婴幼儿肾脏疾病肾组织病理类型的分布与临床

The pathological character of renal biopsy and clinical study of infants

目的分析婴幼儿肾脏疾病病理类型的分布及其对诊断治疗的指导意义。方法中南大学湘雅二院于1996-01—2005-09采用快速经皮肾活检术,对73例临床诊断为10种肾脏疾病的婴幼儿进行肾组织病理检查。将穿刺取得的每份组织标本分成3部分,按常规方法对所有标本均分别进行光镜、电镜及免疫荧光检查,标本均做HE、PAS、PASM、Masson染色,均应用免疫荧光检测肾组织中IgG、IgM、IgA、C3、C4、C1q、Fb,部分病例根据血化验乙肝抗原阳性者加做免疫荧光,检测肾组织中的HBsAg、HBcAg。结果肾活检成功率为100%;最常见的病理类型为系膜增生性肾炎(51/73例,占69·9%);临床表现类似的疾病病理类型不同,同一病理类型的疾病,临床表现可以多样。结论肾活检病理诊断对婴幼儿肾脏疾病的诊断、治疗、估计预后均有重要价值。电镜在婴幼儿肾病理检查中起到不可忽视的作用。

Objective To understand the relationship between pathological features and clinical manifestations in children under 3 years suffering from renal glomerular disease in Hunan Province. Methods Renal biopsy by rapid percutaneous punctuation was performed on 73 children under the age of 6 years who were all diagnosed clinically as kidney diseases of 10 different kinds totally. The specimens were divided into 3 parts for microscope,electron-microscope and immunofluorescence examination separately and procossed by HE, PAS, PASM and Massen staining. Immunofluorescence was used to detect the deposition of IgG, IgM, IgA, C,3, CA, C1q and fibrin in renal tissue. Additional examinations were done to detect HBsAg and HBcAg deposition in some cases with positive serum HBsAg. Results All the renal biopsy performances were successful. The most common pathological type （51/73,69. 86% ） was mesangial proliferation glomerulonephritis （ MsPGN）. Diseases with similar clinical features might present different pathological types, and the similar pathological type might be seen in diseases with different clinical manifestations. Conclusion Renal biopsy is of great value for the diagnosis, treatments and estimation of prognosis for kidney disease in infants. Electron microscope examination plays an important role in pathological diagnosis,too.