儿童急性肾功能不全37例临床分析

目的 探讨儿童急性肾功能不全的病因、治疗和预后.方法 对2002至2007年我院收治的37例急性肾功能不全患儿的临床资料进行回顾性分析.结果 37例患儿中男20例、女17例,起病年龄3个月～16岁.肾小球疾病引起急性肾功能不全占37.8%,免疫抑制剂和(或)替代治疗后78.0%的患儿肾功能恢复;感染、药物为病因的占21.6%,积极治疗原发疾病、停用相关药物,肾功能均恢复.肾前性和肾后性各占18.9%,经输液对症治疗及外科插管尿液引流,肾功能恢复;儿童横纹肌溶解综合征占2 7%,透析对症治疗后肾功能恢复正常.结论 肾小球疾病是儿童急性肾功能不全的最常见原因,感染、药物、胃肠道体液丢失、泌尿系统先天畸形均可致急性肾功能不全,临床要早期监测,合理用药.     

儿童急性肾功能不全37例临床分析

目的 探讨儿童急性肾功能不全的病因、治疗和预后.方法 对2002至2007年我院收治的37例急性肾功能不全患儿的临床资料进行回顾性分析.结果 37例患儿中男20例、女17例,起病年龄3个月～16岁.肾小球疾病引起急性肾功能不全占37.8%,免疫抑制剂和(或)替代治疗后78.0%的患儿肾功能恢复;感染、药物为病因的占21.6%,积极治疗原发疾病、停用相关药物,肾功能均恢复.肾前性和肾后性各占18.9%,经输液对症治疗及外科插管尿液引流,肾功能恢复;儿童横纹肌溶解综合征占2 7%,透析对症治疗后肾功能恢复正常.结论 肾小球疾病是儿童急性肾功能不全的最常见原因,感染、药物、胃肠道体液丢失、泌尿系统先天畸形均可致急性肾功能不全,临床要早期监测,合理用药.     

原发性肾小球疾病的免疫治疗进展

肾小球疾病是儿童最常见的泌尿系统疾病之一 ,也是导致儿童慢性肾功能衰竭的主要病因。临床及实验研究证实 ,肾小球疾病的主要发病机制是免疫性炎症介导的病理损伤 ,包括全身性自身免疫性疾病所致的肾病变和肾脏本身特发性免疫损伤。后者即原发性肾小球疾病 ,其致病形式又可分为两大类 ,一是免疫复合物致病 ,二是循环或肾内特有的致病因子导致的损伤。因此 ,针对不同的损伤机制给予适当的免疫干预治疗是改善肾小球疾病预后的重要手段。现将通过影响原发性肾小球疾病免疫发病机制而发挥治疗作用的药物或方法的进展状况简述如下。一、糖皮质激…     

儿童肾功能衰竭临床与病理分析

目的　探讨儿童肾功能衰竭的病因、临床和病理特点。方法　回顾分析 1996年 1月至 2 0 0 2年 6月诊治的 2 1例儿童肾功能衰竭病历资料。结果　①急性肾功能衰竭 12例 ,其中肾小球疾病引起者 8例 ,肾外因素所致者 4例 ;肾活检 6例 ,呈多种病理改变 ,伴不同程度细胞新月体形成。选择利尿、血液透析、甲基泼尼松龙冲击等治疗 ,10例肾功能有不同程度恢复 ,2例死亡。②慢性肾功能衰竭 9例 ,其中先天性肾脏疾病所致 2例 ,肾小球疾病所致 7例 ;肾活检 3例 ,病理呈系膜增生性肾小球肾炎、膜增殖性肾小球肾炎伴肾小球硬化或增生硬化。预后较差。结论　①急性肾功能衰竭治疗关键在于早期明确病因 ,应采用肾活检明确病理类型以指导治疗。②慢性肾功能衰竭缺乏特异性临床表现 ,易漏诊和误诊 ,应定期进行尿液常规检查 ,对肾脏疾病要进行有效治疗 ,防止慢性肾功能衰竭发生。     

