31例尿常规正常的过敏性紫癜肾脏病理改变

The renal pathological change of 31 Henoch.Schiinlein purpura with normal urine routine

目的探讨尿常规正常的过敏性紫癜患儿肾脏病理情况。方法对本院2005年至2010年小儿肾病专科31例住院尿常规正常的过敏性紫癜患儿进行肾穿刺活检，部分病例检测尿微量白蛋白。结果本组31例患儿存在不同程度的肾脏病理损害，光镜结果显示病理分级Ⅱ一Ⅵ级不等，其中Ⅱ级占35．48％（11／31），Ⅲ级占54．83％（17／31），Ⅳ级、V级及Ⅵ级各占3．23％（1／31）。免疫荧光病理显示单纯IgA沉积型占48．38％（15／31），IgA＋IgG沉积型占19．36％（6／31），IgA＋IgM沉积型占19．36％（6／31），IgA＋IgG＋IgM沉积型占12．90％（4／31）。14例患儿行尿微量白蛋白检测，其中10例（10／14，占71．43％）高于正常值。结论尿常规检查正常的过敏性紫癜患儿可能已经存在肾脏病理改变，尿微量白蛋白是早期发现肾损害有意义的指标。

Objective To research Henoch-Schonlein purpura purpura （HSP） and renal pathology in children. Methods 31 hospitalized HSP children that with normal urine routine and accepted renal bi- opsy in our hospital. Results There were different levels of kidney pathological damage in this group of 31 cases, the results of light microscope were from grade Ⅱ to grade VI. The proportion was gradeⅡ（35.48%, 11 of 31）, grade Ⅲ （54.83%, 17 of 31）, and grade Ⅳ ,V and VI （each 1 case of 31, 3.23% ）. Immunofluorescence pathology results were showed as following： merely IgA depositional （ 48.38%, 15 of 31 ）, IgA ＋ IgG depositional （ 19. 36%, 6 of 31 ）, IgA ＋ IgM depositional （ 19. 36%, 6 of 31 ）, IgA ＋ IgG ＋ IgM depositional （ 12.90% , 4 of 31 ）. Microalbuminuria had been founded in 14 cases, and the microalbuminuria level of 10 cases were higher than normal value（ 10 of 14,71.43% ）. Conclusions HSP children had renal pathologic dysfunction, even the urine routine were normal, and the detection of urine microalbumin was a significant marker in the early stage.