肾活检术前后尿相差显微镜检查282例临床分析

Comparative Study of Urine Sediment Analysis with Microscopy before and after Kidney Biopsy among 282 Patients

目的用尿相差显微镜检查探讨肾活检术前后患者血尿的变化及对临床诊治的影响.方法对2008年1月至2011年7月间进行肾穿刺活检术,并且术前及术后尿样进行尿相差显微镜检查的282例患者的血尿进行分析研究,探讨其变化规律.结果 282例肾活检患者中临床诊断以慢性肾小球肾炎(包括无症状血尿和/或蛋白尿综合征)和原发性肾病综合症为多,继发性肾病以狼疮性肾炎为主,临床表现以血尿、蛋白尿和浮肿为主(42.6%),病理类型以系膜增生性肾炎(32.6%)、IgA肾病(18.8%)和微小病变肾病(16.0%)为主,术后血尿的发生率较高,以镜下血尿为主(74.8%),尿相差镜检以异形红细胞增加相对较多(46.2%),发生肉眼血尿的患者以肾功能异常者为多.结论肾穿刺活检术后血尿增加有诸多原因,并非全由肾穿刺损伤血管引起,及时进行尿差显微镜检查,能迅速查明血尿原因,对临床正确处置具有重要的指导意义.

Objective To study the difference of microscopic hematuria before and after kidney biopsy and the influence on the therapy.Method We evaluated 282 patients＇ microscopic hematuria before and after kidney biopsy in our department from January 2008 to July 2011 and discussed the difference.Results 282 cases were chronic glomerulonephritis（including asymptomatic hematuria and proteinuria syndrome） and essential nephritic syndrome,secondary kidney disease was lupus nephritis,mostly.Clinical manifestations were hematuria,proteinuria,and edema.However,pathological types including mesangial proliferative glomerulonephritis,IgA nephropathy and minor change disease.We found a high incidence of postoperative hematuria,mainly were shaped red blood cells detected by urine sediment analysis with microscopy.Moreover,patients with renal dysfunction were more likely to have gross hematuria.Conclusions Lots of reasons account for the increase of hematuria after kidney biopsy,not only by renal vassal injury caused by the surgery.Timely urine sediment analysis with microscopy will identify the cause of hematuria,which is significantly important for clinical disposal.