1002例慢性肾脏病患儿临床及病理分析

Clinical and pathological analysis of 1002 children with chronic kidney disease

目的了解慢性肾脏病(CKD)儿童的临床及病理特点。方法回顾分析1002例住院CKD患儿的临床及病理资料。结果1002例CKD患儿中,男635例,女376例;中位发病年龄7岁;CKDⅠ期973例,CKDⅡ期4例,CKDⅢ期7例,CKDⅣ期6例,CKDⅤ期12例;病因以后天获得性肾小球疾病为主,原发性肾病综合征390例(38.9%)、紫癜性肾炎372例(37.1%),IgA肾病100例(10.0%);病理改变,微小病变型肾病108例(15.4%)、非微小病变594例(84.6%)。990例患儿随访0~5年,失访12例,死亡4例,中位随访时间894天;Ⅰ期患儿肾功能分期均无加重;Ⅱ~Ⅴ期患儿肾功能好转2例,肾功能恶化3例。结论后天获得性肾小球疾病是导致儿童CKD发生的主要原因,病理改变以非微小病变为主,早诊断、早干预可延缓CKD进入终末期肾衰竭。

Objective To investigate the clinical and pathological features of children with chronic kidney disease (CKD).Methods The clinical and pathological data of 1002 hospitalized children with CKD were retrospectively analyzed.Results Among the 1002 children with CKD included in the study,the male to female ratio was 1.7:1 and the median age of onset was 7 years.973 patients with CKD Ⅰ,4 patients with CKD Ⅱ,7 patients with CKD Ⅲ,6 patients with CKD Ⅳ,and CKD Ⅴ 12 cases.The deposit disease is mainly acquired glomerulopathy in 390 cases of primary nephrotic syndrome (38.9%),372 cases of Henoch-Sch?nlein purpura nephritis (37.1%),and 100 cases of IgA nephropathy (10%).Pathological classification included 108 cases of nephropathy and 594 cases of non-minor lesions.990 cases were fully followed up,12 were lost and 4 died,with a median follow-up of 894 days.Conclusion Acquired glomerular disease is the main cause of CKD in children.The pathological changes are mainly non-minimal lesions.Early diagnosis and intervention are the key factors to delay the progression to end-stage renal failure in children with CKD.