重复肾活检在免疫相关肾小球疾病诊治中的应用价值

Application of repeat renal biopsy in the diagnosis and treatment of immune-related glomerular diseases

狼疮肾炎、IgA肾病、肾病综合征等免疫相关的肾小球疾病病因多样,病理变化和发病机制复杂,诊断和治疗策略选择多,其诊断和治疗高度依靠肾活检病理学。肾活检病理提供肾小球和肾小管-间质病变、免疫复合物沉积、肾小球超微病变等信息,为评估疾病严重程度并指导下一步治疗提供帮助。然而,临床常有部分患者治疗预后效果不佳,临床缓解和组织学缓解对治疗的反应不平行等情况出现。若患者症状处于未缓解状态,医师可考虑进行第二次肾活检,从而调整治疗方案,为进一步精准诊治疾病起到指导作用。因此,重复肾活检作为一种可靠的工具,在免疫相关肾小球疾病诊断、治疗效果评估、治疗方案调整以及预后判断上提供必要信息,最终改善患者预后。

Lupus nephritis,IgA nephropathy,nephrotic syndrome and other immune-related glomerular diseases have diverse etiologies,complex pathological changes and elusive pathogenetic mechanisms.Although many diagnostic and therapeutic strategies are readily available,precise managements are highly dependent upon renal biopsy pathology.Biopsy pathology provides information on glomerular and tubule-interstitial lesions,immune complex deposition and glomerular ultrastructural lesions.It helps to evaluate the severity of disease and guide a proper management.However,the prognosis of some patients has remained poor and the responses of clinical remission and histological remission to treatment are not always parallel.If patient symptoms are not alleviated,physician may perform a second renal biopsy to fine-adjust treatment and implement accurate management of disease.Thus repeat renal biopsy may provide the necessary information for diagnosing immune-related glomerular diseases,evaluating treatment outcomes,modifying treatment regimens and ultimately improving patient outcomes.