儿童无症状血尿肾穿刺指征探讨

Indications for percutaneous renal biopsy in children with asymptomatic hematuria

目的探讨无症状血尿儿童的肾穿刺指征。方法回顾分析485例无症状血尿儿童的肾脏病理类型。根据血尿程度及有无合并蛋白尿将入组患儿分为,镜下血尿组、肉眼血尿组和血尿合并蛋白尿组;其中镜下血尿组再根据血尿程度分为尿红细胞<15/HPF组,15~30/HPF组和>30/HPF组。结果 485例患儿中,男227例、女258例,平均(7.23±2.93)岁;镜下血尿组318例,最常见病理类型为轻微病变(64.8%),其次为局灶性肾小球病变(16.7%)和局灶节段性肾小球硬化(8.2%);肉眼血尿组119例,最常见病理类型也是轻微病变(26.1%),其次为Ig A肾病(24.4%)和系膜增生性肾小球疾病(20.2%);血尿合并蛋白尿组48例,最常见病理类型为Ig A肾病(29.2%)和轻微病变(29.2%)。镜下血尿组、肉眼血尿组和血尿合并蛋白尿组的病理类型分布差异有统计学意义(χ~2=152.03,P<0.001);其中镜下血尿组的轻微病变比例最高;IgA肾病和系膜增生性肾小球肾炎比例在在肉眼血尿和血尿合并蛋白尿组中比例较高。镜下血尿组中,尿红细胞<15/HPF组149例,(15~30)/HPF组96例,>30/HPF组73例,三组间病理类型构成差异无统计学意义(χ~2=15.18,P=0.512);最常见病理类型均为轻微病变。结论无症状血尿者中,为肉眼血尿或者血尿合并蛋白尿者应尽早行肾穿刺明确病理诊断。

Objective To explore the indications for percutaneous renal biopsy of asymptomatic hematuria in children.Methods The renal pathological types of 485 children with asymptomatic hematuria were analyzed retrospectively.According to the degree of hematuria and whether or not combined with proteinuria,the children were divided into microscopic hematuria group,gross hematuria group and hematuria with proteinuria group.The microscopic hematuria group was further divided into urine red blood cell<15/HPF group,(15~30)/HPF group,and >30/HPF group according to hematuria degree.Results In 227 males and 258 females with the average age of 7.23±2.93 years,there were 318 cases in microscopic hematuria group,in which the most common pathological types were minor lesions(64.8%),followed by focal glomerular lesions(16.7%) and focal segmental glomerulosclerosis(8.2%).There were 119 cases in gross hematuria group,in which the most common pathological types were also minor lesions(26.1%),followed by Ig A nephropathy(24.4%) and mesangial proliferative glomerulopathy(20.2%).There were 48 cases in hematuria with proteinuria group,in which the most common pathological types were Ig A nephropathy(29.2%) and minor lesions(29.2%).The distribution of the pathological types among microscopic hematuria group,gross hematuria group and hematuria with proteinuria group were statistically different(χ~2=152.03,P<0.001).In three groups,microscopic hematuria group had the highest proportion of minor lesions,while gross hematuria group and hematuria with proteinuria group had higher proportion of Ig A nephropathy and mesangial proliferative glomerulonephritis.In microscopic hematuria group,there were 149 children with urine red blood cell<15/HPF,96 with urine red blood cell(15~30)/HPF,and 73 with urine red blood cell >30/HPF.There was no difference in pathological types among three sub-groups(χ~2=15.18,P=0.51),and mild lesions were the most common pathological types in each group.Conclusion Renal biopsy should be performed at earliest possible time to make pathological diagnosis in asymptomatic hematuria children with gross hematuria or proteinuria.