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目的探讨小儿肾脏疾病的病理分布特点。方法回顾性分析246例小儿肾活检资料,参照WHO 1995年改良肾小球疾病组织学分型修订方案进行病理分型。结合临床资料、实验室检查、免疫病理及超微结构改变特点作出诊断。结果246例患儿中原发性肾小球肾炎104例(42.28%),继发性肾小球肾炎136例(55.28%),遗传性肾病3例(1.22%),不能分类3例(1.22%)。原发性肾小球肾炎中临床表现为肾病综合征66例,迁延性肾炎23例,急性肾炎8例,慢性肾炎3例,孤立性蛋白尿2例,孤立性血尿、急进性肾炎各1例。病理表现以IgA肾病(39例,15.85%)为主,其次为系膜增生性肾炎和微小病变型肾病,再次为IgM肾病、毛细血管内增生性肾炎、局灶性节段性肾小球硬化、膜性肾病、轻微病变肾病。继发性肾小球肾炎以紫癜性肾炎(119例,48.37%)为主,其次为乙型肝炎相关性肾炎(11例)和狼疮性肾炎(6例)。遗传性肾病中临床表现为孤立性血尿2例,迁延性肾炎1例,病理表现为薄基膜肾病2例,A lport综合征1例。结论246例肾活检病例中以继发性肾小球肾炎为主,紫癜性肾炎是最常见的继发性肾小球肾炎;IgA肾病是原发性小球肾炎中最常见的病理类型。
Objective To investigate the pathological features of pediatric kidney disease. Methods Retrospective analysis of 246 cases of pediatric renal biopsy data, with reference to the WHO 1995 improved glomerular disease histological typing program for pathological classification. Combined with clinical data, laboratory tests, immunopathology and ultrastructural changes to make the diagnosis. Results Of the 246 children, 104 (42.28%) had primary glomerulonephritis, 136 (55.28%) had secondary glomerulonephritis, 3 (1.22%) had inherited nephropathy, and 3 %). Clinical manifestations of primary glomerulonephritis in 66 cases of nephrotic syndrome, 23 cases of persistent nephritis, acute nephritis in 8 cases, 3 cases of chronic nephritis, isolated proteinuria in 2 cases, isolated hematuria, 1 case of acute nephritis . Pathological findings were IgA nephropathy (39 cases, 15.85%), followed by mesangial proliferative glomerulonephritis and minimal change nephropathy, again IgM nephropathy, capillary proliferative glomerulonephritis, focal segmental glomerulosclerosis , Membranous nephropathy, minor pathological nephropathy. Secondary glomerulonephritis with purpura nephritis (119 cases, 48.37%), followed by hepatitis B-related nephritis (11 cases) and lupus nephritis (6 cases). Hereditary nephropathy in clinical manifestations of hematuria in 2 cases, 1 case of persistent nephritis, pathological manifestations of thin basement membrane nephropathy in 2 cases, 1 case of A lport syndrome. Conclusion 246 cases of renal biopsy in the main secondary glomerulonephritis, purpuric nephritis is the most common secondary glomerulonephritis; IgA nephropathy is the most common primary glomerulonephritis pathological types.