无症状肾小球性血尿63例临床与病理

A clinical and pathological analysis of asymptomatic hematuria in children

目的探讨小儿无症状肾小球性血尿的临床与病理关系。方法符合条件者行肾穿刺活检进行光镜、电镜和免疫荧光镜检查。结果临床分为持续镜下血尿（A）13例，发作性肉眼血尿（B）6例，A＋B28例，持续肉眼血尿（C）16例。病理以IgA肾病最常见（44．4％）。不同临床表现类型的血尿之病理类型无明显差异，但B之病理以IgA肾病更常见。病变程度似以A＋B和C表现者相对偏重。结论IgA肾病是小儿无症状肾小球性血尿的主要疾病之一。掌握肾治检的适应证对无症状肾小球性血尿患儿进行肾病理检查，对明确诊断、指导治疗、估计预后有重要意义。

To study the relationship of clinical manifestation and pathology of asymptomatic glomerular hematuria in children Methods Renal biopsies were performed on 63 cases of asymptomatic glomerular humaturia for the light, electron and immunofluorescent microscopic examinations.Results According to the features of hematuria, the patients(n = 63)were divided int0 those (n = 13) with persistent microscopic hematuria (PMiH ), those (n = 6 ) with intermittent macroscopic hematuria (1MaH), those (n = 28) wiht PMiH accompanied with IMaH and those(n= 16)with persistent macroscopic hematuria. IgA nephropathy ranked the top (44. 4%) in pathologic patterns and mesangial proliferative glomerulonephritis the second. No significant difference was found in pathololgic patterns of hematuria with different clinical phenotypes. However, IgA nephropathy comprised the majority in patients with IMaH. The pathologic changes of patients with PMiH accompanied with IMaH or PMaH might be more serious than those of PMiH or IMaH.Conclusion IgA nephropathy is a predominant cause of asymptomatic glomerular hematuria. Renal biopsy plays an impor-tant role in diagnosis, treatment and appraisal of prognosis.