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发生于肾病综合征(NS)的急性肾衰(ARF)临床罕见,然而预后可能很严重,常发生不可逆性肾衰,甚至死亡。作者报告4例患者,描述了其临床特征,探讨其可能的发病机理,提出可行的治疗措施。男女各2例,年龄29～74岁,3例病理类型为肾小球微小病变(MCN),1例为膜增殖型肾小球肾炎(MPGN),临床表现为NS,发生ARF时,除无尿、BUN和Scr明显升高以外,均有低尿钠(分别为10、12、4、20mmol/L)和低FENa(分别为0.4、0.04、0.16、0.08%)。静脉应用白蛋白(25～50g/d)及小量速尿(20～100mg/d)无效,且1例(MCN)死于败血症。其余3例加大速尿剂量到500～600mg/d后(1例同时口服强的松龙50mg/d,2例出现利尿时口服强的松龙60mg/d)产生利尿,肾功能逐渐恢复正
Acute renal failure (ARF) occurring in nephrotic syndrome (NS) is clinically rare, however, the prognosis may be severe and irreversible renal failure often occurs and even death occurs. The authors report 4 patients, described the clinical features, explore its possible pathogenesis, put forward feasible treatment. There were 2 males and 2 females, aged from 29 to 74 years old. The pathological types of 3 were pathologic type of glomerular disease (MCN), 1 case of proliferative glomerulonephritis (MPGN). The clinical manifestations were NS. When ARF occurred, Urine, BUN, and Scr were significantly elevated except for low urinary sodium (10, 12, 4, 20 mmol / L, respectively) and low FENa (0.4, 0.04, 0.16, 0.08%, respectively). Intravenous albumin (25 ~ 50g / d) and a small amount of furosemide (20 ~ 100mg / d) is invalid, and 1 case (MCN) died of sepsis. The remaining three cases increased diuretic dose to 500 ~ 600mg / d (1 case of simultaneous oral prednisolone 50mg / d, 2 cases of diuretic oral prednisolone 60mg / d) diuretic, renal function gradually recovered positive