6例特发性肾梗塞临床特征分析并文献复习
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摘要
目的探讨6例特发性肾梗塞的临床特点。方法对作者医院收治的6例特发性肾梗塞进行回顾性分析。结果 6例患者临床表现均有腹痛、胸背痛,其中3例合并消化道症状,未见发热、少尿和肉眼血尿等。血乳酸脱氢酶(lactate dehydrogenase,LDH)水平升高是最常见的实验室检查异常,仅1例患者血肌酐(creatinine,Cr)水平显著升高。结论特发性肾梗塞临床症状不典型,极易误诊。急诊医生对腹痛、胸背痛的患者应提高警惕,以免误诊漏诊。
Objective To explore the clinical characteristics of 6 patients with idiopathic renal infarction. Methods A total of 6 patients with idiopathic renal infarction in author′s hospital were retrospectively analyzed. Results All the 6 patients had abdominal pain and chest backache,among which 3 patients had gastrointestinal symptoms, and no fever oliguria and gross hematuria were observed.Increased blood lactate dehydrogenase(LDH) levels were the most common laboratory abnormality.Only 1 patient had high serum creatinine(Cr) level. Conclusion Clinical features of idiopathic renal infarction are atypical and misdiagnosed easily. Emergency doctors should be vigilant when patients with abdominal pain and chest backache to avoid misdiagnosis and missed diagnosis.
Objective To explore the clinical characteristics of 6 patients with idiopathic renal infarction. Methods A total of 6 patients with idiopathic renal infarction in author′s hospital were retrospectively analyzed. Results All the 6 patients had abdominal pain and chest backache,among which 3 patients had gastrointestinal symptoms, and no fever oliguria and gross hematuria were observed.Increased blood lactate dehydrogenase(LDH) levels were the most common laboratory abnormality.Only 1 patient had high serum creatinine(Cr) level. Conclusion Clinical features of idiopathic renal infarction are atypical and misdiagnosed easily. Emergency doctors should be vigilant when patients with abdominal pain and chest backache to avoid misdiagnosis and missed diagnosis.
引文
[1] Kagaya S,Yoshie O,Fukami H,et al.Renal infarction volume and renal function decline in acute and chronic phases[J].Clin Exp Nephrol,2017,21(6):1030-1034
[2] Eren N,Gungor O,Kocyigit I,et al.Acute renal infarction in Turkey:a review of 121 cases[J].Int Urol and Nephrol,2018,50 (11):2067-2072
[3] Goodman PE,Rennie WP.Renal infarction secondary to nasal insufflation of cocaine[J].Am J Emerg Med,1995,13(4):421-423
[4] Mesiano P,Rollino C,Beltrame G,et al.Acute renal infarction:a single center experience[J].J Nephrol,2017,30(1):103-107
[5] Huang CC,Lo HC,Huang HH,et al.ED presentations of acute renal infarction[J].Am J Emerg Med,2007,25(2):164-169
[6] Domanovits H,Paulis M,Nikfardjam M,et al.Acute renal infarction.Clinical characteristics of 17 patients[J].Medicine (Baltimore),1999,78(6):386-394
[7] Antopolsky M,Simanovsky N,Stalnikowicz R,et al.Renal infarction in the ED:10-year experience and review of the literature[J].Am J Emerg Med,2012,30(7):1055-1060
[8] Nagasawa T,Matsuda K,TakeuchiY,et al.A case series of acute renal infarction at a single center in Japan[J].Clin Exp Nephrol,2016,20(3):411-415
[9] Faucon AL,Bobrie G,Jannot AS,et al.Cause of renal infarction:a retrospective analysis of 186 consective cases[J].J Hypertens,2018,36(3):634-640
