Zuo L, Wang M, Wang H
Department of Nephrology, The First Hospital, Beijing Medical University, Beijing 100034.
Zhonghua Nei Ke Za Zhi. 1999 Aug;38(8):537-40.
To improve the diagnostic accuracy of acute renal failure (ARF) by analyzing the causes of misdiagnosis.
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.
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.
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 interstitial 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.
通过分析误诊原因提高急性肾衰竭（ARF）的诊断准确性。
比较入院诊断与最终诊断之间的相关性，找出可能的误诊原因，并总结早期诊断和治疗对预后的影响。
111例ARF患者中，入院前仅67.6%（75/111）被诊断为ARF；14.4%（16/111）被误诊为慢性肾衰竭（CRF）；18.0%（20/111）被误诊为肾肿瘤、尿路结石及不明原因的血尿或蛋白尿。69例患者进行了肾活检。活检后21.7%（15/69）的病例诊断得以纠正，56.5%（39/69）的病例治疗方法发生改变。
结果表明部分ARF病例被误诊为CRF。肾脏大小及指甲肌酐水平有助于鉴别CRF和ARF。ARF病因诊断的难点在于急性肾小球肾炎与急进性肾小球肾炎（RPGN）、急性肾小管坏死（ATN）与急性间质性肾炎（AIN）之间的鉴别。ATN或AIN合并慢性肾小球肾炎可能与RPGN混淆。鉴别困难时应尽早进行肾活检。
