[Misdiagnosis of acute renal failure and the clinical significance of renal biopsy].

OBJECTIVE

To improve the diagnostic accuracy of acute renal failure (ARF) by analyzing the causes of misdiagnosis.

METHODS

To compare the correlation between admission and final diagnoses, find the possible causes of misdiagnosis and summarize the influence of early diagnosis and treatment on prognosis.

RESULTS

In 111 ARF patients, only 67.6% (75/111) was diagnosed as ARF before admission; 14.4% (16/111) was misdiagnosed as chronic renal failure (CRF); 18.0% (20/111) as renal tumor, urinary lithiasis and hematuria or proteinuria of unknown origin. Renal biopsy was performed in 69 cases. Diagnosis was corrected in 21.7% (15/69) of the cases and the method of treatment was changed in 56.5% (39/69) cases after biopsy.

CONCLUSION

It is showed that some cases of ARF were misdiagnosed as CRF. The size of the kidney and finger nail creatinine level would be helpful in the differentiation of CRF and ARF. The difficulty in establishing the causes of ARF is the differentiation between acute glomerulonephritis and rapidly progressive glomerulonephritis (RPGN), acute tubular necrosis (ATN) and acute interstitial nephritis (AIN). ATN or AIN with chronic glomerulonephritis may be confused with RPGN. When there is difficulty in differentiation, renal biopsy should be performed as soon as possible.