Kourilsky O
Service de Médecine Interne, Centre hospitalier Louise-Michel, Evry.
Rev Prat. 1995 Sep 1;45(13):1648-52.
The mortality rate of acute renal failure is still high, about 50%. About 10% of the survivors have chronic renal failure, sometimes requiring dialysis. The course of some of these cases can be improved by appropriate therapeutic measures, if they are undertaken early. Early identification of these lesions is therefore mandatory. The clinical diagnosis is often difficult: 1. rare atypical forms of acute tubular necrosis, with renal or extrarenal signs, may lead to renal biopsy; 2. vascular and glomerular disease are most often recognized clinically (sometimes misdiagnosed), but the histological type (and therefore the appropriate treatment) cannot be determined; 3. acute interstitial nephritis is rarely diagnosed clinically and the nature of the infiltrate remains unknown. In certain cases of acute renal failure, the contribution of early renal biopsy to the etiological diagnosis and to prognosis and therapy is obvious. In acute renal failure, renal biopsy should be considered early in a rather limited number of patients (about 20%), everytime the diagnosis of tubular necrosis is doubtful, especially in acute renal failure associated with persistent infection, in order to guide the therapy.
急性肾衰竭的死亡率仍然很高，约为50%。约10%的幸存者会发展为慢性肾衰竭，有时需要透析治疗。如果能早期采取适当的治疗措施，其中一些病例的病程可以得到改善。因此，早期识别这些病变至关重要。临床诊断往往很困难：1. 急性肾小管坏死的罕见非典型形式，伴有肾脏或肾外体征，可能需要进行肾活检；2. 血管和肾小球疾病大多在临床上得以识别（有时会误诊），但无法确定其组织学类型（以及相应的治疗方法）；3. 急性间质性肾炎很少能在临床上被诊断出来，浸润的性质也仍然不明。在某些急性肾衰竭病例中，早期肾活检对病因诊断、预后及治疗的作用是显而易见的。在急性肾衰竭中，对于相当一部分（约20%）患者应尽早考虑进行肾活检，每当肾小管坏死的诊断存疑时，尤其是在伴有持续感染的急性肾衰竭患者中，以便指导治疗。