[10] Bae EJ,Hwang K,Jang HN,et al.A retrospective study of short- and long-term effects on renal function after acute renal infarction[J].Ren Fail,2014,36(9):1385-1389
[11] Bourgault M,Grimbert P,Verret C,et al.Acute renal infarction:a case series[J].Clin J Am Soc Nephrol,2013,8(3):392-398
[12] Oh YK,Yang CW,Kim YL,et al.Clinical characteristics and outcomes of renal infarction[J].Am J Kidney Dis,2016,67(2):243-250
[13] 黄毅,王南,严丽,等.41例急性肾梗死回顾性分析[J].临床急诊杂志,2016,17(3):214-216
[14] Bolderman R,Oyen R,Verrijcken A,et al.Idiopathic renal infarction[J].Am J Med,2006,119(4):356.e9-356.e12
[15] Korzets Z,Plotkin E,Bernheim J,et al.The clinical spectrum of acute renal infarction[J].Isr Med Assoc J,2002,4(10):781-784
[16] Norman RA Jr,Galloway PG,Dzielak DJ,et al.Mechanisms of partial renal infarct hypertension[J].J Hypertens,1988,6(5):397-403
[17] Di Serafino M,Severino R,Gullotto C,et al.Idiopathic renal infarction mimicking appendicitis[J].Case Rep Emerg Med,2017:8087315
[18] 周其赵,邓剑平,钟伟枫,等.2例原发性急性肾梗塞的临床诊治[J].现代泌尿外科杂志,2012,17(1):81-83
[19] Fu ZF,Zhang ZG,Liu XM.A rare case of acute renal infarction due to idiopathic renal arterial thrombosis[J].Chin Med J (Engl),2008,121(2):185-187
[20] Eickhoff C,Mei JM,Martinez J,et al.Idiopathic Renal Infarction in a Previously Healthy Active Duty Soldier[J].Mil Med,2014,179(2):e259- e262
[21] Ressica JS,Pollack ML.Idiopathic renal infarction in a young woman[J].Am J Emerg Med,2005,23(3),397-398
[22] Chen YJ,Chen WL,Tsai WC,et al.Sentinel central retinal artery occlusion:a forme fruste of idiopathic renal infarction[J].Am J Emerg Med,2009,27(2):253.e1-253.e2
[23] ?zpolat T,Kayar Y.Acute renal infarction:a presentation of essential thrombocytosis[J].Kidney Int,2017,92(5):1292
[24] Kagaya S,Yoshie O,Fukami H,et al.Renal infarct volume and renal function decline in acute and chronic phases[J].Clin Exp Nephrol,2017,21(6):1030-1034
[25] Miyoshi T,Okayama H,Hiasa G,et al.Contrast-enhanced ultrasound for the evaluation of acute renal infarction[J].J Med Ultrason(2001),2016,43(1):141-143
[26] Yun WS.Long-term follow-up results of acute renal embolism after anticoagulation therapy[J].Ann Vasc Surg,2015,29(3):491-495
[27] Hazanov N,Somin M,Attali M,et al.Acute renal embolism.Forty-four cases of renal infarction in patients with atrial fibrillation[J].Medicine (Baltimore),2004,83(5):292-299
[28] Tsai SH,Chu SJ,Chen SJ,et al.Acute renal infarction:a 10-year experience[J].Int J Clin Pract,2007,61(1):62-67
[2] Eren N,Gungor O,Kocyigit I,et al.Acute renal infarction in Turkey:a review of 121 cases[J].Int Urol and Nephrol,2018,50 (11):2067-2072
[3] Goodman PE,Rennie WP.Renal infarction secondary to nasal insufflation of cocaine[J].Am J Emerg Med,1995,13(4):421-423
[4] Mesiano P,Rollino C,Beltrame G,et al.Acute renal infarction:a single center experience[J].J Nephrol,2017,30(1):103-107
[5] Huang CC,Lo HC,Huang HH,et al.ED presentations of acute renal infarction[J].Am J Emerg Med,2007,25(2):164-169