小儿慢性肾功能不全病因分析

为了解目前儿童慢性肾功能不全的病因构成特点，以指导早期发现儿童隐匿性肾脏疾病。回顾性分析1989年1月至2001年12月住院的37例慢性肾功能不全患儿，其中肾小球疾病16例(43．24％)，先天性解剖异常16例(43．24％)，遗传性肾病2例(5．41％)，间质性肾炎2例(5．41％)，肾母细胞瘤1例(2．70％)，与10年前的统计资料相比，肾小球疾病比例减少，先天性和遗传性肾病比例增多；与国外80年代后统计资料一致。提示目前先天性泌尿系统畸形及遗传性肾病是儿童慢性肾功能不全的主要原因。减少儿童慢性肾功能不全发生的重点在于早期发现儿童隐匿性肾脏疾病。     

急性肾损伤121例临床与病理分析

目的 探讨儿童急性肾损伤(AKI)发病情况、病因、病理改变及病程转归情况.方法 回顾性分析2005年9月-2010年9月本院儿肾科收治的所有AKI患儿发病情况、临床诊断、病理诊断、住院天数及预后资料.采用SPSS 13.0软件进行分析.结果 共收治AKI患儿121例,每年儿童AKI人数/每年因肾脏疾病住院人数呈递增趋势,其中70例患儿进行了肾活检.121例AKI患儿中,男79例,女42例,发病年龄1~14岁[(7.6±3.8)岁],临床诊断前4位分别为急性感染后肾炎,肾病综合征,溶血尿毒综合征和急性间质性肾炎;病理诊断前4位分别为系膜增生性肾小球肾炎,毛细血管内皮细胞增生性肾小球肾炎,间质性肾炎和狼疮肾炎.所有AKI患儿中61例行血液透析,5例行腹膜透析,其余患儿对症保守治疗后好转.治疗后完全康复95例(78.51%),部分康复24例(19.83%),维持性透析治疗2例(1.66%).AKI衰竭期患儿住院时间(25.6±6.8) d,明显长于AKI危险期和损伤期患儿,且预后差.结论 儿童AKI的病因以感染性疾病为主,尤以感染后肾小球肾炎和间质性肾炎为主,但狼疮肾炎有逐年增多趋势,易并发肾功能不全.肾实质性AKI患儿均应行肾活检以明确病因,进行有效治疗.早期诊断、及时治疗是改善AKI预后的关键.     

儿童狼疮性肾炎的诊断治疗

狼疮性肾炎(LN)是儿童期常见的继发性肾小球疾病,男:女1:4 5,发病高峰为青春期.儿童系统性红斑狼疮(SLE)诊断标准乃采用1982美国风湿协会制定的分类诊断标准[1].儿童LN是儿童期肾功能不全原因之一.近30年来儿童LN患者预后已有极大地改善.与此同时,长期接受免疫抑制治疗,药物副作用就成为突出问题,有文献报道半数以上患者是死于治疗的副作用,因而合理治疗对LN患者预后至关重要[2,3].     

儿童狠疮性肾炎的诊断治疗

狼疮性肾炎（LN）是儿童期常见的继发性肾小球疾病,男:女1:45,发病高峰为青春期。儿童系统性红斑狼疮（SLE）诊断标准乃采用1982美国风湿协会制定的分类诊断标准[1]。儿童LN是儿童期肾功能不全原因之一。近30年来儿童LN患者预后已有极大地改善。与此同时,长期接受     

1002例慢性肾脏病患儿临床及病理分析

目的了解慢性肾脏病(CKD)儿童的临床及病理特点。方法回顾分析1002例住院CKD患儿的临床及病理资料。结果1002例CKD患儿中,男635例,女376例;中位发病年龄7岁;CKDⅠ期973例,CKDⅡ期4例,CKDⅢ期7例,CKDⅣ期6例,CKDⅤ期12例;病因以后天获得性肾小球疾病为主,原发性肾病综合征390例(38.9%)、紫癜性肾炎372例(37.1%),IgA肾病100例(10.0%);病理改变,微小病变型肾病108例(15.4%)、非微小病变594例(84.6%)。990例患儿随访0~5年,失访12例,死亡4例,中位随访时间894天;Ⅰ期患儿肾功能分期均无加重;Ⅱ~Ⅴ期患儿肾功能好转2例,肾功能恶化3例。结论后天获得性肾小球疾病是导致儿童CKD发生的主要原因,病理改变以非微小病变为主,早诊断、早干预可延缓CKD进入终末期肾衰竭。     

