IgA肾病重复肾活检13例报告及原因分析  

Reasons for repeated renal biopsy in patients with IgA nephropathy

作　　者：王文博[1] 张念荣[1] 邹古明[1] 李文歌[1] 

机构地区：[1]中日友好医院肾内科,北京100029

出　　处：《中日友好医院学报》2016年第4期207-209,共3页Journal of China-Japan Friendship Hospital

摘　　要：目的:寻找Ig A肾病患者重复肾活检的原因。方法:对比13例重复肾活检Ig A肾病患者2次肾穿刺前临床表现、两次肾脏病理结果以及肾穿后治疗方案的不同,分析第2次肾活检的原因,总结Ig A肾病治疗失败的原因。结果:第2次肾活检原因:13例患者中有11例因蛋白尿未缓解;2例出现急性肾损伤;1例患者病理类型发生改变。通过比较2次肾活检前后患者临床表现、病理改变及治疗方案,分析治疗失败的原因是:(1)感染:3例患者因不同部位的感染(上呼吸道感染、肺炎、丹毒各1例)后出现水肿加重,蛋白尿增多,以及肾功能受损;(2)出现急性肾损伤:2例患者服用成分不明的中药,出现急性肾损伤;(3)药物治疗不充分:第2次肾穿刺后,4例患者ACEI/ARB加大剂量,2例加用糖皮质激素和免疫抑制剂,经随诊观察13例患者尿蛋白定量均有下降。结论:感染、急性肾损伤、药物治疗不充分可能是Ig A肾病治疗失败重复肾活检的原因。Objective：To search for the reasons for repeated renal biopsy in patients with Ig A nephropathy（Ig AN）.Methods：Clinical symptoms before kidney biopsy,pathological results and treatments after kidney biopsy in 13 Ig AN patients who underwent twice renal biopsies were compared.Reasons for the second renal biopsy and treatment failure in Ig AN patients were analyzed.Results：Reasons for the second renal biopsy were nonremission of proteinuria（11 cases）,acute renal injury（2 cases）and pathology type changes.Treatment failure may be caused by a）infection：3 patients developed infection in different sites（upper respiratory tract infection,pneumonia and erysipelas,one each）,with progressed edema,increased proteinuria and impaired renal function;b）drug-related acute renal injury：2 patients took traditional Chinese medicine with unknown ingredients,and appeared acute renal injury;c）drug insufficiency：after the the second kidney biopsy,doses of ACEI/ARB drugs were doubled in 4 patients,and glucocorticoid or immunosuppressive drugs were respectively given to another2 patients.Proteinuria in all the 13 patients after adjustment of treatment was decreased during follow-up.Conclusion：Mucosal infection,drug-related acute renal injury and drug insufficiency lead to treatment failure and repeated renal biopsy of Ig AN patients.

关 键 词：IGA肾病 重复肾活检 

分 类 号：R692.31[医药卫生—泌尿科学]