马蹄肾的临床研究

发布时间：2018-06-25 23:09

本文选题：马蹄肾 + 影像学检查　；参考：《中国人民解放军医学院》2014年硕士论文

【摘要】：1、目的：⑴马蹄肾是一种常见的先天性肾脏发育畸形，容易被漏诊或者误诊。本研究的目的是加深临床医生对马蹄肾临床和影像表现的认识，并评价放射性核素肾图（ECT）用于检测马蹄肾患者的肾小球滤过率（GFR）的可靠性；⑵马蹄肾是先天性肾脏融合畸形，马蹄肾合并肾小球病时，由于担心肾穿刺术后并发症，很少进行肾活检，从而得不到明确的病理诊断，难以得到应有的正确治疗。本文通过总结分析马蹄肾合并肾小球病的临床病理资料，旨在提高其诊断与治疗水平。 2、方法：⑴回顾分析2008年1月至2013年6月在解放军总医院确诊为马蹄肾患者的一般情况、首诊表现、合并症、影像学检查结果，比较ECT检测的马蹄肾患者的GFR及CKD-EPI估算的eGFR的差别；⑵分析接受肾活检的马蹄肾患者的临床资料、实验室检查、影像学检查及肾活检的病理结果，并比较根据病理结果治疗前后患者的血压、血肌酐、尿蛋白定量等；归纳总结对马蹄肾行肾活检的适应证、意义、方法及肾穿刺注意事项。 3、结果：⑴临床资料：①本研究共收集53例马蹄肾患者的临床资料，其中男性30例、女性23例，男：女约为1.3：1。②首诊时表现：以腰痛、尿检异常等泌尿系统疾病相关临床表现为主诉就诊的28例（52.8%）；体检或因其他疾病意外发现的25例（47.2%）。③合并症：马蹄肾合并肾实质病变(表现为血尿或/和蛋白尿及肾功能不全)16例（30.2%），尿路感染10例（18.9%），泌尿系结石10例（18.9%），肾积水10例（18.9%），肾囊肿7例(13.2%）。④影像学检查：25位患者进行了腹部超声检查。其中19例患者通过超声直接诊断了马蹄肾，6例患者被超声漏诊后经CT确诊马蹄肾。16例患者接受了静脉肾盂造影检查(IVP),15例患者直接诊断了马蹄肾，1例被漏诊后经CT确诊马蹄肾。29例患者进行了CT检查，10例患者进行了MRI检查，2例患者进行了PET检查，，均直接诊断马蹄肾。13例患者进行了ECT检查，可见患者肾脏呈马蹄形或者双侧肾脏轮廓欠清晰或单侧肾脏不显影。⑵肾图检测资料：ECT测得的马蹄肾患者的GFR远远小于CKD-EPI公式估算的eGFR (GFR-eGFR=-52.0±25.0, p0.001)。⑶肾活检资料：共5例患者影像学检查确诊马蹄肾且肾活检病理诊断为肾小球病。①临床上主要表现为夜尿增多、下肢水肿、高血压及尿检异常。②尿蛋白定量均1g/24h，血肌酐正常或偏高。③影像检查明确诊断为马蹄肾，均为下极融合。④均有肾活检的适应证，没有肾脏大血管畸形等肾活检禁忌证，患者血压均控制在140/90mmHg以下，凝血功能正常；在患者签署知情同意书后，由经验丰富的医生在超声引导下用肾穿刺活检枪在“肾上极”进行肾活检；肾穿刺术后严密观察，患者没有出现术后并发症。⑤肾活检病理诊断分别为局灶节段性肾小球硬化、膜性肾病、原发性IgA肾病、过敏性紫癜肾炎（继发性IgA肾病）、狼疮肾炎。⑥根据肾活检病理结果给予相应治疗，每月随访1次，随访6个月后结果显示患者尿蛋白定量明显下降、血压及血肌酐趋于稳定。 4、结论：⑴马蹄肾在无合并症时可无症状。马蹄肾常见的合并症是肾实质病变、尿路感染、结石、肾积水。当患者出现与马蹄肾合并症相关的临床表现时，有必要进行肾脏影像检查以明确有无马蹄肾，超声诊断马蹄肾容易漏诊或者误诊，CT或者MRI是诊断马蹄肾最好的影像学检查方法。⑵ECT检测马蹄肾患者的GFR远远小于CKD-EPI公式估算的eGFR，提示ECT检测马蹄肾患者的GFR不准确。⑶肾小球病是马蹄肾的重要合并症，充分评估其肾活检的意义及风险，明确其病理类型，有助于指导治疗、延缓疾病的进展。
[Abstract]:1, objective: (1) horseshoe kidney is a common congenital renal malformation, easy to be missed or misdiagnosed. The purpose of this study is to deepen the clinicians' understanding of the clinical and imaging manifestations of horseshoe kidney and to evaluate the reliability of the radionuclide nephrigraph (ECT) for detecting the glomerular filtration rate (GFR) of horseshoe kidney patients; (2) horseshoe kidney (2) Congenital renal fusion malformation, when the horseshoe kidney is associated with glomerulopathy, because of the complications of renal puncture, little renal biopsy is carried out, so no definite pathological diagnosis can be obtained, and it is difficult to get proper treatment. In this paper, the clinical and pathological data of horseshoe kidney with glomerulopathy are summarized and analyzed in order to improve the diagnosis and treatment level.
2, method: (1) review and analyze the general situation of the patients with horseshoe kidney diagnosed from January 2008 to June 2013 at the General Hospital of PLA, first diagnosis, complication, imaging examination, comparison of the difference between GFR and CKD-EPI estimated by ECT for horseshoe kidney patients; (2) analysis of clinical data of horseshoe kidney patients receiving renal biopsy, laboratory Examination, imaging examination and pathological results of renal biopsy, and compare the blood pressure, serum creatinine, urine protein before and after the treatment of pathological results, and summarize the indications, significance, methods and precautions of renal biopsy for the kidney biopsy of the horseshoe kidney.
