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目的探讨原发性肾病综合征(PNS)并发急性肾功能衰竭(ARF)患者的临床及肾活检病理特点及其发病机制。方法回顾分析36例PNS并发ARF患者的临床及肾活检病理表现、诊断、治疗及其预后。结果36例患者出现大量蛋白尿及低蛋白血症,血肌酐、尿素氮进行性升高,肾活检病理检查示微小病变型肾病23例(63.9%),以肾小球轻微病变多见。肾小管间质明显水肿、肾小管细胞微绒毛脱落、细胞变性、细胞扁平化、散在小管细胞坏死及小管内蛋白管型。经泼尼松、速尿和前列腺素E1脂微球载体制剂及血液透析等综合治疗后,91.7%的患者肾功能完全恢复正常。结论PNS并发ARF常见于微小病变型肾病,肾小球病变轻微,部分病例有轻度系膜增生与肾小管损害及间质病变,早期综合治疗,其预后较好。
Objective To investigate the clinical features and pathological features of renal biopsy in patients with primary nephrotic syndrome (PNS) complicated with acute renal failure (ARF) and its pathogenesis. Methods The clinical manifestations, diagnosis, treatment and prognosis of 36 patients with PNS complicated with ARF were retrospectively analyzed. Results Thirty-six patients developed massive proteinuria and hypoalbuminemia. Serum creatinine and urea nitrogen increased progressively. Pathological examination of renal biopsy showed that 23 cases (63.9%) had minimal change of glomerulus. Tubulointerstitial edema, tubular cells microvilli shedding, cell degeneration, flattened cells, scattered in small tubular necrosis and tubular protein tube. After prednisone, furosemide and prostaglandin E1 lipid microsphere carrier preparations and hemodialysis and other comprehensive treatment, 91.7% of patients with renal function completely returned to normal. Conclusions PNS complicated with ARF is common in minimal change nephropathy. Glomerular lesions are mild. Some cases have mild mesangial hyperplasia, tubulointerstitial lesions and interstitial lesions. Early comprehensive treatment has good prognosis.