摘要
目的分析慢性肾功能不全(CRF)的临床特点及发生误诊的原因,并总结防范误诊措施。方法回顾性分析2014年2月—2020年1月收治的3例误诊CRF的临床资料。结果本组误诊率为9.38%。1例以食欲不振、厌食、恶心、呕吐、上腹部不适3个月就诊,1例以排黑便3 d,呕吐咖啡色液体1 h伴有胸闷、气促、头晕、乏力就诊,1例以头晕、乏力1年,胸闷、恶心、心悸1周就诊,分别误诊为慢性胃炎、上消化道出血、高血压病,误诊时间1~2个月,予以对症治疗未见明显好转。进一步查尿常规、肾功能、肾脏超声等,综合分析病情后确诊为CRF。3例确诊后予以相关治疗,1例因肾功能逐渐衰竭转上级医院治疗后失访,另2例病情稳定出院。结论CRF发病隐匿,早期症状无特异性,随着病情发展可出现全身多系统症状,若患者仅以某一系统症状就诊,极易发生误诊。加强对CRF的认识,仔细查体及问诊,开阔诊断思维,全面分析病情,及时行尿常规、肾功能、肾脏超声检查,有助于明确诊断。
Objective To analyze clinical characteristics and misdiagnosed causes of patients with chronic renal insufficiency(CRF),and to summarize measures to prevent misdiagnosis.Methods Clinical data of 3 misdiagnosed patients with CRF admitted between February 2014 and January 2020 was retrospectively analyzed.Results The misdiagnosed rate in this group was 9.38%.One patient saw a doctor for loss of appetite,anorexia,nausea,vomiting and epigastric discomfort for 3 months;1 saw a doctor for melena for 3 d,and vomiting with brown liquid for 1 h accompanied by chest tightness,shortness of breath,dizziness and fatigue,and 1 for dizziness and fatigue for 1 year,as well as chest tightness,nausea,and palpitations for 1 week.They were misdiagnosed as having chronic gastritis,upper gastrointestinal bleeding,and hypertension respectively.The misdiagnosed duration was 1 to 2 months.After symptomatic treatments,patients’conditions were not improved significantly.Further examinations such as urine routine,renal function and renal ultrasound,CRF was confirmed after a comprehensive analysis of conditions.All 3 patients received relevant treatments after confirming diagnosis,1 patient was lost to follow-up after being transferred to a higher-level hospital for treatment due to progressive renal failure,and the other 2 patients were discharged after having stable conditions.Conclusion The onset of CRF is insidious,and the early symptoms are non-specific.As the disease progresses,systemic multisystem symptoms may appear.If a patient sees a doctor with only one systemic symptom,misdiagnosis is more likely to occur.Strengthening the understanding of CRF,careful physical examinations and consultation,broadening diagnostic thinking,comprehensive analysis of conditions,and timely examinations of urine routine,renal function,and renal ultrasonography are helpful for a definite diagnosis.
作者
王应莉
周巧
刘自强
周智力
陈娣
WANG Ying-li;ZHOU Qiao;LIU Zi-qiang;ZHOU Zhi-li;CHEN Di(Department of General Medicine Affairs,Taikang Tongji(Wuhan)Hospital,Wuhan 430050,China;Department of ICU/Emergency Internal Medicine,Tongji Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology,Wuhan 430030,China)
出处
《临床误诊误治》
CAS
2022年第4期6-8,12,共4页
Clinical Misdiagnosis & Mistherapy
关键词
肾功能不全
慢性
误诊
胃炎
上消化道出血
高血压
Renal insufficiency
chronic
Misdiagnosis
Gastritis
Upper gastrointestinal bleeding
Hypertension
