慢性肾功能不全患者肾穿刺活检的风险与价值研究

The study of chronic renal insufficiency patients with renal biopsy

目的回顾性分析慢性肾功能不全(CRI)患者经皮肾穿刺活检(PRB)的风险与价值。方法对符合条件的50例CRI患者进行PRB,行光镜、免疫组化染色和选择性电镜检测,观察肾穿刺组织肾小球个数、病理类型、诊断以及穿刺并发症。结果肾组织标本合格率为96%。病理类型前三位为增生性肾小球硬化症21例(42%),IgA肾病(IgAN)9例(18%),狼疮性肾炎(LN)8例(16%)。PRB后修改诊断5例(10%),明确病因3例(6%),诊断修正率为16%,根据病理结果决定治疗方案16例(32%),治疗方案修正率为26%。并发症以镜下血尿最常见,共48例(98%),肾周小血肿11例,肾周大血肿2例,腹膜后血肿1例。结论原发性肾脏疾病肾穿后病理结果多为慢性病变,大部分患者的诊断治疗方案不受肾穿刺病理结果的影响,且肾周血肿出现机率较多且较大,偶可合并腹膜后血肿,但狼疮性肾炎表现为慢性肾衰时其肾脏病理的活动指数仍较高,少数病例肾脏病理显示新月体肾炎,仍需应用免疫抑制剂以改善预后。

Objective To study the risk and value of chronic renal insufficiency（CRI）patients percutaneous computed renal biopsy（PRB）.Methods 50 cases on CRI,extremity immunohistochemical study and selective electron detection.Observed renal biopsy tissue glomerular number and pathologic types,diagnosis and puncture complications.Results Renal tissue samples to 96%.The pathologic types of proliferative glomerular sclerosis 21 cases（42%）,IgAN disease（IgA）9 cases（18%）,with lupus nephritis LN 8 cases（16%）.After PRB modification in 5 patients（10%）diagnosis,clear etiology in 3 cases（6%）,the diagnosis rate of 16%,according to the revised pathological results treatment decisions in 16 cases（32%）,treatment,fixed rate of 26%.Complications in the most common microscopic hematuria,48 patients（98%）,11 cases of perirenal small hematoma,2 cases of perienal big hematoma,1 case retroperitoneal hematoma.Conclusion The kidney pathological results diagnosed of primary renal disease is almost chronic disease.Most diagnosis and treatment won＇t affected by renal biopsy,and the effect of perienal hematoma appear more and bigger accationally retroperitoneal hematoma merge.With lupus nephritis,but for chronic renal failure with its kidney pathological activity index is higher,a few cases of renal pathology revealed crescent body nephritis,still need to improve the prognosis of application of immunosuppressive agents.