小儿急进性肾炎和新月体肾炎的再认识:附43例临床与病理分析  

Reassessment of the children with rapidly progressive glomerulonephritis and crescentic glomerulonephritis

作　　者：钟旭辉[1] 黄建萍[1] 刘建英[1] 丁洁[1] 杨霁云[1] 

机构地区：[1]北京大学第一医院儿科,北京100034

出　　处：《临床儿科杂志》2004年第1期30-33,共4页Journal of Clinical Pediatrics

摘　　要：目的探讨小儿急进性肾炎和新月体肾炎的病因、临床以及病理特点及两者之间的关系。方法回顾总结1987年至2002年临床诊断急进性肾炎或病理诊断新月体肾炎的43例住院患儿的临床资料。结果患儿以学龄儿童多见 ,60.5 %为原发性肾脏疾病 ,绝大多数表现为浮肿、少尿、高血压、肉眼血尿及肾病水平蛋白尿。部分(24.0 %)急进性肾炎的肾脏病理为非新月体肾炎 ,包括毛细血管内增生性肾小球肾炎、Ⅳ型膜增殖性狼疮性肾炎、增生硬化性肾小球肾炎及局灶节段性肾小球硬化 ;而部分(32.1 %)新月体肾炎的临床表现为非急进性肾炎 ,包括肾病综合征(肾炎型)、急性肾炎综合征及慢性肾脏疾病。予正规治疗的25例患儿中 ,44.0 %的患儿肾功能恢复 ,44.0 %的患儿肾功能好转。结论急进性肾炎是临床诊断 ,新月体肾炎是病理诊断 ,两者并非完全一致 ;积极行肾穿刺活检 ,有助于明确肾脏病理类型 ,指导治疗 ;早期诊断、及时治疗有助于改善急进性肾炎或新月体肾炎患儿的预后。Objective To investigate the etiological,clinical,and pathological characteristics in children with rapidly progressive glomerulonephritis(RPGN)or crescentic glomerulonephritis(CGN)and the relationship between them.Methods Fourty_three children with RPGN and CGN diagnosed according to the clinical presentation or pathological examination were retrospectively summarized from1987to2002in our hospital.Results The most of the sick children in this group were at the school age with65.5%of them resulting from primary renal disease.Edema,hyponuria,hypertension,gross hematuria and proteinuria apˉproaching to the nephrotis level were the most common clinical presentation.Only some children with RPGN(24.0%)were diagnosed as non_CGN according to the pathological findings including diffuse endocapillary proliferative glomerulonephritis,lupus nephritis type IV,proliferative sclerosing glomerulonephritis and focal segmental glomerulonephritis.Whereas some children with CGN also could have the clinical manifestation similar to the non_RPGN including nephrotic syndrome(nephritis type),acute glomerulonephritis syndrome and chronic renal diseases.Among25sick children who received standardized treatment,the renal function could get recovery in44%of them.44%of these children could have renal function improveˉment.Conclusions RPGN just was clinical diagnosis,whereas the CGN was the pathological diagnosis.So they were not the same.Renal biopsy should be actively performed in order to confirm the renal pathological patterns and guide the treatment.Early diagnosis,timely treatment,thus for to be conducted to improve the prognosis for the children with RPGN and CGN.

关 键 词：急进性肾炎 小儿 新月体肾炎 临床资料 病理分析 RPGN 肾脏疾病 

分 类 号：R726.9[医药卫生—儿科]