隐匿性肾小球肾炎73例临床病理分析  

Pathological analysis of latent glomerulonephritis in 73 cases

作　　者：杨磊[1] 朱铁锤[1] 

机构地区：[1]新乡医学院第一附属医院肾病科,河南卫辉453100

出　　处：《医学信息（内.外科版）》2009年第3期218-219,共2页Medical Information Operations Sciences Fascicule

摘　　要：目的观察疑诊为隐匿性肾小球肾炎(患者无自觉症状,蛋白尿和/或血尿,24 h尿蛋白定量<1.0 g)患者的临床和病理类型,以便对病理类型较重者临床给予积极的干预治疗,以延缓肾脏病的进展。方法选择疑诊为隐匿性肾小球肾炎73例,发现尿异常至肾活检时间最短者6个月,最长5年零4个月,平均时间为3.0±2.3年,其中男39例,女34例,年龄14～62岁,平均年龄(36.0±12.3)岁。IgA肾病病理分级参考Hass分级1997,临床上进行内生肌酐清除率、血肌酐、免疫学和B超的测定。结果表现为单纯血尿最多见32例,占44%;蛋白尿合并血尿28例,占38%;单纯蛋白尿13例,占18%。其中12例内生肌酐清除率下降<80 m l/m in,其中4例血肌酐升高并双肾萎缩。肾脏病理:73例中68例为原发性肾小球疾病,IgA肾病28例;非IgA系膜增生性肾小球肾炎22例;膜性肾病3例;轻微病变肾病4例;局灶增生性肾炎3例;局灶节段肾小球硬化6例;薄基膜肾病2例。继发性肾炎5例,其中狼疮性肾炎3例,紫癜性肾炎2例。结论隐匿性肾小球肾炎,临床上往往无任何症状,常常在体检中发现,一般预后良好,但部分病例预后不良,特别是病理类型较重者。因其特点隐匿,故不易引起注意,容易延误治疗,持续反复尿异常半年以上除外非肾小球因素引起的血尿,都应及早进行肾活检,对病理类型较重者应及早进行药物干预,延缓肾功能减退。Objective To investigate the clinical and pathological types of cases with suspected latent glomerulonephritis yet without symptoms, proteinuria and/or hematuria and a 24 - hour urinary protein 〈 1.0 g, so that more aggressive intervention therapy to the severe pathological type cases can be made to postpone the progression of kidney disease. Methods Seventy - three suspected cases of latent glomerulonephritis were selected, with 39 cases of men and 34 cases of women aged 14 -62 years, average age 36.0 ± 12.3 ;and the shortest time between urine abnormality found and renal biopsy is 6 months and the longest 5 years and four months, with an average time of 3.0± 2.3 years. The pathological grade of IgA nephropathy referred to Hass Gradation 1997 ,and creatinine clearance rate, serum creatinine, immunology and ultrasonic changes were observed. Results Thirty - two cases with hematuria alone, 28 cases with proteinuria and hematuria, and 13 cases with proteinuria alone were found, with respective percentage of 44%, 38% and 18%. 12 cases was found with creatinine clearance rate 〈 80 ml/min,4 cases with elevated serum creatinine and renal atrophy. Renal pathology： In the 73 patients,68 cases are primary glomerular diseases including 28 cases of IgA nephropathy,22 cases of non- IgA mesangial proliferative glomerulonephritis,3 cases of membranous nephropathy,4 cases of mild kidney disease ,3 cases of focal glomerulonephritis ,6 cases of focal segmental glomerulosclerosis, and 2 cases of thin basement membrane nephropathy ;5 cases are secondary nephritis, including 3 cases of lupus nephritis ,2 cases of purpura nephritis. Conclusions Latent glomerulonephritis,without any clinical symptoms,is often found in the physical examination and generally has good prognosis, but some cases have poor prognosis, particularly the severe pathological type. Because of hidden characteristics,it is easy to be ignored and delayed in the treatment; those with sustained abnormal urine for more than half a year except non - glomerular h

关 键 词：隐匿性 肾小球肾炎 临床 病理 

分 类 号：R692[医药卫生—泌尿科学]