Prakash Jai, Sen D, Kumar N Sarat, Kumar H, Tripathi L K, Saxena R K
Department of Nephrology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India.
Ren Fail. 2003 Mar;25(2):225-33. doi: 10.1081/jdi-120018723.
In this study we have analyzed incidence, causes and clinical course of ARF due to primary intrarenal disease other than acute tubular necrosis. Thousand hundred and twenty two cases of ARF of diverse etiology were studied over a period of 16 years; July 1984 to Dec, 1999. Surgical ARF 231 (20.6%) were not included in the present study. Intrinsic renal diseases were responsible for ARF in 891 (79.4%) of cases. The most common intrinsic renal diseases 705 (79.4%) causing ARF were ischemic/toxic acute tubular necrosis, but not included in this study. Acute renal failure was related to acute glomerulonephritis (9.3%), acute interstitial nephritis (7%), and renal cortical necrosis in (4.6%) of cases. Therefore intrinsic renal diseases other than ATN were the causative factor for acute renal failure in 186 (20.8%) patients in our study. Crescentic (51.8%) and endocapillary proliferative glomerulonephritis (34.9%), were the main glomerular diseases responsible for ARF and 75.9% of GN was related to infectious etiology. Fifty three percent of acute interstitial nephritis was drug induced and in 25 (40%) patients it was related to an infectious etiology. Renal cortical necrosis due to HUS was observed in 16 (39%) children and majority (76.47%) of the cases had a diarrhoeal prodrome. Obstetrical complications were the main causes (61%) of cortical necrosis in adults with acute renal failure. Thus, intrinsic renal diseases other than ATN were responsible for ARF in 186 (20.8%) cases. Post-infectious glomerulonephritis, acute interstitial nephritis and renal cortical necrosis (complicating HUS in children and obstetrical complications in adult) are the main causes of acute renal failure in our study. Both acute GN and interstitial nephritis had excellent prognosis, however renal cortical necrosis was associated with a very high mortality.
在本研究中,我们分析了除急性肾小管坏死外,原发性肾内疾病所致急性肾衰竭(ARF)的发病率、病因及临床病程。在1984年7月至1999年12月的16年间,我们研究了1222例病因各异的ARF病例。本研究未纳入231例(20.6%)外科性ARF。891例(79.4%)病例的ARF由肾内疾病引起。导致ARF的最常见肾内疾病为缺血性/中毒性急性肾小管坏死,共705例(79.4%),但本研究未纳入。急性肾衰竭与急性肾小球肾炎(9.3%)、急性间质性肾炎(7%)及肾皮质坏死(4.6%)相关。因此,在我们的研究中,186例(20.8%)患者的急性肾衰竭病因是除急性肾小管坏死外的其他肾内疾病。新月体性(51.8%)和毛细血管内增生性肾小球肾炎(34.9%)是导致ARF的主要肾小球疾病,75.9%的肾小球肾炎与感染性病因相关。53%的急性间质性肾炎由药物引起,25例(40%)患者与感染性病因有关。16例(39%)儿童因溶血尿毒综合征(HUS)出现肾皮质坏死,大多数病例(76.47%)有腹泻前驱症状。产科并发症是急性肾衰竭成人患者肾皮质坏死的主要原因(61%)。因此,186例(20.8%)病例的ARF由除急性肾小管坏死外的其他肾内疾病引起。感染后肾小球肾炎、急性间质性肾炎和肾皮质坏死(儿童并发HUS,成人并发产科并发症)是我们研究中急性肾衰竭的主要原因。急性肾小球肾炎和急性间质性肾炎预后均良好,然而肾皮质坏死的死亡率极高。