妊娠合并急性肾功能衰竭

doi:10.3877/cma.j.issn.2095-3259.2016.02.002

妊娠合并急性肾功能衰竭病因复杂、母婴病死率高。妊娠期肾功能容易受到损伤，了解妊娠期相关的生理改变和妊娠合并急性肾功能衰竭的常见病因，有助于快速、准确地发现诱发因素，同时积极处理，才能有效阻止疾病恶化，改善母胎预后。本文将从病因、诊断及治疗等方面对妊娠合并急性肾功能衰竭进行阐述。

关键词: 肾功能衰竭，急性, 肾功能试验, 妊娠，高危

Acute renal failure in pregnancy is complex causes, and with high maternal-fetal mortality. Renal is vulnerable to injury during pregnancy. Distinguish physiological changes related to pregnancy and the common etiologies of renal failure in pregnancy are helpful to find the predisposing factors quickly and accurately. Disease progression can be effectively prevented by active interventions and the maternal-fetal prognosis can be improved. This article will elaborate on the etiology, diagnosis and treatment of acute renal failure in pregnancy.

Key words: Kidney failure, acute, Kidney function tests, Pregnancy, high-risk

表1 妊娠合并急性肾功能衰竭病因分类

病因分类	与妊娠相关	与妊娠无关
肾前性	1.出血(胎盘早剥、前置胎盘、子宫收缩乏力、子宫破裂、术中出血、产后出血等)	1.大出血(外伤等)
?	2．呕吐(子痫前期、HELLP综合征、AFLP、妊娠剧吐)	2．肾盂肾炎
?	3．感染(感染性流产、绒毛膜炎等)	3．利尿剂
?	?	4．充血性心力衰竭
?	?	5．呕吐(脓血症、胃肠炎等)
肾性	1.ATN、ACN(子痫前期、HELLP综合征、AFLP、羊水栓塞)	1.ATN
?	2．TMA(TTP、HUS、子痫前期、HELLP综合征、AFLP、DIC)	2．原发性或继发肾小球疾病
?	?	3．急性间质性肾炎、肾毒性药物
肾后性	1.极少数情况下压迫可导致双侧积水	1.双侧输尿管梗阻(结石、肿瘤等)
?	2．医源性膀胱和输尿管损伤	2．肾小管阻塞(尿酸结晶)

表1 妊娠合并急性肾功能衰竭病因分类

病因分类	与妊娠相关	与妊娠无关
肾前性	1.出血(胎盘早剥、前置胎盘、子宫收缩乏力、子宫破裂、术中出血、产后出血等)	1.大出血(外伤等)
?	2．呕吐(子痫前期、HELLP综合征、AFLP、妊娠剧吐)	2．肾盂肾炎
?	3．感染(感染性流产、绒毛膜炎等)	3．利尿剂
?	?	4．充血性心力衰竭
?	?	5．呕吐(脓血症、胃肠炎等)
肾性	1.ATN、ACN(子痫前期、HELLP综合征、AFLP、羊水栓塞)	1.ATN
?	2．TMA(TTP、HUS、子痫前期、HELLP综合征、AFLP、DIC)	2．原发性或继发肾小球疾病
?	?	3．急性间质性肾炎、肾毒性药物
肾后性	1.极少数情况下压迫可导致双侧积水	1.双侧输尿管梗阻(结石、肿瘤等)
?	2．医源性膀胱和输尿管损伤	2．肾小管阻塞(尿酸结晶)

表2 急性肾功能损伤的分期诊断标准^[14]

分期	血清肌酐标准	尿量标准
1期	相对升高≥50%或绝对升高≥0.3 mg/dl	<0.5 ml/(kg·h)(时间>6 h)
2期	相对升高>200%～300%	<0.5 ml/(kg·h)(时间>12 h)
3期	相对升高>300%，或绝对升高≥4.0 mg/dl且急性升高≥0.5 mg/dl	少尿[<0.3 ml/(kg·h)]>24 h或无尿>12 h

表2 急性肾功能损伤的分期诊断标准^[14]

分期	血清肌酐标准	尿量标准
1期	相对升高≥50%或绝对升高≥0.3 mg/dl	<0.5 ml/(kg·h)(时间>6 h)
2期	相对升高>200%～300%	<0.5 ml/(kg·h)(时间>12 h)
3期	相对升高>300%，或绝对升高≥4.0 mg/dl且急性升高≥0.5 mg/dl	少尿[<0.3 ml/(kg·h)]>24 h或无尿>12 h

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