摘要
目的 探讨急性肾功能衰竭 (ARF)误漏诊原因 ,提高ARF诊断水平。方法 分析入院前诊断与最终诊断的符合率寻找误漏诊原因 ,总结肾活检后诊断和治疗的修正率及早期治疗对预后的影响。结果 111例ARF入院前正确诊断为ARF者 75例 ( 67 6% ) ;16例 ( 14 4 % )误诊为慢性肾功能衰竭 (CRF) ;2 0例 ( 18 0 % )误漏诊为肾脏肿瘤、泌尿系统结石、血尿 /蛋白尿原因待查等其他疾病。69例肾活检病理检查纠正了 15例 ( 2 1 7% )肾活检前病因错误诊断 ,肾活检后 3 9例 ( 5 6 5 % )的治疗方案被更改。结论 本组资料显示有相当部分ARF被误诊为CRF ,肾脏大小和指甲肌酐有助于ARF和CRF的鉴别。ARF病因诊断的难点集中在急性肾小球肾炎 (AGN)与急进性肾炎 (RPGN)、急性肾小管坏死 (ATN)与急性间质性肾炎 (AIN)的鉴别诊断 ,慢性肾炎基础上发生的ATN或AIN易与RPGN混淆 ,由于四者的治疗完全不同 ,在病因诊断有困难者应及时肾活检以免延误治疗。
Objective To improve the diagnostic accuracy of acute renal failure (ARF) by analyzing the causes of misdiagnosis. Methods To compare the correlation between admission and final diagnoses, find the possible causes of misdiagnosis and summarize the influence of early diagnosis and treatment on prognosis. Results In 111 ARF patients, only 67.6%(75/111) was diagnosed as ARF before admission; 14.4%(16/111) was misdiagnosed as chronic renal failure (CRF); 18.0%(20/111) as renal tumor, urinary lithiasis and hematuria or proteinuria of unknown origin. Renal biopsy was performed in 69 cases. Diagnosis was corrected in 21.7% (15/69) of the cases and the method of treatment was changed in 56.5%(39/69) cases after biopsy. Conclusion It is showed that some cases of ARF were misdiagnosed as CRF. The size of the kidney and finger nail creatinine level would be helpful in the differentiation of CRF and ARF. The difficulty in establishing the causes of ARF is the differentiation between acute glomerulonephritis and rapidly progressive glomerulonephritis (RPGN), acute tubular necrosis (ATN) and acute intistitial nephritis (AIN). ATN or AIN with chronic glomerulonephritis may be confused with RPGN. When there is difficulty in differentiation, renal biopsy should be performed as soon as possible.
出处
《中华内科杂志》
CAS
CSCD
北大核心
1999年第8期537-540,共4页
Chinese Journal of Internal Medicine