3, results: (1) clinical data: (1) the clinical data of 53 cases of horseshoe kidney were collected in this study, including 30 cases of male, 23 female, male: the first diagnosis of 1.3:1.. The clinical manifestations of urinary system diseases such as low back pain and abnormal urine examination were 28 cases (52.8%), and 25 cases were found by other diseases. 47.2%). (3) complication: 16 cases (30.2%) of horseshoe kidney with renal parenchyma (30.2%), 10 cases of urinary tract infection (18.9%), 10 cases of urinary calculi (18.9%), 10 cases of renal hydronephrosis (18.9%), 7 cases of renal cysts (13.2%). The horseshoe kidney was diagnosed directly by sound. 6 cases of.16 patients with horseshoe kidney were confirmed by CT after ultrasonic leak diagnosis. 15 cases of horseshoe kidney were examined (IVP), 15 cases were directly diagnosed as horseshoe kidney, 1 cases of.29 patients with.29 of horseshoe kidney confirmed by CT were examined by CT, MRI examination was performed in the patients and PET examination was performed in 2 patients. All cases were examined directly. All patients were examined directly by PET. All patients were examined directly ECT examination of.13 patients with horseshoe kidney showed that the kidney was horseshoe or bilateral renal contour was not clear or unilateral renal development. (2) renal map detection data: the GFR of horseshoe kidney patients measured by ECT was far less than eGFR (GFR-eGFR=-52.0 + 25, p0.001) estimated by CKD-EPI formula. (3) renal biopsy data: a total of 5 patients Diagnosis of horseshoe kidney and pathological diagnosis of kidney biopsy were glomerulopathy. (1) the main manifestations were the increase of nocturia, edema of the lower extremities, hypertension and abnormal urine test. (2) the urine protein was 1g/24h, the blood creatinine was normal or high. The patient's blood pressure was controlled below 140/90mmHg and the blood coagulation function was normal. After the patient signed the informed consent book, the experienced doctor took the kidney biopsy gun with the renal biopsy gun under ultrasound guidance. After the renal puncture, the patients were closely observed, and the patients did not have postoperative complications. The pathological diagnosis of renal biopsy was focal segmental glomerulosclerosis, membranous nephropathy, primary IgA nephropathy, allergic purpura nephritis (secondary IgA nephropathy), lupus nephritis. 6. The corresponding treatment was given according to the pathological results of renal biopsy, followed up 1 times a month. After 6 months of follow-up, the results showed a significant decrease in urine protein, blood pressure and creatinine. It tends to be stable.
4, conclusion: (1) the kidney of horseshoe kidney can be asymptomatic without complication. The common complication of horseshoe kidney is renal parenchyma disease, urinary tract infection, stone and hydronephrosis. It is necessary to make a renal imaging examination to clarify whether there is horseshoe kidney, and the diagnosis of horseshoe kidney is easy to be missed or misdiagnosed, CT Or MRI is the best diagnostic method for diagnosis of horseshoe kidney. (2) ECT detection of GFR of horseshoe kidney patients is far less than the eGFR of CKD-EPI formula, suggesting that ECT to detect GFR inaccuracy in horseshoe kidney patients. 3. Glomerulopathy is an important complication of horseshoe kidney. The significance and risk of renal biopsy are fully evaluated, and its pathological type is clearly defined. Treatment to delay the progress of the disease.
【学位授予单位】：中国人民解放军医学院
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R692.1

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