摘要
目的探讨慢性肾衰竭(chronic renal failure, CRF)的临床表现、误诊原因及防范措施。方法对病初误诊的CRF 25例的临床资料进行回顾性分析。结果本组9例以不同程度食欲缺乏、恶心、呕吐、腹部不适及黑便为主要表现,误诊为慢性胃炎6例、消化性溃疡3例;6例以皮肤干燥、皮肤瘙痒、毛发枯萎及皮疹为主要表现,误诊为过敏性皮炎4例、皮肤瘙痒症2例;4例以疲乏无力、头晕、面色苍白为主要表现误诊为贫血;4例以不同程度头痛、头晕及血压升高为主要表现误诊为原发性高血压;2例以胸闷和心悸为主要表现误诊为慢性心力衰竭。误诊时间2个月~2年。25例按误诊疾病给予针对性治疗病情改善不明显,甚者渐进性加重,后经专家会诊综合分析病史、临床表现并经肾功能、肾脏影像学检查确诊为CRF。确诊后积极治疗原发病,并给予相应对症治疗,治疗1~3个月后出院。随访6个月~1年病情稳定。结论 CRF起病隐匿,可累及全身多个系统,临床表现复杂多样且无特异性,极易误诊。加强对本病认识,详细问诊,仔细查体,及时行血尿常规、肾功能及肾脏B超等相关检查,全面系统分析病情,可减少或避免其误诊误治。
Objective To investigate the clinical manifestations, causes of misdiagnosis and preventive measures of chronic renal failure(CRF). Methods The clinical data of 25 cases of CRF misdiagnosed at the initial visit were analyzed retrospectively. Results The main manifestations of the nine patients in this group were anorexia, nausea, vomiting, abdominal discomfort and melena. Of them, 6 were misdiagnosed as chronic gastritis and 3 as peptic ulcer;6 cases were misdiagnosed as allergic dermatitis with dry skin, pruritus, hair wilting and rash as the main manifestations, and 4 cases as anemia with fatigue, dizziness and paleness as the main manifestations;4 were misdiagnosed as essential hypertension with headache, dizziness and elevated blood pressure as the main manifestations, and 2 as chronic heart failure with chest tightness and palpitation as the main manifestations. The duration of misdiagnosis was 2 months to 2 years. Twenty-five patients received targeted treatment according to misdiagnosed diseases, which did not improve significantly, or even worsened progressively. After consultation, they were diagnosed as CRF by comprehensive analysis of the history, clinical manifestations, renal function, and renal imaging examination. After diagnosis, the primary disease was treated aggressively, and the related symptomatic treatment was given. After 1-3 months of treatment, the patients were discharged and then followed up for 6 months to 1 year with stable condition. Conclusion CRF has a latent onset and can involve multiple systems. Its clinical manifestations are complex, diverse and non-specific, which is likely to lead to misdiagnosis. We should strengthen our understanding of CRF, make detailed inquiries and perform careful examination. Timely routine examination of blood and urine, renal function and B-ultrasoound are helpful to reduce or avoid misdiagnosis and mistreatment.
作者
贾志杰
孙伟
张建英
刘雪辉
王巍
JIA Zhi-jie;SUN Wei;ZHANG Jian-ying;LIU Xue-hui;WANG Wei(The First Department of Nephrology,Traditional Chinese Medicine Hospital of Tangshan,Tangshan,Hebei 063000,China;Department of Nephrology,Traditional Chinese Medicine Hospital of Tangshan,Tangshan,Hebei 063000,China)
出处
《临床误诊误治》
2020年第2期9-13,共5页
Clinical Misdiagnosis & Mistherapy
基金
河北省中医药管理局科研计划项目(2017241)
关键词
肾功能衰竭
慢性
误诊
胃炎
消化性溃疡
皮炎
贫血
高血压
Kidney failure,chronic
Misdiagnosis
Gastritis
Peptic ulcer
Dermatitis
Anemia
Hypertension
