儿童急性链球菌感染后肾小球肾炎伴急性肾损伤的临床分析

Clinical analysis of acute streptococcal glomerulonephritis with acute kidney injury in children

目的探讨急性链球菌感染后肾小球肾炎伴有急性肾损伤患儿的临床及病理特征。方法回顾性分析2016年1月至2017年12月在本院住院的急性链球菌感染后肾小球肾炎伴急性肾损伤患儿29例的临床资料。结果患儿男性22例、女性7例,男女比3.1∶1;中位年龄10.6(5.9~15.0)岁。29例患儿中,>10岁的有19例(占65.5%)。中位住院时间18(6~48)d。有前驱感染史的11例,其中10例为呼吸道感染,1例为皮肤感染;高血压9例(占31.0%)。所有患儿均有肾小球性血尿和蛋白尿,其中肾病综合征17例(占58.6%)。泌尿系B超显示实质回声增强23例(79.3%)。Ⅰ期急性肾损伤14例(48.3%),Ⅱ期急性肾损伤6例(20.7%),Ⅲ期急性肾损伤9例(31.0%)。29例患儿肾脏组织病理均为毛细血管内增生性肾小球肾炎。免疫复合物沉积阴性1例,仅C3沉积18例(占62.1%),C3+IgG沉积6例(占20.7%),合并有其他免疫复合物沉积4例,其中C3+IgA沉积2例(占6.9%),C3+IgA+IgG沉积1例(占3.4%),C3+IgA+IgG+C1q沉积1例(占3.4%)。结论急性链球菌感染后肾小球肾炎伴急性肾损伤患儿更易合并肾病综合征,且住院时间长,肾功能损害可持续较长时间,免疫复合物沉积除C3和(或)IgG沉积外,可伴有其他免疫复合物的沉积,经过积极治疗后预后均较好。

Objective To investigate the clinical and pathological characteristics of acute streptococcal glomerulonephritis with acute kidney injury.Methods From January 2016 to December 2017,29 cases of acute glomerulonephritis with acute kidney injury were analyzed retrospectively.Results There were 22 males and 7 females,the ratio of males to females was3.1:1.0,and the median age was 10.6 years(5.9,15.0).Among 29 children,19(65.5%)were over 10 years old,and the median length of stay was 18 days(6,48 days).Among 11 cases with history of prodromal infection,10 cases were respiratory tract infection,1 case was skin infection,9 cases were hypertension(31.0%).All the children had glomerular hematuria and proteinuria,17 cases were nephrotic syn-drome(58.6%),23 cases showed substantial echo enhancement(79.3%),14 cases(48.3%)had stage I acute kidney injury,6 cases(20.7%)had stage II acute kidney injury,and 9 cases(31.0%)had stage II acute kidney injury.The renal histopathology of 29 children was proliferative glomerulone-phritis.In one case,the immune complex deposition was negative,only 18 cases(62.1%)of C3 deposition,6 cases(20.7%)of C3+IgG deposition,and 4 cases(6.9%)of C3+IgA deposition,1 case(3.4%)of C3+IgA+IgG deposition,and 1 case(3.4%)of C3+IgA+IgG+C1q deposition.Conclusions Children with acute streptococcal glomerulonephritis and acute kidney injury are more likely to be associated with nephrotic syndrome,and have been hospitalized for a long time.Renal function damage can last for a long time.The deposition of immune complex can be accompanied by the deposition of other immune complexes except C3 and/or IgG,even without the deposition of immune complex.After active treatment,the prognosis of glomerulonephritis with acute kidney injury is better.