孤立性血尿儿童血尿类型与肾脏病理类型的关系

Relationship between the type of hematuria and renal pathological type in children with isolated hematuria

目的分析孤立性血尿儿童中血尿类型与肾脏病理类型的关系。方法回顾性分析90例临床诊断为孤立性血尿且完善肾活检患儿的临床资料,分别按病理类型、血尿类型和随访结果进行分组,分析血尿类型和肾活检病理类型的关系。结果 90例患儿中,病理类型为轻微肾小球病变/薄基底膜肾病35例,IgA肾病31例(其中IgA肾病Lee分级Ⅰ~Ⅱ级23例,Ⅲ级8例,无Ⅳ~Ⅴ级病例),未见明显异常14例,系膜增生样肾小球病变10例。镜下血尿组患儿中轻微肾小球病变/薄基底膜肾病所占比例显著高于肉眼血尿组(P <0.05),肉眼血尿组患儿中IgA肾病所占比例显著高于镜下血尿组(P <0.05)。血尿类型越严重则肾活检病理改变越严重(P <0.001),而血尿类型与IgA肾病Lee分级无关(P> 0.05),镜下血尿组中红细胞数与病理改变严重程度无关(P> 0.05)。孤立性血尿患儿的近期预后相对较好。结论镜下血尿患儿的肾脏病理改变以轻型为主,肉眼血尿患儿的肾脏病理改变较重,以IgA肾病为主。所有孤立性血尿患儿的近期预后相对较好。

Objective To analyze the relationship between the type of hematuria and renal pathological type in children with isolated hematuria. Methods The clinical records of 90 children with clinically diagnosed isolated hematuria,who underwent renal biopsy,were analyzed retrospectively. The cases were classified into groups based on the pathological type,hematuria type,and follow-up results. The relationship between the type of hematuria and the pathological type of renal biopsy was analyzed. Results In 35 children,the pathological type was mild glomerulopathy/thin basement membrane nephropathy. In 31 children it was nephropathy,and in 10 children it was mesangial proliferative glomerulopathy(gradeⅠ to Ⅱ:23 cases,grade Ⅲ:8 cases,no case of grade Ⅳ to Ⅴ). No obvious abnormality was observed for 14 children. The proportion of mild glomerulopathy/thin basement membrane nephropathy in the microscopic hematuria group was significantly higher than that in the gross hematuria group(P < 0.05). The proportion of IgA nephropathy in the gross hematuria group was significantly higher than that in the microscopic hematuria group(P < 0.05). The renal biopsy pathological changes were directly proportional to the severity of the hematuria type(P < 0.001). There was no relationship between the type of hematuria and the Lee grade of IgA nephropathy(P > 0.05). In addition,the severity of pathological changes was not corelated to the number of urine red blood cells under the microscope(P > 0.05). Conclusion The renal pathological changes of children with microscopic hematuria were mainly mild,while those of children with gross hematuria were more serious,mainly IgA nephropathy. The short-term prognosis of all children is relatively good.