摘要
目的分析肾病综合征的临床特征、症状表现、鉴别诊断要点及误诊原因,并总结防范误诊措施。方法回顾性分析2017—2020年收治的16例肾病综合征误诊病例资料。结果本组16例中9例以口渴、多饮、多尿、乏力、体质量减轻、双下肢及颜面部水肿就诊,均有糖尿病病史,尿蛋白升高,初步诊断为糖尿病肾病,予以相应治疗后病情未见明显好转,进一步查血脂升高,血白蛋白降低,并行肾活组织病理检查确诊为膜性肾病。7例以食欲缺乏、便秘、腹胀、少语、反应迟钝、表情呆滞、颜面部或下肢非凹陷性水肿就诊,查三碘甲状腺原氨酸(T_(3))及甲状腺素(T_(4))降低,血脂升高,初步诊断为甲状腺功能减退症,予以相应治疗后病情未见明显好转,进一步查尿蛋白升高,血白蛋白降低,游离T_(3)、游离T_(4)正常,并行肾活组织病理检查确诊为肾病综合征(膜性肾病)。本组误诊时间5~34(11.28±2.15)d。16例确诊后予糖皮质激素、免疫抑制剂、细胞毒性药物及控制饮食等对症支持治疗,水肿明显消退,各项检测指标恢复正常,临床症状明显好转,随访1年未见复发。结论肾病综合征临床表现缺乏特异性,当以某一并发症为主要表现就诊时,极易误诊。提示接诊医师应熟知本病临床特征、症状表现及鉴别诊断要点,认真鉴别诊断,及时完善肾组织病理检查以及早明确诊断。
Objective To analyze clinical features,manifestations,key points of differential diagnosis and misdiagnosed causes of nephrotic syndrome,and to summarize measures for preventing misdiagnosis.Methods Clinical data of 16 misdiagnosed patients with nephrotic syndrome admitted from 2017 to 2020 was retrospectively analyzed.Results Among the 16 patients,9 patients had thirst,polydipsia,polyuria,fatigue,weight loss,and edema of both lower extremities and face,and all the patients had a history of diabetes and increased urinary protein,and then initially diagnosed was diabetic nephropathy,but the conditions did not improve significantly after corresponding treatments.Further examinations showed increased blood lipids and decreased serum albumin,and membranous nephropathy was confirmed after renal biopsy simultaneously.with the remain 7 patients had anorexia,constipation,abdominal distension,reticence,unresponsiveness,sluggish expression,non-pitting edema of face or lower extremities,and levels of triiodothyronine(T_(3))and thyroid hormone(T_(4))were decreased,while levels of blood lipids were increased,and then initial diagnosis was hypothyroidism,but the conditions did not improve significantly after corresponding treatments.Further examinations showed increased urine protein,decreased serum albumin,and normal free T_(3) and free T_(4),and nephrotic syndrome(membranous nephropathy)was confirmed after renal biopsy.The misdiagnosed duration in this group was 5-34(11.28±2.15)d.After confirming diagnosis,16 patients received symptomatic and supportive treatments such as glucocorticoids,immunosuppressants,cytotoxic drugs and diet control.The edema subsided significantly,and the test indicators returned to normal,and clinical symptoms improved significantly.No recurrence was found during the 1-year follow-up.Conclusion Clinical manifestations of nephrotic syndrome lack specificity,and it is more likely to be misdiagnosed when a certain complication is the main manifestation.It is suggested that the attending physicians should be familiar with the clinical features,manifestations and key points of differential diagnosis of the disease,make a careful differential diagnosis,timely perform pathological examination of the renal tissue,and make an early diagnosis.
作者
石友山
陈天浩
SHI You-shan;CHEN Tian-hao(Department of Nephrology,People's Hospital of Tianchang City,Tianchang,Anhui 239300,China)
出处
《临床误诊误治》
CAS
2022年第6期17-20,共4页
Clinical Misdiagnosis & Mistherapy
关键词
肾病综合征
肾病
膜性
误诊
糖尿病肾病
甲状腺功能减退症
Nephrotic syndrome
Nephropathy,membranous
Misdiagnosis
Diabetic nephropathy
Hypothyroidism
