儿童肾活检病理分析与临床意义探讨(附1100例肾活检资料)

Clinical significance of pathologic data of 1 100 children's renal biopsy

目的 了解 110 0例小儿肾小球疾病的病理类型分布及其与临床表现之间的关系。方法 总结我院 110 0例住院患儿的肾活检资料 ,按WHO 1982年制定的肾小球疾病病理分类及 1995年肾小球疾病组织学分型修订方案 ,结合临床资料、实验室检查结果 ,确定诊断。结果 原发性肾小球疾病 919例 (占 83 5 %) ,继发性肾小球疾病 15 4例 (14 0 %) ,遗传性 /先天性肾小球疾病 19例 (1 7%) ,其他无法归类的 8例 (0 7%) ;其中微小病变 10 2例 (9 3%) ,轻微病变 5 4例 (4 9%) ,系膜增生 5 83例 (5 3 0 %) ,膜性肾病 6 2例 (5 6 %) ,膜增殖 112例 (10 2 %) ,毛细血管内增生 76例 (6 9%) ,局灶节段性硬化 71例 (6 5 %) ,新月体性肾炎 6例 (0 5 %) ,急性肾小管坏死 3例 (0 3%) ,间质性肾炎 5例 (0 5 %) ,溶血性尿毒综合征 6例 (0 5 %) ,Alport综合征 9例 (0 8%) ,弥漫性系膜硬化症 3例 (0 3%) ,薄基底膜病 4例 (0 4 %) ,先天性芬兰型肾病 1例 (0 1%) ,婴儿髓质囊性病 1例 (0 1%) ,肝豆状核变性 1例 (0 1%) ,脂蛋白肾小球病 1例 (0 1%)。结论 本组资料表明国内儿童阶段的肾小球疾病仍以原发性多见 ,病理类型以系膜增生性肾炎、轻微 /微小病变性肾炎、膜增殖性肾炎等为主 ;在继发性肾小球疾病中以紫癜性肾炎?

Objective To understand the pathological types of renal diseases and their significance in clinical diagnosis and treatment. Method According to WHO's pathological classification of renal diseases,combining with author's clinical data and laboratory results, diagnosis was put forward. Results There were 919 patients suffering from primary renal diseases, 154 secondary renal diseases, 19 hereditary/congenital renal diseases and8 others in 1 100 patients. Among them, 156 were minor lesion/minimal change diseases, 583 proliferative glomerulonephritis, 62 membranous glomerulopathy,112 membranoproliferative glomerulonephritis, 76 endocapillary proliferative glomerulonephritis, 71 focal segmental glomerulosclerosis, 6 crescent nephritis, 3 acute tubule necrosis, 5 renal interstitial injury, 6 heomolytic uremicsyndrome, 1 Wilson's disease, 9 Alport's syndrome, 3 diffuse mesangial sclerosis, 1 congenital nephrotic syndrome of finnish type, 1 infanfile renal medullarycystic disease, 4 thin basement membrane, and 1 lipoprotein glomerulopathy. Conclusion These data show that the primary renal diseases are still the main in the childhood, and that mesangial proliferative glomerulonephritis, minimal change disease/minor lesion, membranous proliferative glomerulonephritis are the main pathological types. The commonest renal injury is purpura nephritis in secondary renal diseases, and the second is lupus nephritis. In addition, attention should be paid to the hereditary/congenital renal disease in childhood.