左肾静脉压迫综合征合并肾小球疾病26例报告

Clinical features and pathological analysis of 26 patients with left renal vein entrapment syndrome superimposed on glomerular nephritis

目的探讨彩超诊断左肾静脉压迫综合征的慢性肾脏疾病患者肾组织病理变化和临床特点。方法回顾性分析26例左肾静脉压迫综合征伴肾小球疾病患者的临床病理资料。结果多数病例通过体检发现，部分以活动（或劳累）后出现肉眼血尿、浮肿、泡沫尿、腰酸（或腰痛）以及排尿不适为表现，尿相差显微镜红细胞分类为肾小球源性或混合性血尿，且平卧位即出现尿检异常。临床表现为血尿合并蛋白尿11例，发作性肉眼血尿7例，肾病综合征4例，单纯血尿3例，单纯蛋白尿1例。肾组织病理表现多样化：IgA肾病9例，系膜增生性坚小球病变8例，局灶节段系膜增生性肾炎4例，乙肝病毒相关性肾炎4例，膜性肾病1例。结论左肾静脉压迫综合征合并肾小球疾病在临床上并不少见；其临床及病理均呈现多样性；当临床上遇到左肾静脉综合征不能解释的血尿及蛋白尿时．应积极进行肾活检，避免漏诊而延误病情和治疗。

Objective To investigate the clinical and pathological characteristics of patients with left renal vein entrapment syndrome diagnosed by colour Doppler sonography superimposed on renal glomerular diseases. Method This retrospective study included clinical and pathological data of 26 patients with left renal vein entrapment syndrome superimposed on renal glomerular disease is in our department. Results Most of the cases were discovered by health examination, Some showed gross hematuria after physical activly or exertion. Edema or foam urine, lumbar sorenss lumbago or discomfort on urination were also complaints at first visit time. Urine examined by phase contrast microscope analysis displayed glomerular hematuria or heterogenicity RBC. Uronoscopic abnormality were found when pationts were on decubitus position. Clinical manifestation： microscopic hematuria （3 cases）, proteinuria （1 case）, microscopic hematuria and proteinuria （12 cases）, gross hematuria（6 cases） and nephrotic syndrome （4 cases）. Renal tissue pathological diagnoses were diverse： mesangial proliferative nephritis （8 cases）, IgA nephropathy （8 cases）, focal-segmental mesangial proliferative neph：dtis （5 cases）, HBV associated glomerulonephritis （4 cases）, membranous nephropathy （1 cases）. Conclusions Left renal vein entrapment syndrome superimposed with glomerular nephritis is underestimated in clinic, which presents multiply clinical manifestations and pathological diagnoses are multiplicity. When hematuria or proteinuria can＇t be completely explained by left renal vein entrapment syndrome, renal puncture is encouraged to do to avoid of missing diagnosis and delaying treatment.