48例儿童系膜IgM肾病的临床病理分析

Clinical and Pathological analysis of 48 cas-es of IgM nephropathy in children

本文分析４８例儿童系膜ＩｇＭ肾病（ＩｇＭＮ）的临床表现与病理改变，占同期原发性肾小球疾病肾活检总数的２１．５％。临床表现为肾病综合征３７例（７７．１％），单纯性蛋白尿８例（１６．７％），迁延性肾炎３例（６．２％）。病理类型：局灶性系膜增殖（ＭｓＰＧＮ）１６例（３３．３％），弥漫性系膜增殖２９例（６０．４％），微小病变（ＭＣＮ）２例（４．２％），轻微损害（ｍｉｎｏｒｌｅｓｉｏｎ）１例（２．１％）。有１２例（２５％）系膜区见到电子致密物沉积。４８例均见到ＩｇＭ呈颗粒状沉积于系膜区及血管拌（１１例）。对强的松治疗多数反应较差，且易反复发作。作者随访３５例，多数预后良好，仅３例（８．６％）患儿有轻度肾功能减退。

linical menifestations and pathologicalchanges were analyzed in 48 cases of pedi-atric patients with mesangial IgM nephropa-thy (IgMN ) accounting for 21. 5‰, of prima-ry glorTierular disease in the same period.Nephrotic syndrome appeared in 37 cases( 77. 1 ‰ ) ,isolated proteinuria in 8 ( 16. 7‰)and persistent glomerulo nephritis (GN )in 3 (6. 2 ‰ ). The histopathological classifi-cation of these cases included: focal mesan-gial proliferative (MsPGN ) , 16 (33. 3‰) ;diffuse MsPGN, 29 ( 60. 4‰): minimalchange nephrosis (MCN) . 2 (4. 2‰) : minorlesion. 1 (2. 1‰ ). Electron dense depositswere found in mesangium in 12 (25‰).With immunofluorescence examinationgranular deposition of IgM was detected inniesangial area in all 48 and was also detect-ed along capillary loops in 11 of them. TheIgMN responded poorly to prednisone andwas easy to relapse. Follow-up of 35 casesshowed that prognoses were good with mostof them ,and only 3 (8. 6‰ ) had slightly im-paired renal function.