451例肾活检临床病理分析

Clinical Pathological Analysis of 451 Cases of Renal Biopsy Epartment of Nephrology

目的:探讨肾脏病理类型分布及临床、病理类型特点并分析其相互关系。方法:收集2015年04月~2019年02月上海中医药大学附属龙华医院肾病科451例≥14岁肾活检患者资料,根据患者性别、年龄、地域,分析肾脏各病理类型的变化及分布。结果:(1)原发性肾小球疾病(PGD)376例(83.37%),继发性肾小球疾病(SGD)66例(14.63%),肾小管间质性疾病6例(1.33%),遗传性肾病2例(0.44%)急性肾衰竭1例(0.22%)。(2)原发性肾小球疾病最常见病理类型为IgA肾病(208例,55.32%),其次为膜性肾病(80例,21.28%),局灶节段性肾小球硬化症(40例,10.64%);继发性肾小球疾病最常见的病理类型为糖尿病肾病(32例,48.48%),其次是紫癜性肾炎(11例,16.67%),乙肝相关性肾炎(9例,13.64%);(3)PGD的临床表现以肾炎综合征(184例,48.94%)为主;其次是无症状尿检异常(74例,19.68%)和肾病综合征(63例,16.76%)。结论:本院IgA肾病是原发性肾小球疾病最常见的肾小球疾病,其次是膜性肾病,继发性肾脏疾病中糖尿病肾病占第一位。肾脏病理类型与患者年龄、性别、临床表现有有一定相关性,但未构成明确的规律对应关系,故对于肾脏疾病,肾活检仍是明确诊断,指导治疗的最佳手段。

Objective:To investigate the distribution,clinical and pathological characteristics of renal pathological types and analyze their correlation.Methods:Date of 451 renal biopsy patients aged over 14 years from April 2015 to February 2019 in the department of nephrology,longhua hospital affiliated to Shanghai university of traditional Chinese medicine were collected.Changes and distribution of each pathological type of the kidney were analyzed according to the gender,age and region of the patients.Results:(1)primary glomerular disease(PGD)in 376 cases(83.37%),secondary glomerular disease(SGD)in 66 cases(14.63%),tubulointerstitial disease in 6 cases(1.33%),hereditary nephropathy in 2 cases(0.44%)and acute renal failure in 1 case(0.22%).(2)the most common pathological type of primary glomerular disease was IgA nephropathy(208 cases,55.32%),followed by membranous nephropathy(80 cases,21.28%),and focal segmental glomerular sclerosis(40 cases,10.64%).The most common pathological type of secondary glomerular disease was diabetic nephropathy(32 cases,48.48%),followed by purpura nephritis(11 cases,16.67%)and hepatitis b related nephritis(9 cases,13.64%).The clinical manifestations of PGD were mainly nephritis syndrome(184 cases,48.94%).Asymptomatic abnormal urine tests(74 cases,19.68%)and nephrotic syndrome(63 cases,16.76%)were followed.Conclusion:IgA nephropathy is the most common primary glomerular disease,followed by membranous nephropathy,and diabetic nephropathy ranks the first among secondary renal diseases.There is a certain correlation between the pathological type of the kidney and the patient's age,gender and clinical manifestations,but there is no clear rule corresponding to the relationship.Therefore,for renal diseases,renal biopsy is still the best method to make a clear diagnosis and guide treatment.