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患儿,女,11岁.双下肢对称性皮肤瘀点4d伴黑便3d,于1992年1月29日住院治疗.双膝及踝关节肿痛,阵发性腹痛伴柏油样梗.神志清,血压16/12KPa,无浮肿;咽无充血,心肺无异常;全腹轻压痛,未及包块,肾区无叩击痛;下肢对称性出血性皮疹,部分融合成片.以我科常规治疗.入院第6d和第8d关节肿痛及黑便消失,下肢反复出现对称性皮疹.血小板110×10~9/L;粪隐血+++;血HBs Ag-;血浆蛋白、肝肾功能及血C_3均正常.住院查8次尿常规均无异常.发病第19d电透下行肾活检,标本送南京军区总医院检查,结果光镜与电镜均符合系膜增殖性肾炎,免疫荧光见系膜区及血管拌见颗粒状IgA+~+,IgG+,C_3+-,HBsAg-.随访已3年余,尿常规无异常.讨论 过敏性紫癜并发得损伤的发生率各家报告不一,从尿常规改变诊断紫癜性肾炎发生率约在62%,但若从尿酶改变分析则达100%.国外有学者认为本病与lgA肾病是相同的病理缺陷引起的不同临床表现.但近年来有学者认为本病是过敏性紫癜的基本症状之一;和田将本病203例临床分作4型,
Children, female, 11 years old. Both lower extremity symmetry dermatological petechia 4d with melena 3d, hospitalized January 29, 1992. Both knees and ankle joint pain, paroxysmal abdominal pain with asphalted terrier. , Blood pressure 16 / 12KPa, no edema; pharyngeal no congestion, no abnormal heart and lung; full tender mild tenderness, not mass, no percussion pain in the kidney area; lower extremity symmetrical hemorrhagic rash, The pain and melena disappeared on the 6th day and the 8th day after admission, and the symmetrical rash occurred repeatedly in the lower limbs.Platelet 110 × 10 ~ 9 / L, fecal occult blood +++, blood HBs Ag-, plasma protein, liver and kidney function and Blood C_3 were normal .Investigation of urine routine 8 times no abnormalities .19 days after the onset of dialysis renal biopsy samples sent to the Nanjing Military Region General Hospital examination, the results of light and electron microscopy are consistent with mesangial proliferative glomerulonephritis, immunofluorescence see mesangial District and blood vessels see grainy IgA + ~ +, IgG +, C_3 + -, HBsAg-. Follow-up has been more than 3 years, no abnormal urine. Discuss the incidence of anaphylactoid purpura complicated by injury reports vary from routine urine Diagnosis of purpura nephritis incidence of about 62%, but if the change from the urease is up to 100% of foreign scholars believe that the disease and lgA nephropathy is the same pathological defects . Since there are different clinical manifestations but in recent years, scholars believe that this disease is one of the basic symptoms of allergic purpura; Wada 203 cases of the disease will be divided into 4 clinical type,