成人无症状性血尿蛋白尿的临床病理分析及预后

Clinical and pathological analysis of asymptomatic glomerulonephritis in adults.

目的 探讨成人无症状性肾小球肾炎的临床与病理关系 ,了解其早期肾功能变化。方法 5 4例临床诊断为隐匿性肾炎的患者均行肾组织活检术 ,肾组织行光镜、免疫组化及电镜检查 ;同时查肝肾功、血脂、尿蛋白定量、肾功放免、自身抗体、乙肝系列等。结果 单纯性血尿 30例占 5 5 .5 % ;余为单纯性蛋白尿 11例及血尿、蛋白尿 13例。肾脏病理改变以轻度系膜增生性肾炎 (Ms PGN2 4例 )及 Ig A肾病 (Ig AN15例 )为主 ,分别占 44 .4%、2 7.7% ,余为局灶增生性肾炎(FPGN)、局灶节段肾小球硬化症 (FSGS)、Ig M肾病、 型膜增生性肾炎 (MPGN)、毛细血管内增生性肾炎 (En PGN ) ,5 1.8%伴小血管炎 (2 8例 )。结合临床可见 :发作性肉眼血尿多见于 Ig AN,单纯性蛋白尿多见于 Ms PGN,早期肾功损害主要见于 Ig AN、FSGS。 2 8例随访 6月至 5年 ,仅 2例血 Scr轻度升高。结论 成人隐匿性肾炎临床以单纯血尿和 /或蛋白尿为主要表现 ,其病理类型多样 ,但以 Ms PGN及 Ig AN为主 ,发作性肉眼血尿多为 Ig AN,单纯性蛋白尿多见于 Ms PGN,约5 1.8%伴明显小血管炎 ,约 40 %有早期肾功能损害。对于发作性肉眼血尿或单纯性血尿、蛋白尿。

Objective To study the relationship between the clinical feature and pathology of asymptomatic glomerular hematuria and /or proteinuria in adults and their early kidney function as well as prognosis.Methods Renal biopsy was performed on 54 patients with asymptomatic glomerulonephritis (AsGN) for light microscopy,immuno pathologic examination and electron microscopy.Results Clinically,30 cases (55.5%) were categorized as pure hematuria,11 cases were pure proteinuria and 13 cases were hematuria companied by proteinuria.The pathologic findings included:mesangial proliferative glomerulonephritis(MsPGN, n= 24),constituting 44.4%,IgA nephropathy(IgAN, n =16),accounting for 27.7%;the others being focal proliferative glomerulonephritis(FPGN),focal segment glomerular sclerosis(FSGS),IgM nephropathy (IgMN), membranoproliferative glomenrulonephritits (MPGN I)and encapillary proliferative glomerulonephritis(EnPGN).And 51.8%of the 54 cases were accompanied by tiny arteritis.Those clinical and pathologic findings revealed that intermittent macroscopic hematuria was mostly seen in IgAN,proteinuria was mainly seen in MsPGN,and early impaired renal function was mostly seen in IgAN,and FSGS.28 cases were followed up for 6 months to 5 years;only 2 of them were found to have slightly higher level of serum creatinine.Conclusion There are various pathologic changes in AsGN.Intermittent macroscopic hematuria is mostly seen in IgAN,proteinuria is mainly seen MsPGN and early impairment of renal function is mostly seen in IgAN and FSGS.About 51.8%of AsGN cases are accompanied by arteritis and about 40%of AsGN cases have early impairment of renal function.Renal biopsy is of important value in making diagnosis determining treatment and prognosticating the course and outcome of intermittent macroscopic hematuria and hematuria accompanied by proteinuria.