儿童无症状尿检异常IgA肾病的临床病理和预后分析
Clinicopathological and prognositic analysis of asymptomatic IgA nephropathy in children
曹琦 1徐虹 1黄文彦 1周利军 1沈茜1
作者信息
- 1. 200032,上海,复旦大学附属儿科医院肾内科
- 折叠
摘要
目的 探讨儿童无症状尿检异常的IgA肾病的临床病理特征和预后.方法 对54例IgA肾病儿童的临床和病理特征进行分析.根据起病时有无临床症状分为无症状尿检异常组和有症状肾炎组.组织病理学分级参照Lee氏和Katafuchi氏半定量积分法.结果 无症状尿检异常组18例,有症状肾炎组36例.有症状肾炎组尿蛋白量(24 h)明显高于无症状尿检异常组[(2 .3±2 .2)g比(0 .4±0 .3)g,P＜0 .05].无症状尿检异常的IgA肾病儿童表现为镜下血尿者,87%有尿微量白蛋白增高.无症状尿检异常TgA肾病患儿病理表现以Lee氏Ⅰ-Ⅱ级为主,2例表现为Lee氏Ⅳ-Ⅴ级和5例发生Katafuchi Ⅱ～Ⅲ级肾小管间质病变.有症状肾炎组Lee氏病理分级以Ⅱ～Ⅲ级为主,两者病理分级分布差异无统计学意义(P＞0 .05).全组息儿平均随访(26 .9±8 .8)月后,1例病理为Lee氏Ⅴ级患儿进入终末期肾衰竭,其余患儿Scr均无升高1倍以上.结论 无症状尿检异常的儿童IgA肾病虽临床症状轻微,但可出现病理损害严重的病例,并影响其预后.
Abstract
Objective To study the clinicopathological characteristics and prognosis of asymptomatie IgA nephropathy (IgAN) children with pmteinuria and/or microscope haematuria .Methods Clinical and pathological characteristics of 54 children with IgA nephropathy confirmed by renal biopsy were analyzed . These children with IgAN were divided into two groups according to their clinical characteristics at the first onset: asymptomatic IgAN group (AsIgAN) and symptomatic IgAN group (SIgAN) . Histologic changes were classified by Lee SM and Katafuchi semiquantitative scoring system . Results Eighteen children were in AslgAN group and 36 children were in SIgAN group . The degree of proteinuria in SIgAN group [(2 .3±2 .2) g/d] was higher than that in AslgAN group [(0 .4±0 .3) g/d] at the time of biopsy (P＜0 .05) . Although asymptomatic IgAN children were mainly of Lee's type Ⅰ ～Ⅱ, 2 children (11%) were of Lee's type Ⅳ～Ⅴ and 5 cases (27%) presented interstitial injury . Symptomatic IgAN children were mainly of Lee's type Ⅱ ～Ⅲ, there was no significant difference between two groups (P＞0 .05) . Urine micrealbumin was increased in 87% children presented with microscope haematuria . After an average of (26 .9±8 .8)months follow-up, only one case of Lee's Ⅴ progressed into renal failure and the others maintained normal renal function . Conclusions Although children with asymptomatic IgAN have minor clinical symptoms, severe renal pathological lesion and poor prognosis also occur . Urine screening helps to detect renal diseases and renal biopsy should be performed in the patients with increased urine microalbumin .
关键词
儿童/肾小球肾炎,IgA/病理学/预后Key words
Child/Glomerulonephritis, IgA/Pathology/Prognosis引用本文复制引用
出版年
2008
NETL
NSTL
维普
万方数据