以一位第一型糖尿病病人為例討論腎臟切片之現行適應症與禁忌症

Discussion on Current Consensus and Ambiguity of Renal Biopsy Based on the Case of a Male Patient with Type 1 Diabetic Nephropathy

本個案為37歲男性，患第一型糖尿病及糖尿病腎病變，一年內腎功能逐漸下降、並出現噁心及食慾減退等尿毒症狀，經家庭醫學科醫師轉介腎臟科門診，進行腎臟切片之適應症評估與透析準備。本個案報告從第一型糖尿病腎病變之自然史進而探討現今腎臟切片適應症及禁忌症的共識，以期第一線醫師對有需要經腎臟切片診斷、且能受益於此的族群有所覺察並適時轉介。

A 37-year-old man with type 1 diabetes and diabetic nephropathy was followed at a family medicine clinic. His renal function had declined in the past year while uremic symptoms of nausea and anorexia also developed. As causes other than diabetes leading to deterioration of his renal function were suspected, he was referred to a renal specialist for discussion on receiving renal biopsy. After initial assessment with serology tests, sonography, as well as follow-up serum creatinine and blood urea nitrogen, renal biopsy was deferred given the chronicity of his condition and the inevitability of dialysis at the point. Current consensus and ambiguity concerning indications and contraindications of renal biopsy were examined via the case. Family medicine doctors are front-line physicians who should be able to detect the slightest change in manifestation of patients’ renal function. The importance of timely referral in yielding greatest possible benefits from renal biopsy for patients in need should be emphasized.