1例难治性复杂性泌尿系感染患者的诊疗体会

田晓彤; 刘正印; 李太生; 张黎

doi:10.16766/j.cnki.issn.1674-4152.004475

1例难治性复杂性泌尿系感染患者的诊疗体会

doi: 10.16766/j.cnki.issn.1674-4152.004475

田晓彤^{1, 2},
刘正印²,
李太生²,
张黎^2, ,

1.
中国医学科学院/北京协和医学院/北京协和医院全科医学科, 北京 100006
2.
中国医学科学院/北京协和医学院/北京协和医院感染内科, 北京 100006

基金项目:

北京协和医院高水平医院临床科研专项 2022-PUMCH-B-043

详细信息

通讯作者:
张黎，E-mail: zhangli36@pumch.cn

中图分类号: R691.3
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- 被引次数: 0
出版历程
- 收稿日期: 2025-09-29

An experience in the diagnosis and treatment of difficult-to-treat complicated urinary tract infection

1.
Department of General Practice, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100006, China

摘要

摘要: 患者, 女性，29岁。临床以反复发热、腰痛、脓尿和肾区包块为主要表现，影像学提示右肾结构异常，呈“熊掌征”，存在鹿角形或长条形结石；肾血流功能显像提示右肾无功能。予充分抗感染治疗后患者仍间断排脓尿，伴炎症指标轻度增加。复习文献及请专科医师会诊，最终制定了以根治性右肾切除术为主的治疗方案。组织病理确诊为黄色肉芽肿性肾盂肾炎(xanthogranulomatous pyelonephritis，XGP)，明确了疾病诊断。6个月后随访预后好。本文总结XGP的诊断要点，旨在提高全科医生对XGP的认识，使XGP患者尽早得到诊断、治疗和康复。
- 黄色肉芽肿性肾盂肾炎 /
- 脓尿 /
- 熊掌肾
Abstract: A 29-year-old female presented with recurrent fever, lumbar pain, pyuria, and renal masses. Imaging revealed structural abnormalities of the right kidney, demonstrating the classical "Bear's Paw sign", with angular or linear calculi. Renal hemodynamic scintigraphy suggested that the right kidney was non-functional. Despite adequate anti-infective treatment, the patient continued to exhibit persistent pyuria with mildly increased inflammatory markers. Reviewing the literature and consulting multidisciplinary specialists, a therapeutic regimen centered on radical right nephrectomy was ultimately determined. Histopathology identified xanthogranulomatous pyelonephritis (XGP), establishing the final diagnosis. The prognosis of XGP was improved over a 6-month follow-up period. This study summarizes the key points of XGP diagnosis to improve the general physicians' awareness, facilitating earlier diagnosis, treatment, and rehabilitation.
- Xanthogranulomatous pyelonephritis /
- Pyuria /
- Bear's paw kidney
利益冲突 无

HTML全文

图 1 患者血WBC、Hb、Cr以及CRP变化

Figure 1. Changes in blood WBC, Hb, Cr, and CRP of the patient

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图 2 患者泌尿系结构参数变化

Figure 2. Changes in urinary system structural parameters of the patient

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图 3 患者肾脏CT

Figure 3. Renal CT of the patient

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参考文献(14)

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