小结
定义
病史和体格检查
关键诊断因素
- 尿量减少
- 咯血
- 水肿
其他诊断因素
- 男性
- 20至30岁或60至70岁
- 呼吸短促
- 咳嗽
- 发热
- 恶心
- 肺部听诊湿啰音
危险因素
- HLA-DRB1或DR4
- 吸烟
- 碳氢化合物、有机溶剂、重金属暴露
- 碎石术治疗史
- 近期呼吸道感染
- 免疫治疗
- Alport 综合征患者肾移植后
诊断性检查
首要检查
- 肾功能检查
- 肾脏活检
- 抗肾小球基底膜(抗-GBM)抗体滴度
- 抗中性粒细胞胞质抗体 (ANCA)
- 血清补体(C3和C4)
- 抗核抗体
- 冷球蛋白
- 肝炎病毒检测
- 抗链球菌溶血素O滴度
- 凝血筛查
治疗流程
疑似急进性肾小球肾炎
可逆性肾病或任何肺部受累
可逆性肾病且无肺部受累证据
初始治疗无应答
撰稿人
作者
Tingting Li, MD, MSCI, FASN
Professor of Medicine
Director, Glomerular Diseases Program
Division of Nephrology
Washington University School of Medicine in St Louis
St Louis
MO
利益声明
TL receives research support from Travere Therapeutics, Genentech, Omeros Corporation, and the US NIH/NIAID, and reports consultancy agreements with ChemoCentryx, Travere Therapeutics, Aurinia Pharmaceuticals, Calliditas Therapeutics, and GlaxoSmithKline.
Christina Mariyam Joy, MD
Assistant Professor of Medicine
Division of Nephrology
Froedtert and Medical College of Wisconsin
Milwaukee
WI
利益声明
CMJ declares that she has no competing interests.
鸣谢
Dr Tingting Li and Dr Christina Mariyam Joy would like to gratefully acknowledge Dr Richard G. Phelps, Professor Andre A. Kaplan and Dr Michael S. Gersch, previous contributors to this topic. RGP and MSG declare that they have no competing interests. AAK has received honoraria in 2013 to speak about plasma exchange from Gambro and Alexion (Gambro manufactures products for plasma exchange and Alexion manufactures a complement cascade inhibitor).
同行评议者
Dorin-Bogdan Borza, PhD
Assistant Professor of Medicine
Division of Nephrology
Department of Medicine
Vanderbilt University School of Medicine
Nashville
TN
利益声明
DBB declares that she has no competing interests.
鉴别诊断
- 系统性红斑狼疮
- 肉芽肿性多血管炎（韦格纳肉芽肿）
- 显微镜下多发性血管炎
更多 鉴别诊断指南
- 肾小球肾炎临床实践指南
- 治疗性单采术在临床实践中的使用
更多 指南
登录或订阅即可浏览 BMJ Best Practice 临床实践完整内容
内容使用需遵循免责声明