儿童IgA肾病临床与病理的关系

Relationship between Clinical and Histological Features in Children with Immunoglobulin A Nephropathy

目的探讨儿童IgA肾病(IgAN)的临床特点及其与病理的关系。方法对肾活检确诊为IgAN 21例进行临床分型、病理分级及免疫分型,并分析之间的相互关系。结果本组IgAN发病率男童多于女童(2.5∶1.0),临床表现为单纯性肉眼血尿14例(66.7%),血尿伴蛋白尿4例(19.1%),肾病综合征1例(4.7%),肾炎综合征2例(9.5%),病理改变以Ⅲ级为主,免疫球蛋白沉积以复合型为主。结论随着对无症状血尿、蛋白尿者肾活检的增多,小儿IgAN的诊断有逐年增加趋势。IgAN临床表现多样,几乎包括肾小球疾病的所有类型,且临床与病理有一定关系。单纯血尿者病理改变相对较轻,预后较好;蛋白尿者病理改变较重,应早期诊断,早期治疗。

Objective To explore the relationship between clinical and histological features in children with immunoglobulin A（IgA） nephropathy（IgAN）. Method Twenty - one children with IgAN were classified by clinical features, histological and immunological changes. The relationships among them were analyzed. Results lgAN occurred in boys more than girls with the ratio of 2.5 ： 1. Clinical feature manifested by asymptomatic hematuria （66.7 % ）, hematuria with proteinuria （ 19.1% ）, nephrotic syndrome （4.7 % ）, nephritic syndrome（ 9.5 % ）. The grade Ⅲ （ Hass M. classification） in pathological changes was commonly .seen with more combined immunoglobulin deposit. Conclusions The incidence of IgAN increased followed by more renal biopsies in asymptomatic hematuria and proteinuria. Clinical features varied and involved all the kinds of glomerulonephritis. There are some relations between clinical and pathological features. Asymptomatic hematuria presented with mild histological changes achieved better outcome. The more proteinuria is always with more severity of histological changers, which should be diagnosed and treated early.