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男性,38岁。患者一年前无明显诱因出现面部和双下肢浮肿,因时轻和休息后好转并未在意。后渐明显,并伴有头昏眼花,皮乏无力,腰痛,难以坚持工作而就诊,发现蛋白尿和血尿(显微镜下),当时查肾功能正常,肾B肾脏大小形态正常。无肉眼血尿,无发热、关节痛、皮疹。主要采用中草药治疗,仅浮肿有时减轻,其他症状均无改善。期间3次因呼吸道感染而诱发浮肿加重及肾功能损害,经抗生素治疗好转。既往身体健康,无肾病家族史。 体格检查:体温36.5 °C,脉搏88/min,呼吸16/min,血压160/100mmHg。轻度贫血貌,未见皮疹。浅表淋巴结不大,面部及双下肢浮肿,眼和耳正常。双肺正常,心界不大,心率88/min,律齐,无杂音。肝胆脾均未发现异常,双肾区叩痛阳性。 辅助检查:血常规Hb92g/L,WBC3.8x109/L,PTL96x109/L。尿常规PRO2+,RBC+,WBC 0—3/H.pyori,见透明和颗粒管型。24小时尿蛋白定量1.19g。尿蛋白电泳为混合性蛋白尿。尿沉渣显微镜检查示细胞形态成畸形。肝功能ATL、AST正常,TP58.6g/L,ALB32.2g/L。 肾功能 BUN 10.3mmol/L,Cr 167.4mmol/L,UA 345.9μmol/L,IgG 7.8lg/L,IgA 1.86g/L,C3 0.76g/L.B双肾大小及形态正常。胸部X线透视示心脏大小形态正常,双肺纹理稍增多。肾穿刺病检示系膜增生性肾炎,免疫沉积物以IgG 和C3 为主,肾间质部分纤维化和肾小管部分萎缩。 诊断 诊断依据 鉴别诊断
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A.
coming
B.
to come
C.
came
D.
has come
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A.
is
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was
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has been
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had been
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A.
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A.
coming
B.
to come
C.
came
D.
has come
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A.
On the fifth floor.
B.
On the sixth floor.
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