ISSN 1006-298X      CN 32-1425/R

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肾脏病与透析肾移植杂志 ›› 2022, Vol. 31 ›› Issue (2): 108-113.DOI: 10.3969/j.issn.1006-298X.2022.02.002

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伴肾皮质坏死急性肾损伤患者的临床特点及预后

  

  • 出版日期:2022-04-28 发布日期:2022-04-21

Clinical and prognostic features of acute kidney injury with renal cortical necrosis

  • Online:2022-04-28 Published:2022-04-21

摘要: 目的:总结肾皮质坏死(RCN)患者的临床特点和预后。
方法:回顾性分析2000年1月至2021年7月就诊于国家肾脏疾病临床医学研究中心,并经肾脏MRI或肾穿刺活检确诊RCN患者的临床表现、实验室检查及预后转归。 
结果:20例患者均以急性肾损伤起病,其中妊娠相关RCN 13例(8例患者合并血栓性微血管病,1例合并抗磷脂抗体综合征,3例合并HELLP综合征);非妊娠相关RCN7例(2例合并脓毒症,其中1例同时伴冷球蛋白血症,2例伴动脉血管疾病,3例系统性红斑狼疮伴抗磷脂抗体综合征)。与非妊娠相关RCN组相比,妊娠相关RCN组肾功能损害进展速度快,更快进入无尿期,且急性心力衰竭发生率更高。妊娠相关RCN患者中9例进入终末期肾病(ESRD),而非妊娠相关患者均未进入ESRD。
结论:妊娠相关RCN肾脏预后差,肾功能恶化进展快,预后更差,临床须高度重视。


关键词: 肾皮质坏死, 妊娠, 血栓性微血管病

Abstract: Objective:To summarize the characteristics and prognosis of renal cortical necrosis(RCN) associated acure kidney injury(AKI).
Methodology:Retrospectively analysis of clinical manifestations, laboratory examinations and prognosis of AKI patients who were diagnosed with RCN from January 2000 to July 2021.
Results:Twenty AKI with RCN patients were included. Among 13 pregnancyrelated RCN, 8 cases were accompanied by thrombotic microangiopathy(TMA), 1 case by antiphospholipid antibody syndrome, and 3 by HELLP syndrome. In 7 nonpregnancyrelated RCN group, 2 cases were secondary to sepsis, 3 cases were due to vascular disease, and 3 cases were secondary to systemic lupus erythematosus with antiphospholipid antibody syndrome. Renal function impairment progressesd rapidly in pregnancyrelated RCN patients, and had more severe acute heart failure than the nonpregnant group. In terms of prognosis, 9 patients with pregnancyrelated RCN deteriorated to end stage kidney disease (ESRD), while all nonpregnancyrelated patients were free of dialysis.
Conclusion:Pregnancyrelated RCN patients had poor prognosis, rapid deterioration of renal function and pay more attention in clinic.


Key words: renal cortical necrosis, pregnancy-related, thrombotic microangiopathy