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肾梗死

Author
Jai Radhakrishnan, MD, MS
Section Editor
Paul M Palevsky, MD
Deputy Editor
Alice M Sheridan, MD
Translators
弓孟春, 主治医师

引言

肾梗死较罕见[1-7]。在一项发表于1940年的针对14,411例尸检结果的研究中，肾梗死的发病率为1.4%[6]。后来的一项病例系列研究纳入了差不多250,000例于4年间就诊于某急诊科的患者，发现仅17例(0.007%)被诊断为急性肾梗死[7]。

肾梗死的发生频率很可能高于上述研究所报道的，因为肾梗死的临床诊断经常被漏掉或延误，这是由于患者因腹痛或腰痛而就诊时这些症状酷似其他更为常见的疾病，如肾结石和肾盂肾炎。 (参见下文‘临床表现’)

肾梗死的两种主要病因是血栓栓塞和原位血栓形成，前者通常源自心脏或主动脉的血栓，而后者则可能导致肾动脉主干或肾段分支动脉的完全闭塞[1,7]。动脉粥样硬化栓子的肾脏表现是不同的，因为动脉粥样硬化栓子通常不会扩大、形状不规则且体积较小，往往造成更远端的动脉的不完全闭塞，伴有继发性缺血性萎缩，而非肾梗死。 (参见“肾动脉粥样硬化栓子的临床表现、评估和治疗”，关于‘肾损伤’一节)

血栓栓塞性肾梗死将总结在此。来自心脏的栓塞的主要来源、来自主动脉斑块的血栓栓塞和动脉粥样硬化性栓塞性疾病的临床表现将单独讨论。 (参见“超声心动图在心源性和主动脉源性体循环栓塞检测中的作用”和“主动脉斑块导致的栓塞：血栓栓塞”和“动脉粥样硬化斑块导致的栓塞：动脉粥样硬化栓塞(胆固醇结晶栓塞)”)

病因与发病机制

肾梗死的主要病因包括心房颤动和肾动脉损伤[1,3,5]。已发表的最大型病例系列研究纳入了在1989-2011年间被诊断为肾梗死的94例患者，记录到以下研究结果[1]：

                

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Literature review current through: 2017-06 . | This topic last updated: 2017-01-06.
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