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目的 分析高血压肾病误诊为痛风性肾病的原因，并探讨其防范措施，以提高临床医师的鉴别诊断能力，减少误诊的发生。方法 回顾分析2021年1月至2023年12月收治的初诊被误诊为痛风性肾病的高血压肾病2例患者的临床资料。结果 1例因双膝及足部关节疼痛和高血尿酸被误诊为痛风性肾病，接受非甾体类抗炎药和别嘌呤醇治疗但效果不佳；转肾内科后发现蛋白尿（++）、尿微量白蛋白增高及肾皮质轻度变薄，最终确诊为高血压肾病，误诊时间1周。确诊后改用依那普利和低盐低蛋白饮食治疗，随访6个月血压稳定、肾功能好转、症状消失。1例因持续腰部钝痛及双膝剧烈疼痛伴高尿酸血症被误诊为痛风性肾病，接受萘普生和别嘌呤醇治疗但效果不佳；转肾内科经尿常规和影像学等检查，发现肾小球损伤特征，确诊为高血压肾病，误诊时间1周。确诊后治疗方案调整为氯沙坦及低嘌呤饮食，随访6个月症状消失、肾功能稳定。结论 高血压肾病症状复杂，易与痛风性肾病混淆。临床医生在遇到类似患者时，应详细询问病史，特别是有无高血压病史，须结合实验室及影像学检查进行综合判断，以降低误诊风险。
Abstract：Objective To analyze the causes of misdiagnosis of hypertensive nephropathy as gouty nephropathy and to explore its preventive measures, in order to improve the differential diagnosis ability of clinicians and reduce the occurrence of misdiagnosis. Methods A retrospective analysis was conducted on the clinical data of 2 patients with hypertensive nephropathy who were initially misdiagnosed as gouty nephropathy and admitted from January 2021 to December 2023. Results One patient was misdiagnosed with gouty nephropathy due to joint pain in both knees and feet and hyperuricemia, and received treatment with non-steroidal anti-inflammatory drugs and Allopurinol, but the effect was not good. After being transferred to the Nephrology Department, proteinuria(++), increased urinary microalbumin and mild thinning of the renal cortex were found. Eventually, the patient was diagnosed with hypertensive nephropathy. The misdiagnosis lasted one week. After diagnosis, Enalapril and a low-salt and lowprotein diet were adopted for treatment. During the 6-month follow-up, the blood pressure was stable, the renal function improved,and the symptoms disappeared. One patient was misdiagnosed with gouty nephropathy due to persistent dull pain in the waist and severe pain in both knees accompanied by hyperuricemia. After treatment with naproxen and allopurinol, the effect was far fro msatisfactory. After being transferred to the Nephrology Department and undergoing examinations such as urine routine and imaging,the characteristics of glomerular injury were found, and it was diagnosed as hypertensive nephropathy. The misdiagnosis lasted one week. After diagnosis, the treatment plan was adjusted to Losartan and a low-purine diet. During the 6-month follow-up, the symptoms disappeared and renal function remained stable. Conclusion The symptoms of hypertensive nephropathy are complex and easily confused with gouty nephropathy. When clinicians encounter similar patients, they should inquire about the medical history in detail, especially whether there is a history of hypertension. A comprehensive judgment should be made in combination with laboratory and imaging examinations to reduce the risk of misdiagnosis.
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基本信息:
DOI：
中图分类号:R692;R544.1
引用信息:
[1]蓝青,于昊伟.高血压肾病误诊痛风性肾病原因及防范措施分析[J].临床误诊误治,2025,38(11):10-14.
基金信息:
河北省中医药管理局科技计划项目（2021463）