Feriozzi S, Muda A O, Massimetti C, Costantini S, Ancarani E
Centro di Riferimento di Nefrologia e Dialisi, Azienda USL, Viterbo, Italy.
J Nephrol. 1998 Sep-Oct;11(5):261-5.
We report 4 cases of sepsis-induced acute renal failure (ARF) with peculiar clinical presentation in which the renal biopsy was the only clue to a correct diagnosis. We observed 66 cases of ARF in a 4-year experience. Seven (11%) were associated with sepsis; in 3 of these (4.5%) a shock was present. Clinical picture of the remaining 4 cases (6%) was characterized by ARF with oligoanuria and proteinuria (> 2 g/L), fever, resistant to antimicrobial therapy, negative hemocultures and severe systemic symptoms. Such a presentation could suggest a non-infectious systemic disease; renal biopsies were carried out. Histological findings consisted of microabscesses of variable size in the interstitium and within the tubular lumina. A full-dose, broad-spectrum, i.v. antimicrobial therapy was started, with favourable outcome and recovery of renal function. Our clinical experience points out that the clinical picture of ARF in course of sepsis may be variable and that its relationship with septicaemia could not be readily discernible.
我们报告了4例脓毒症诱发的急性肾衰竭（ARF），其临床表现特殊，肾活检是正确诊断的唯一线索。在4年的临床经验中，我们共观察到66例ARF。其中7例（11%）与脓毒症相关；其中3例（4.5%）伴有休克。其余4例（6%）的临床表现为ARF伴少尿和蛋白尿（>2g/L）、发热、对抗菌治疗耐药、血培养阴性及严重的全身症状。这种表现可能提示非感染性全身性疾病，遂进行了肾活检。组织学检查发现间质和肾小管腔内有大小不一的微脓肿。开始给予全剂量、广谱静脉抗菌治疗，结果良好，肾功能得以恢复。我们的临床经验指出，脓毒症过程中ARF的临床表现可能多种多样，其与败血症的关系也不易识别。
