【摘要】 目的探讨不同病因慢性肾衰竭患者的临床、病理及肾脏B超特点。方法 618例慢性肾衰竭患者根据肾活检病理分为3组:慢性肾小球肾炎组(CGN)、慢性肾小管间质肾病组(CTIN)和高血压肾损害组(BN),分别从临床资料、肾脏病理及肾脏B超3方面进行分析。结果 BN组肾性贫血最不明显,而CTIN组最重;CGN组的蛋白尿和血尿最多;CTIN组的尿α1-MG升高最显著,BN组禁水12h尿渗透压下降最明显;CTIN组可伴范可尼综合征和肾小管酸中毒。肾脏病理检查示:CTIN组肾小管间质病变最严重,CGN组最轻,CTIN组和BN组的肾小球以缺血硬化为主,而CGN组以增生硬化为主。肾脏B超示:CGN组肾脏均匀萎缩,表面较光滑,轮廓较清楚;CTIN组不均匀萎缩,肾缩小和肾外形改变最显著;BN组介于二者之间。结论病因不同的慢性肾衰竭患者临床及肾脏B超各有特点,可以辅助疾病的诊断。更多还原

【Abstract】 Objective To identify the profile of clinical features,pathological changes and renal ultrasonography presentations due to various causes of chronic renal failure. Methods 618 patients with chronic renal failure (glomerular filtration rate was 30~89 ml/min·1.73m2) were divided into three groups:chronic glomerulonephritis (CGN),chronic tubulointerstitial nephropathy (CTIN),and benign nephrosclerosis (BN). The clinical data,pathological data,and features of renal B ultrasound were analyzed. Results Renal failure associated anemia was mildest in the BN group,while the anemia was the worst in the CTIN group. Proteinuria and hematuria were the worst in the CGN group. Urinary α1-MG was markedly elevated in the CTIN group,while urine osmotic pressure of water deprivation for 12h was remarkably decreased in the BN group. Some patients had concurrent renal tubular acidosis and/or Fanconi syndrome in the CTIN group. The tubulointerstitial lesion was most serious in the CTIN group and the slightest in the CGN group. Ischemic and sclerosis were the primary pathological changes in the CTIN and the BN groups,while hyperplastic and sclerosis were the most predominant pathological changes in the CGN group. There was also difference in renal B ultrasound presentation between the three groups. The volume of kidney decreased in the CGN group with smooth surface and clear outline,while uneven atrophy could be observed in the CTIN group with massive loss of volume and remarkable change in the contour. Conclusions There are differences in the clinical and ultrasound presentations between chronic renal failure due to various causes. These changes may be helpful in the differential diagnosis for the causes of chronic renal failure.更多还原