老年人肾脏萎缩30例临床病理分析

目的回顾性分析30例经尸检证实的单侧或双侧肾脏明显萎缩的老年患者临床病理资料,分析患者年龄、原发疾病、肾脏大小、并发冠心病的情况以及最终死亡原因,以期指导临床诊治。方法选择1980年1月至2005年12月在我院有完整尸检病理结果和临床资料的30例患者。结果30例患者高血压发生率最高,糖尿病其次,前列腺肥大第三。患者的肾脏重量与血清肌酐呈负相关,心脏重量和冠脉血管病变呈负相关。8例患者有单侧肾动脉狭窄,24例可见肾脏皮质变薄,小球数目减少,部分肾小球纤维化或玻璃样变;小管细胞萎缩,部分小管扩张,管腔内有透明管型;可见病变部位间质纤维化,有淋巴细胞浸润,肾小动脉壁增厚及玻璃样变。14例患者死于尿毒症晚期的各种并发症,如心力衰竭、感染、呼吸衰竭、出血性休克等,其余患者死于恶性肿瘤、急性心肌梗死、严重心律失常、脑血管病。结论单肾或双肾萎缩,肾脏重量与血清肌酐呈负相关,心脏重量和冠脉血管病变呈负相关,半数以上患者死于心脑血管疾病。

Clinical and pathological analysis of 30 elderly patients of single or bilateral renal atrophy

Objective To retrospectively analysis of 30 elderly patients of single or bilateral renal atrophy approved by cadaver examination,and investigate the primary diseases,the weight of kidney,heart complicated with coronary disease and the cause of death.Methods From Jan 1980 to Dec 2005.The cadaver pathdogical and clinical data of 30 elderly patients were collected and analyzed.case(age 67-99) whose cadaver pathological results and clinical data were completed,bilateral renal weight below 250g or one side of renal artery showed stenosis were selected for observing the correlation of age,primary disease,weight of kidney and heart,coronary pathological changes,the causes of death and characteristic of renal pathological changes.Results The incident of hypertension among the patients was highest,diabetes mellitus was the second and prostate hypertrophy,the third.The weight of kidney was correlated with serum creatinine and the weight of heart with coronary vascular pathological changes.Other variable were not correlated with each others.Renal artery stenosis of one side were reported in 8 cases.14 patients died of complications of terminal stage of uremia,others died of malignancy,acute myocardial infarction,severe arrhythmia and stroke.Conclusions The weight of single or bilateral renal atrophy is negative correlation with serum creatinine,so doweight of heart with coronary vascular pathological changes,more than half of patients died of cardio-cerebrovascular diseases.