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男33岁。因颜面及下肢浮肿伴腹胀、尿少一周入院。查体:T、P、R均正常,BP22/14kPa,颜面浮肿,双下肢轻度水肿,心肺无异常所见。实验室检查:Hb105g/L;总蛋白50g/L,A22g/L,G28g/L;BUN、SCr正常;尿蛋白((?))。给予降压、利尿治疗,4天后浮肿消退。因再次感冒,病情加重,尿量锐减,双下肢又浮肿,并出现胸、腹水。B超示:双肾体积增大,左14cm×6cm,右12.2cm×5.8cm,肾实质2.8cm。尿常规:尿糖((?)),蛋白((?)),复粒细胞((?)),WBC4～6/HP,RBC2～3/HP,腊状管型(++),BUN15.4mmol/L,SCr774μmol/L。查SDS—PAGE高中分子蛋白尿.尿比重1.008～1.010,尿钠135mmol/24h,肾衰指数>2。诊断:肾病综合征Ⅱ型并急性肾小管坏死,继发性范可尼氏综合征,继发
Male 33 years old. Due to facial and lower limb edema with abdominal distension, less urine a week hospitalization. Physical examination: T, P, R are normal, BP22 / 14kPa, facial edema, mild lower extremity edema, no abnormal heart and lung see. Laboratory tests: Hb105g / L; total protein 50g / L, A22g / L, G28g / L; BUN, SCr normal; urine protein ((? Given antihypertensive, diuretic treatment, edema subsided after 4 days. Due to another cold, aggravating, sharp drop in urine output, both lower extremities and edema, and chest, ascites. B ultrasound showed: increased renal volume, left 14cm × 6cm, right 12.2cm × 5.8cm, renal parenchyma 2.8cm. Urine: urine (protein), protein (?), Multiple myeloid cells (WBC), WBC4-6 / HP, RBC2-3 / HP, waxy tubes (++) and BUN15. 4mmol / L, SCr774μmol / L. Check SDS-PAGE high school proteinuria urine specific gravity 1.008 ~ 1.010, urinary sodium 135mmol / 24h, renal failure index> Diagnosis: nephrotic syndrome type Ⅱ and acute tubular necrosis, secondary Fanconi’s syndrome, secondary