[申覆] 醫學(三) 23
23.一位56歲男性因噁心、食慾不佳3天，至急診處就診。
病人無糖尿病史。生化檢查發現BUN118 mg/dL，肌酐 8.1 mg/dL。下列有關此病人是急性或
慢性腎衰竭的診斷，
那一項比較具鑑別診斷價值？
A)病人下肢有明顯水腫
B)病人的血紅素為 8 g/dL
C)病人的尿液有蛋白 300 mg/dL，以及高倍鏡下有 15-25 RBC
D)病人的血清鈣 1.95 mmol/L，磷離子 7.0 mg/dL，鉀離子 6.0 mmol/L
Harrison p.1755
The first step in evaluating a patient with renal failure is to determine if
the disease is acute or chronic. If review of laboratory records demonstrates
that the rise in blood urea nitrogen and creatinine is recent, this suggests
that the process is acute. However, previous measurements are not always
available. Findings that suggest chronic kidney disease (Chap. 274) include
anemia, evidence of renal osteodystrophy (radiologic or laboratory), and small
scarred kidneys. However, anemia may also complicate ARF (see below), and renal
size may be normal or increased in several chronic renal diseases (e.g.,
diabetic nephropathy, amyloidosis, polycystic kidney disease, HIV associated
nephropathy). Once a diagnosis of ARF has been established, the etiology of ARF
needs to be determined. Depending on the cause, specific therapies may need to
be instituted. If the etiology is felt to be an exogenous nephrotoxin (often a
medication), the nephrotoxin should be eliminated or discontinued. Lastly, the
prevention and management of complications should be instituted.
建議:B,D 都給分
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