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目的探讨以肾功能衰竭为主要表现的迟发性系统性红斑狼疮(systemic lupus erythematosus,SLE)的临床特点,提高对该病的认识。方法对我院收治的以肾功能衰竭为主要表现的迟发性SLE 10例的临床资料进行回顾性分析,总结其临床特点及诊断体会。结果 10例首发表现为水肿及恶心、食欲缺乏各4例,发热及肺部感染各1例。病初误诊为原发性肾功能衰竭4例,高血压肾损害、肾功能衰竭3例,糖尿病肾病、紫癜性肾炎、类风湿性关节炎肾损害各1例。误诊时间1个月～4年。10例按误诊疾病治疗效果均欠佳,进一步行免疫学检查,确诊为迟发性SLE并予相应治疗,随访3～6个月,病情好转8例,死亡2例。结论对肾功能衰竭患者,特别是伴与血肌酐升高不相平行或不能解释的贫血、脑病、胸腹腔及心包积液者,应常规行免疫学检查,以尽早明确诊断,及时治疗。
Objective To investigate the clinical features of systemic lupus erythematosus (SLE) with renal failure as the main manifestation and to improve its understanding of the disease. Methods The clinical data of 10 cases of delayed SLE with renal failure as the main manifestation in our hospital were retrospectively analyzed, and their clinical features and diagnosis were summarized. Results The first episode showed edema and nausea, loss of appetite in 4 cases and fever and infection in 1 case. Initial misdiagnosis as primary renal failure in 4 cases, hypertensive renal damage, renal failure in 3 cases, diabetic nephropathy, purpura nephritis, rheumatoid arthritis and kidney damage in 1 case. Misdiagnosis time 1 month ~ 4 years. 10 cases of misdiagnosis of disease treatment are poor, further immunological tests, diagnosed as delayed SLE and the corresponding treatment, followed up for 3 to 6 months, 8 cases improved condition, 2 patients died. Conclusion In patients with renal failure, especially those with anemia, encephalopathy, thoracoperitoneal and pericardial effusion that are not parallel or unexplained with elevated serum creatinine, routine immunological examination should be performed to confirm the diagnosis and prompt treatment as soon as possible.