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关键词：轻微病变；急性肾功能衰竭；肾小管间质
【摘要 】 目的 总结17例成人肾小球轻微病变伴发急性肾功能衰竭，以进一步了解该类患者急性肾衰发生的成因、机制、特征及预后。方法 肾穿刺活检，组织行光镜、电镜及免疫荧光学检查。结果 本组男女之比4.7∶1；年龄30～40岁。临床上以肾病综合征为主要表现。病理学上肾小球的主要表现为肾小球轻微病变；肾小管间质的病变主要以肾小管细胞变性、扁平化、微绒毛脱落、单个小管细胞脱落、坏死及间质水肿纤维化等亚致死性损伤为特征。本组患者从发现肾病到肾衰发生的平均时间为(40±17)天。患者经早期激素治疗及适当的支持疗法后预后良好，从肾衰发生到临床恢复的平均病程为(64±21)天。结论 成人肾小球轻微病变伴发急性肾衰可能为肾小管间质的亚致死性损伤所致；这类病变因其病理学改变不甚典型而易被忽视；该类患者早期使用激素可能对肾功能改善及病变恢复有一定的帮助。
Acute renal failure in adult patients with glomerular minimal change
JIANG Tang,HUANG Fengxian,GUAN Weiming,et al.Department of Nephrology,First Affiliated Hospital,Sun Yat-sen University of Medical Sciences,Guangzhou 510080
【Abstract 】 Objective To explore seventeen cases of adult patients with glomerular minimal change accompanied by acute renal failure,and further to analyse its clinical features,factors,mechanisms,and outcome.Methods The renal biopsies were examined by light microscopy,electromicroscopy and immunoflurecence microscopy.Results The average age of these patients is 30～40 years. Males were affected more commonly than females,in a 4.7∶1 ratio.A notable clinical feature of these cases was nephrotic syndrome.The histopathologic change of these cases was mainly glomerular minimal change.In contrast,abnormalities of the tubulointerstitium were frequent,ranging from focal simplication of the proximal tubule,scattered tubular cell necroses and/or disappearance of proximal brush border to frank tubular necrosis with marked interstitial edema and fibrosis.The average interval between observation of nephropathy and the development of acute renal failure was(40±17)days.It appeared that renal failure was reversible soon after prednisone and appropriate supporting treatment,averaging about(64±21)days.Conclusion Occurance of acute renal failure in some patients with glomerular minimal change may result from subfatal injury of renal tubulointerstitium.The pathologic abnormality of which is atypic and easy to be overlooked.
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