肾组织活检在移植肾功能损害的诊断与鉴别诊断中的价值

The value of biopsy in diagnosis and differentiate diagnosis of human renal allograft impairment

目的 探讨移植肾组织活检在移植肾功能损害的诊断与鉴别诊断中的价值。方法 对15 8例移植肾组织活检资料进行回顾分析。结果 15 8例中以急性排斥反应多见 ,共 5 5例 (34.8% ) ,移植肾改变 35例 (2 2 .2 % ) ,临界改变 32例 (2 0 .2 % ) ,慢性排斥反应 13例 (8.3 % ) ,系膜增生性病变 13例 (8.3 % ) ,急性肾小管坏死 6例 (3 .8% ) ,新月体性肾炎、溶血性尿毒综合征和毛细血管内增生性肾炎各 1例 (0 .6 % ) ;血中环孢素A的浓度与急性排斥反应的发生率无明确正相关关系 ;临床诊断与肾组织活检结果尚存在一些差异。

Objective To investigate the relation between clinical diagnosis and histologic lesion in renal allograft patients who received graft biopsies. Method 158 cases undergoing renal allograft biopsies from June 1996 to Dec. 1998 were analyzed retrospectively. Results Among the 158 cases, acute rejection occurred in 55 cases ( 34.8 ?%), renal allograft change in 35 cases ( 22.2 ?%), borderline lesion in 32 cases ( 20.2 ?%), chronic rejection in 13 cases ( 8.3 ?%), mesangial proliferative lesion in 13 cases ( 8.3 ?%), acute tubular necrosis in 6 cases ( 3.8 ?%), glomerular crescents formation in 1 case ( 0.6 ?%), HUS in 1 case ( 0.6 ?%), endocappillary proliferative lesion in 1 case ( 0.6 ?%). The level of CsA in plasma had no relation with the occurrence of acute rejection. The difference between clinical and histological diagnosis were encountered in some patients. Conclusions The renal biopsy might be essential for establishing the correct diagnosis of renal allograft dysfunction and so selecting the appropriate management.