[6] Domanovits H,Paulis M,Nikfardjam M,et al.Acute renal infarction.Clinical characteristics of 17 patients[J].Medicine (Baltimore),1999,78(6):386-394
[7] Antopolsky M,Simanovsky N,Stalnikowicz R,et al.Renal infarction in the ED:10-year experience and review of the literature[J].Am J Emerg Med,2012,30(7):1055-1060
[8] Nagasawa T,Matsuda K,TakeuchiY,et al.A case series of acute renal infarction at a single center in Japan[J].Clin Exp Nephrol,2016,20(3):411-415
[9] Faucon AL,Bobrie G,Jannot AS,et al.Cause of renal infarction:a retrospective analysis of 186 consective cases[J].J Hypertens,2018,36(3):634-640
[10] Bae EJ,Hwang K,Jang HN,et al.A retrospective study of short- and long-term effects on renal function after acute renal infarction[J].Ren Fail,2014,36(9):1385-1389
[11] Bourgault M,Grimbert P,Verret C,et al.Acute renal infarction:a case series[J].Clin J Am Soc Nephrol,2013,8(3):392-398
[12] Oh YK,Yang CW,Kim YL,et al.Clinical characteristics and outcomes of renal infarction[J].Am J Kidney Dis,2016,67(2):243-250
[13] 黄毅,王南,严丽,等.41例急性肾梗死回顾性分析[J].临床急诊杂志,2016,17(3):214-216
[14] Bolderman R,Oyen R,Verrijcken A,et al.Idiopathic renal infarction[J].Am J Med,2006,119(4):356.e9-356.e12
[15] Korzets Z,Plotkin E,Bernheim J,et al.The clinical spectrum of acute renal infarction[J].Isr Med Assoc J,2002,4(10):781-784
[16] Norman RA Jr,Galloway PG,Dzielak DJ,et al.Mechanisms of partial renal infarct hypertension[J].J Hypertens,1988,6(5):397-403
[17] Di Serafino M,Severino R,Gullotto C,et al.Idiopathic renal infarction mimicking appendicitis[J].Case Rep Emerg Med,2017:8087315
[18] 周其赵,邓剑平,钟伟枫,等.2例原发性急性肾梗塞的临床诊治[J].现代泌尿外科杂志,2012,17(1):81-83
[19] Fu ZF,Zhang ZG,Liu XM.A rare case of acute renal infarction due to idiopathic renal arterial thrombosis[J].Chin Med J (Engl),2008,121(2):185-187
[20] Eickhoff C,Mei JM,Martinez J,et al.Idiopathic Renal Infarction in a Previously Healthy Active Duty Soldier[J].Mil Med,2014,179(2):e259- e262
[21] Ressica JS,Pollack ML.Idiopathic renal infarction in a young woman[J].Am J Emerg Med,2005,23(3),397-398
[22] Chen YJ,Chen WL,Tsai WC,et al.Sentinel central retinal artery occlusion:a forme fruste of idiopathic renal infarction[J].Am J Emerg Med,2009,27(2):253.e1-253.e2
[23] ?zpolat T,Kayar Y.Acute renal infarction:a presentation of essential thrombocytosis[J].Kidney Int,2017,92(5):1292
[24] Kagaya S,Yoshie O,Fukami H,et al.Renal infarct volume and renal function decline in acute and chronic phases[J].Clin Exp Nephrol,2017,21(6):1030-1034
[25] Miyoshi T,Okayama H,Hiasa G,et al.Contrast-enhanced ultrasound for the evaluation of acute renal infarction[J].J Med Ultrason(2001),2016,43(1):141-143
[26] Yun WS.Long-term follow-up results of acute renal embolism after anticoagulation therapy[J].Ann Vasc Surg,2015,29(3):491-495
[27] Hazanov N,Somin M,Attali M,et al.Acute renal embolism.Forty-four cases of renal infarction in patients with atrial fibrillation[J].Medicine (Baltimore),2004,83(5):292-299
[28] Tsai SH,Chu SJ,Chen SJ,et al.Acute renal infarction:a 10-year experience[J].Int J Clin Pract,2007,61(1):62-67