原发性IgA肾病患儿伴发急性肾损伤19例临床分析  

Clinical and pathological analysis of IgA nephropathy with acute kidney injury

作　　者：陈敏广[1] 叶晓华[1] 梁海燕[1] 杨青[1] 

机构地区：[1]温州医科大学附属育英儿童医院肾内科,325027

出　　处：《中华儿科杂志》2016年第8期610-613,共4页Chinese Journal of Pediatrics

摘　　要：目的 了解原发性儿童IgA肾病中急性肾损伤的发生率和病因构成、临床病理特点和预后。方法 对温州医科大学附属育英儿童医院肾内科1996年1月至2012年6月收治的196例IgA肾病患儿中伴发急性肾损伤的19例患儿的临床及病理表现、随访结果进行回顾性的分析。结果 （1）19例伴发急性肾损伤的患儿在196例IgA肾病中占9.7%；19例中肉眼血尿17例，大量蛋白尿16例，低白蛋白血症10例，水肿10例，高血压1例。血肌酐峰值94.5-282.0 μmol/L。（2）组织学改变：伴新月体形成10例，弥漫毛细血管内增生5例，肾小管损伤15例，红细胞及蛋白管型10例，1例有明显急性间质性肾炎。（3）IgA肾病发生急性肾损伤的临床诱因：13例与本身肾小球病变严重相关，包括新月体肾炎及弥漫毛细血管内增生；1例应用抗生素后合并急性间质性肾炎；2例分别因口服贝那普利及消炎痛引起肾小球滤过率下降；1例肾小球病变轻微但反复肉眼血尿致肾小管损伤，另2例原因不明确。（4）多因素Logistic回归分析显示：伴大量蛋白尿是IgA肾病患儿发生急性肾损伤的独立危险因素（OR值为27.370，95%可信区间为3.151-237.740，P〈0.01）。（5）所有患儿均未透析治疗，激素治疗13例（其中7例进行甲泼尼松冲击治疗），联合环磷酰胺治疗6例，除1例无明显好转外，其余患儿在治疗1-2个月内肾功能恢复正常或好转。随访1个月至7年不等，随访期间有3例一度肾功能好转，但其中2例失访后3年进入慢性肾衰竭，1例32个月后肾功能又减退，重复肾穿刺病理示肾小球硬化达32%。结论 在儿童IgA肾病中发生急性肾损伤约占10%，其诱发因素除本身肾小球严重病变外，与临床用药及反复肉眼血尿相关，伴大量蛋白尿是IgA肾病患儿发生急性肾损伤的独立危险因素，临床观察短期预后尚好。Objective To investigate the incidence, etiology, clinico- pathological characteristics and prognosis in primary IgA nephropathy （IgAN） children with acute kidney injury （AKI）. Method Retrospective analysis of the clinical and pathological manifestations and follow-up results of 19 Chlidren, who were associated with AKI in 196 cases of children with IgA nephropathy treated in our department from January, 1996 to Jun, 2012 was performed. Result （1） The 19 cases associated with AKI accounted for 9.7% of all 196 Chlidren with IgAN. Within the 19 cases, there were gross hcmaturia in 17 cases, massive proteinuria in 16 cases, hypoalbuminemia in 10 cases, edema in 10 cases and hypertension in one case. The peak serum creatinine was from 94.5 μmol/L to 282 μmoL/L. （2） Histological changes ： with the formation of crescent in 10 cases, diffuse endocapillary proliferation in 5 cases, 15 cases had renal tubular injury, 10 cases had red blood cell and protein cast, 1 case with acute interstitial nephritis. （3） The cause of IgA nephropathy with AKI： 13 patients had severe glomerular damage, including crescentic glomerulonephritis and diffuse endocapillary proliferation; 1 case was complicated with acute interstitial nephritis after being treated with antibiotics, 2 patients had decreased glomerular filtration rate because of taking benazepril or oral indomethacin, 1 case with renal tubular injury induced by gross hemaluria, and the other two cases the reason was not clear. （4） Multivariate Logistic regression analysis showed that massive proteinuria was independent risk factor of IgAN in children with AKI （ OR = 27. 370, 95% confidence interval was 3. 151 -237. 740, P 〈 0.01 ）. （5） None of the patients were on dialysis, steroid therapy was used in 13 cases （including 7 cases of methylprednisolone pulse therapy ）, 6 cases were treated with combined cyclophosphamide treatment. Except 1 cases no significant improvement, the renal functiones of all patients recovered or improved within

关 键 词：肾小球肾炎 IGA 儿童 急性肾损伤 

分 类 号：R726.9[医药卫生—儿科]