经皮肾穿刺活检在急性肾功能衰竭诊治中的地位

Percutaneous renal biopsy in the diagnosis and treatment of acute renal failure

目的探讨急性肾功能衰竭(ARF)患者的病理类型及病因分布,评价肾活检在肾脏病诊治中的作用与地位。方法对30例ARF具有肾穿刺活检适应证的患者,在B超介入定位下行经皮肾穿刺活检,并做光镜、免疫病理检查及结合临床特点进行分析。结果 30例ARF患者肾穿刺均能成功取得肾小球,标本合格率为97%,病理分析显示:硬化性肾炎2例(6.67%);原发性肾小球肾炎17例(56.67%),其中IgA肾病3例,肾小球轻微病变5例,膜性肾病2例,局灶节段性硬化性肾炎2例,毛细血管内增生性肾炎2例,新月体肾炎3例;继发性肾小球肾炎8例(26.62%),其中狼疮性肾炎6例,过敏性紫癜肾炎2例;急性肾小管坏死2例(6.67%);急性间质性肾炎1例(3.33%)。并发症主要有肉眼血尿2例,肾周血肿1例,未发生误穿其他脏器、感染及严重大出血等并发症。结论对ARF患者行肾活检检查有助于明确病因及病理类型,对指导治疗及判断预后均有非常重要的作用。

Objective To explore pathological types and causes of acute renal failure（ARF） and evaluate the importance of renal biopsy in the diagnosis and treatment of kidney disease.Methods Thirty cases of ARF with indications for renal biopsy undergone percutaneous renal biopsy through B-ultrasonic-positioning,and analysis was done according to their light microscopy,immune pathology and clinical characteristics.Results Thirty patients with ARF undergone renal biopsy and glomerulus was successfully obtained,with a pass rate of 97%.Pathological analysis showed： 2 patients with sclerosing glomerulonephritis（6.67%）,17 patients with primary glomerulonephritis（56.67%）,8 patients with secondary glomerulonephritis（26.62%）,2 patients with acute tubular necrosis（6.67%） and 1 patient with acute interstitialnephritis（3.33%）.In 17 cases of primary glomerulonephritis,there were 3 cases of IgA nephropathy,5 cases of minor glomerular lesions,2 cases of membranous nephropathy,2 cases of focal segmental sclerosing glomerulonephritis,2 cases of capillary proliferative glomerulonephritis and 3 cases of crescentic glomerulonephritis.For secondary glomerulonephritis,there were 6 cases of lupus nephritis and 2 cases of allergic purpura nephritis.Complications occurred in 2 cases of gross hematuria and 1 case of perirenal hematoma.There was no complication such as penetration through other organs by mistake,infection or severe bleeding.Conclusion For patients with acute renal failure,renal biopsy examination plays an extremely important role in identifying the etiology and pathological types,guiding the treatment and defining the prognosis.