较低等。因此，对PNS合并ARF者宜尽早行肾穿刺活检术，以便明确其病理类型，根据病理特点选择有效的治疗方案，能大大改善病人的预后。

The clinic and pathology analyze of 43 cases with primary nephrotic syndrome accompanied by acute renal failure

0bjective:To investigate the clinical manifestations and pathological features of patients with primary nephritic syndrome(PNS) accompanied by acute renal failure(ARF),we can effectively prevent and treat this disease.Methods:This study involved 86 patients with PNS from June 2004 to June 2006,which were divided into two groups according as if the patients have ARF :ARF groups and control groups.The clinical manifestations and pathological features of two groups were analyzed and compared.Results:In ARF group,the blood pressure(systolic blood pressure and diastolic blood pressure) and serum albumin and serum creatinine and blood urea nitrogen are significantly different from control group.The rate of middle and serious mesangial proliferative glomerulonephritis(MsPGN) in the ARF are more higher than in the control group,the incidence of the membranoproliferative glomerulonephritis(MPGS) was higher in ARF group than in control group.The renal interstitial lesion in ARF group are more significant than in the control group.the positive rate of D-dimer in the ARF group are higher in the control group;plasma fibrinogen in the ARF group are higher than the control group,Conclusion:In the ARF group,the glomerular pathological lesion are severity,most of them combined with renal interstitial-tubular lesion,hypercoagulabsle state or thrombogenesis.or low serum albumin.Most cases of renal dysfunctions can be cured by means of appropriate treatment.The curative effects can be greatly improved if early renal biopsy is performed to get the definite diagnosis.