23.一位56岁男性因恶心、食慾不佳3天，至急诊处就诊。 病人无糖尿病史。生化检查发现BUN118 mg/dL，肌酐 8.1 mg/dL。下列有关此病人是急性或 慢性肾衰竭的诊断， 那一项比较具监别诊断价值？ A)病人下肢有明显水肿 B)病人的血红素为 8 g/dL C)病人的尿液有蛋白 300 mg/dL，以及高倍镜下有 15-25 RBC D)病人的血清钙 1.95 mmol/L，磷离子 7.0 mg/dL，钾离子 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. 建议:B,D 都给分 --

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