小儿新月体肾炎临床研究

Clinical research on children cresentic nephritis

目的了解小儿新月体肾炎的临床特点及诊断和治疗。方法对我科近3年来经肾脏病理确诊的16例新月体肾炎患儿发病年龄、病因、临床特点,实验室检查特点、肾脏病理改变、治疗和预后进行分析。结果小儿新月体肾炎以>10岁的儿童多见,最常见的原因为IgA肾病,其次为紫癜性肾炎和狼疮性肾炎,以急进性肾炎表现的较少。本组患儿均有肉眼血尿,大量蛋白尿、血清肌酐清除率(Ccr)逐渐下降、血尿素氮(BUN)逐渐上升的发生率分别为87.5%、75%、62.5%,病理有广泛的细胞性及细胞纤维性新月体形成,治疗主要是激素加免疫抑制剂,联合抗凝,抗血小板治疗及对症治疗。结论(1)小儿新月体肾炎以IgA肾病为最常见的病因,对肉眼血尿并大量蛋白尿持续存在的患儿建议早期肾病理检查,早期诊断,及时治疗,坚持随访尤为重要;(2)治疗采用激素加用免疫抑制剂,先强化后维持的治疗方案。

Objective To comprehend clinical characteristic, diagnosis, and treatment for children cresentic nephritis. Methods Clinical data including ages, causes for onset of the illness, clinical characteristics, related lab tests, pathological alteration of kidney, treatment and prognosis in 16 patients who had been pathologically diagnosed as cFfildren cresentic nephritis were analysed. Results Children cresentic nephritis was found in the children above 10 years old in this study. The most common reason was IgA nephropathy. Other reasons were purpuric nephritis and lupus nephritis. It rarely appeared as primary rapidly progressive nephritis. All patients observed had hematuria with naked eyes. The incidence rate for large amount of proteinnuria, Ccr decreasing, and BUN increasing gradually were 87.5%, 75%, and 62.5%, respectively. Comprehensive cellular fibrous crescents were seen pathologically. Glucocorticoid and immunosupressant were the main drugs for the disease, and combining with anticoagulation medicine. Conclusion IgA nephropathy is the most common reason for children cresentic nephritis. The children with continuous hematuria naked eyes and large amount of proteinuria are suggested to have pathological determination in time so as to get early diagnosis and treatment.