临床误诊误治

目的 分析原发性肾病综合征误诊为甲状腺功能减退症（甲减）的原因，以提升诊治水平。方法 对2022年2月至2023年12月收治的曾误诊为甲减的4例原发性肾病综合征患者的临床表现、实验室及影像学资料进行回顾分析。结果 4例患者中，1例表现为面部及下肢水肿、全身乏力，1例表现为食欲缺乏、便秘、活动后气促，1例表现为乏力、食欲下降，1例表现为口渴、乏力及双下肢、面部水肿，体质量均增加，尿蛋白均升高，甲状腺功能检查示4例三碘甲状腺原氨酸及甲状腺素降低，2例血脂升高，初步诊断为甲减，予对症治疗后病情无好转，后经肾活检确诊为原发性肾病综合征。误诊时间为15～21 d。确诊后予泼尼松、环磷酰胺和（或）他克莫司治疗，水肿明显消退，各项检测指标好转，临床症状改善，随访1年未见复发。结论 原发性肾病综合征患者因并发症表现就诊时，其原发疾病往往被非专科医师忽视，从而导致误诊。医务人员应提升专业知识水平，规范诊疗流程，加强对肾穿刺病理诊断的重视，以减少因误诊带来的不必要医疗负担和并发症风险。

Objective To analyze the causes of misdiagnosis of primary nephrotic syndrome(PNS) as hypothyroidism,in order to improve the diagnosis and treatment. Methods A retrospective analysis was conducted on the clinical manifestations,laboratory and imaging data of 4 patients with primary nephrotic syndrome who were initially misdiagnosed as hypothyroidism and admitted from February 2022 to December 2023. Results Among the 4 patients, 1 patient presented with facial and lower extremity edema and general weakness, 1 patient with anorexia, constipation and shortness of breath after activity, 1 patient with weakness and decreased appetite and 1 patient with thirst, weakness and edema of both lower extremities and face. The body weight increased in all patients, and the urine protein increased in all patients. Thyroid function tests showed decreased triiodothyronine and thyroxine in 4 patients, who also had elevated blood lipid levels, therefore, they were initially diagnosed with hypothyroidism. After symptomatic treatment, the condition did not improve. Afterwards, it was confirmed as PNS through renal biopsy. The misdiagnosis lasted 15 to 21 d. After diagnosis, Prednisone, Cyclophosphamide and/or Tacrolimus were administered. The edema subsided significantly, various test indicators improved, clinical symptoms improved, and no recurrence was observed during the 1-year follow-up. Conclusion When patients with PNS seek medical treatment due to complications, their primary diseases are often ignored by non-specialist physicians, resulting in misdiagnosis. Medical staff should enhance their professional knowledge level,standardize the diagnosis and treatment process, and attach greater importance to the pathological diagnosis of renal biopsy, so as to reduce the unnecessary medical burden and complication risk caused by misdiagnosis.