本文選題：馬蹄腎 + 影像學(xué)檢查�。� 參考：《中國(guó)人民解放軍醫(yī)學(xué)院》2014年碩士論文

【摘要】：1、目的：⑴馬蹄腎是一種常見(jiàn)的先天性腎臟發(fā)育畸形，容易被漏診或者誤診。本研究的目的是加深臨床醫(yī)生對(duì)馬蹄腎臨床和影像表現(xiàn)的認(rèn)識(shí)，并評(píng)價(jià)放射性核素腎圖（ECT）用于檢測(cè)馬蹄腎患者的腎小球?yàn)V過(guò)率（GFR）的可靠性；⑵馬蹄腎是先天性腎臟融合畸形，馬蹄腎合并腎小球病時(shí)，由于擔(dān)心腎穿刺術(shù)后并發(fā)癥，很少進(jìn)行腎活檢，從而得不到明確的病理診斷，難以得到應(yīng)有的正確治療。本文通過(guò)總結(jié)分析馬蹄腎合并腎小球病的臨床病理資料，旨在提高其診斷與治療水平。 2、方法：⑴回顧分析2008年1月至2013年6月在解放軍總醫(yī)院確診為馬蹄腎患者的一般情況、首診表現(xiàn)、合并癥、影像學(xué)檢查結(jié)果，比較ECT檢測(cè)的馬蹄腎患者的GFR及CKD-EPI估算的eGFR的差別；⑵分析接受腎活檢的馬蹄腎患者的臨床資料、實(shí)驗(yàn)室檢查、影像學(xué)檢查及腎活檢的病理結(jié)果，并比較根據(jù)病理結(jié)果治療前后患者的血壓、血肌酐、尿蛋白定量等；歸納總結(jié)對(duì)馬蹄腎行腎活檢的適應(yīng)證、意義、方法及腎穿刺注意事項(xiàng)。 3、結(jié)果：⑴臨床資料：①本研究共收集53例馬蹄腎患者的臨床資料，其中男性30例、女性23例，男：女約為1.3：1。②首診時(shí)表現(xiàn)：以腰痛、尿檢異常等泌尿系統(tǒng)疾病相關(guān)臨床表現(xiàn)為主訴就診的28例（52.8%）；體檢或因其他疾病意外發(fā)現(xiàn)的25例（47.2%）。③合并癥：馬蹄腎合并腎實(shí)質(zhì)病變(表現(xiàn)為血尿或/和蛋白尿及腎功能不全)16例（30.2%），尿路感染10例（18.9%），泌尿系結(jié)石10例（18.9%），腎積水10例（18.9%），腎囊腫7例(13.2%）。④影像學(xué)檢查：25位患者進(jìn)行了腹部超聲檢查。其中19例患者通過(guò)超聲直接診斷了馬蹄腎，6例患者被超聲漏診后經(jīng)CT確診馬蹄腎。16例患者接受了靜脈腎盂造影檢查(IVP),15例患者直接診斷了馬蹄腎，1例被漏診后經(jīng)CT確診馬蹄腎。29例患者進(jìn)行了CT檢查，10例患者進(jìn)行了MRI檢查，2例患者進(jìn)行了PET檢查，，均直接診斷馬蹄腎。13例患者進(jìn)行了ECT檢查，可見(jiàn)患者腎臟呈馬蹄形或者雙側(cè)腎臟輪廓欠清晰或單側(cè)腎臟不顯影。⑵腎圖檢測(cè)資料：ECT測(cè)得的馬蹄腎患者的GFR遠(yuǎn)遠(yuǎn)小于CKD-EPI公式估算的eGFR (GFR-eGFR=-52.0±25.0, p0.001)。⑶腎活檢資料：共5例患者影像學(xué)檢查確診馬蹄腎且腎活檢病理診斷為腎小球病。①臨床上主要表現(xiàn)為夜尿增多、下肢水腫、高血壓及尿檢異常。②尿蛋白定量均1g/24h，血肌酐正�；蚱摺＂塾跋駲z查明確診斷為馬蹄腎，均為下極融合。④均有腎活檢的適應(yīng)證，沒(méi)有腎臟大血管畸形等腎活檢禁忌證，患者血壓均控制在140/90mmHg以下，凝血功能正常；在患者簽署知情同意書后，由經(jīng)驗(yàn)豐富的醫(yī)生在超聲引導(dǎo)下用腎穿刺活檢槍在“腎上極”進(jìn)行腎活檢；腎穿刺術(shù)后嚴(yán)密觀察，患者沒(méi)有出現(xiàn)術(shù)后并發(fā)癥。⑤腎活檢病理診斷分別為局灶節(jié)段性腎小球硬化、膜性腎病、原發(fā)性IgA腎病、過(guò)敏性紫癜腎炎（繼發(fā)性IgA腎病）、狼瘡腎炎。⑥根據(jù)腎活檢病理結(jié)果給予相應(yīng)治療，每月隨訪1次，隨訪6個(gè)月后結(jié)果顯示患者尿蛋白定量明顯下降、血壓及血肌酐趨于穩(wěn)定。 4、結(jié)論：⑴馬蹄腎在無(wú)合并癥時(shí)可無(wú)癥狀。馬蹄腎常見(jiàn)的合并癥是腎實(shí)質(zhì)病變、尿路感染、結(jié)石、腎積水。當(dāng)患者出現(xiàn)與馬蹄腎合并癥相關(guān)的臨床表現(xiàn)時(shí)，有必要進(jìn)行腎臟影像檢查以明確有無(wú)馬蹄腎，超聲診斷馬蹄腎容易漏診或者誤診，CT或者M(jìn)RI是診斷馬蹄腎最好的影像學(xué)檢查方法。⑵ECT檢測(cè)馬蹄腎患者的GFR遠(yuǎn)遠(yuǎn)小于CKD-EPI公式估算的eGFR，提示ECT檢測(cè)馬蹄腎患者的GFR不準(zhǔn)確。⑶腎小球病是馬蹄腎的重要合并癥，充分評(píng)估其腎活檢的意義及風(fēng)險(xiǎn)，明確其病理類型，有助于指導(dǎo)治療、延緩疾病的進(jìn)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.
【學(xué)位授予單位】：中國(guó)人民解放軍醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R692.1

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