肾活检489例临床病理分析

Clinical pathological analysis of 489 renal biopsy

目的 回顾性分析本科自2004年8月～2005年6月共489例因肾脏疾病行活检的病理资料，总结重庆地区肾脏疾病的临床病理类型特点。方法 参照WHO肾小球疾病组织学分型修订方案（1982年及1995年），对每1例患者均进行临床病理讨论，由病理医师和临床医师结合临床资料、实验室检查结果、免疫病理及超微结构改变特点，共同探讨、明确病理诊断及拟定相应的治疗措施。结果 本组489例肾活检组织中有4例为移植肾，其余485例为固有肾脏。患者年龄8～72岁，平均（32±16）岁；男女之比0．72：1。除移植肾活检者，本组中原发性肾小球疾病占73．40％，继发性肾小球疾病占17．32％，先天性肾小球疾病占0．21％，终末期肾脏疾病占4．12％，小管间质性疾病占4．95％。原发性肾小球疾病以IgA肾病居多（27．20％），其次分别为系膜增生性肾小球肾炎（21．27％），膜性肾病（8．18％），FSGS（6．13％）。继发性肾脏病中以狼疮性肾炎多见（9．41％），其次是紫癜性肾炎（3．27％）。急性肾衰起病者仍以急性肾小管坏死多见，在急性间质性肾病中与药物相关的也不可忽视。肾穿刺并发症少，最严重的是肉眼血尿，余无特殊并发症。结论 重庆地区原发性肾小球肾炎仍是最常见的肾小球疾病，其中以IgA肾病和系膜增生性肾小球肾炎最常见，继发性肾脏病以狼疮性肾炎多见，女性占绝对优势。急性肾衰的病理变化多样。肾活检的适应证可以扩大。

Objective Between August 2004 and June 2005 in our center,489 cases of percutaneous renal biopsy were performed in Chongqing district. The pathologic entities were analyzed retrospectively and the clinical pathological characteristics of renal diseases in Chongqing district were concluded. Methods Pathological classifications were made according to the WHO criteria of 1982 for renal pathology or the modified WHO criteria of 1995 by a panel of pathologists and nephrologists in routine clinical pathological rounds. Therapy measures were also made by the panel. Results The mean age at renal biopsy was （32±16） （8-72） years in 489 cases of renal diseases with a male to female ratio of 0.72 ：1 ,and among them 4 cases were renal transplant recipients. Primary glomerular diseases（PGD） accounted for 73.40% of the total renal biopsies,secondary glomerulonephritis （SGN） 17.32%, hereditary and congenital renal diseases 0.21%, end-stage renal disease 4.12 %, tubularinterstitial diseases 4.95%. IgA nephropathy was the most frequent patholigical type（27.2%） of PGD,followed by mesangial proliferative glomerulonephritis （21.27%）,membranous nephropathy（8. 18%）, focal segmental glomerulosclerosis（6. 12%）. The most frequent type of SGN was lupus nephritis （9.41%）, followed by purpuric glomerulonephritis （3.27%）. Acute tubular necrosis still accounted for most of cases manifested with acute renal failure and drug related acute interstitial nephritis also should not be ignored. The complications of renal biopsy were very few. The most severe of them was gross hematuria. And there were not unusual complications. Conclusion In Chongqing district,IgA nephropathy is still the most frequent pathological type in primary glomerular diseases. In SGN,LN is the most frequent and female patients are still predominant. Pathological types of acute renal failure are variable. The indications are enlarged.