肾梗死:在摩洛哥拉巴特伊本西那大学医院肾内科的临床和进化方面

D. K., D. M
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简介:肾梗死是一种罕见的内科外科急诊,应在任何腰痛综合征之前引起。我们报告了两例肾梗塞的临床进展。临床观察:患者年龄分别为48岁和70岁,均因腰痛在我科住院治疗。栓塞性心脏病是两例肾梗死的主要原因。通过注射造影剂的CT扫描确定诊断。年轻患者肾功能正常,而老年患者肌酐为20mg/l, GFR为35ml/分钟,根据MDRD,肾功能不全。我们在临床和生物学上都有了改善,通过治疗性抗凝治疗,再通过抗维生素K的长期治疗,这两例患者都得到了改善,但老年人仍然存在连续性肾功能不全。结论:急性肾梗死是一种罕见的病理,必须在腰痛综合征前系统地引起。血管造影注射造影剂可以做出诊断。在单侧受累的情况下,有效剂量的肝素化治疗是主要的治疗方法,如果双侧受累则手术治疗。
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Renal Infarction: Clinical and Evolutionary Aspects in the Nephrology Department Ibn Sina University Hospital of Rabat-Morocco
Introduction: Renal infraction is a rare medical-surgical emergency that should be evoked before any lumbar pain syndrome. We report in this work, two cases of renal infraction with their clinical evolution. Clinical observation: These patients, aged respectively 48 and 70 years, were hospitalized in our department concomitant for low back pain. Emboligenic heart disease was responsible for the renal infraction in both cases. Diagnostic certainty was established by a CT scan with injection of contrast medium. Renal function was normal in the young patient versus renal insufficiency at 20mg/l creatinine for a GFR estimated at 35ml/minute according to MDRD in the elderly patient. We had a clinical and biological improvement with a curative anticoagulant treatment relayed by a long term treatment with an anti vitamin K in both cases but the elderly man kept a sequential renal insufficiency. Conclusion: Acute renal infarction is a rare pathology which must be systematically evoked in front of a lumbar pain syndrome. Angioscan with injection of contrast medium allows to make the diagnosis. Heparinization at an effective dose is the mainstay of treatment in the case of unilateral involvement, or surgery if bilateral.
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