药物性肾损害

近10年来药物引起的肾脏损害已愈来愈被人们所重视。事实上药物都有其意想不到的毒性副作用。若临床上滥用、无限制地增加剂量、无目的的联合用药都会增加药物的肾毒作用。有人认为目前20%的急、慢性肾功能不全可能与用药有关。药物引起的急性间质性肾炎占不明原因的急性肾功能衰竭肾活检的10～14%。     

儿童急性感染后IgA为主型肾小球肾炎1例报道并文献复习

目的 提高对儿童急性感染后IgA为主型肾小球肾炎（简称肾炎）临床和病理特征的认识。方法分析1例急性感染后IgA为主型肾炎患儿的临床和病理资料,并结合文献分析其临床特点、诊断、发病机制、治疗及预后。结果 本例患儿临床表现为肉眼血尿、大量蛋白尿、急性肾损伤,抗链球菌溶血素“0”(ASO)升高、血清IgA升高等,肾脏病理组织学见肾小球系膜细胞轻度增生性病变,免疫荧光见IgA（+） 、C3（+）沉积于肾小球系膜区和血管襻;电镜见肾小球上皮下“驼峰”样电子致密物沉积伴系膜区少量致密物沉积。在病程9周时患儿肾功能恢复正常,血尿和蛋白尿消失。结论急性感染后IgA为主型肾炎临床和病理特征均具有不典型性,诊断依赖早期肾活检,电镜检查必不可少,短期疗效尚可,远期疗效仍需观察。     

Chronic renal insufficiency in the child. Etiology, development and prognosis

Our study concerned 147 children with chronic renal failure (CRF) (creatinine clearance less than 50 ml/min/1.73 m2). Its goal was to analyse the distribution of primary renal diseases, natural history of renal failure (RF) according to etiology, and long term survival. Renal diseases responsible for RF were: malformations of the urinary tract (38%), glomerular pathology (26%), hereditary renal diseases (20%), isolated renal hypoplasias (11%), and miscellaneous (5%). Corticoresistant nephrosis accounted for 34% of glomerular diseases and nephronophtisis 63% of hereditary renal diseases. On the whole, RF was related with an uropathy or renal hypoplasia in half of cases and with congenital renal disease in almost 3/4 of cases. The natural history varied according to primary renal disease: slow deterioration after a period of relative stability for uropathy or renal hypoplasias, slow and regular deterioration for nephronophtisis, rapid deterioration for glomerular diseases.     

Clinicopathologic correlations in the nephrotic syndrome.

The wide utilization of renal biopsy and the introduction of electron microscopic and immunohistologic methods has allowed better definition of the clinico-pathological conditions associated with the nephrotic syndrome (NS). Two major categories of facts can be differentiated. In the first one, diffuse lesions of glomeruli, either secondary to specific diseases, or apparently primary diseases such as membranous or membrano-proliferative glomerulonephropathy (GN) are responsible for the increased permeability of the glomerular capillaries. In most of these, there is evidence that immunological mechanisms play a role in the injury of the glomerular capillary. Any of the following clinical symptoms are suggestive of this category of NS: an acute nephritic onset, a moderate NS, macroscopic hematuria, marked hypertension and/or renal insufficiency, poorly selective proteinuria and decreased plasma C3 levels. Patients affected with any of these glomerulopathies usually do not respond to steroids. In the second one, usually referred to as the idiopathic nephrotic syndrome (INS) the mechanism of glomerular capillary alteration is unknown and the nephrotic syndrome is more marked. Minimal change NS (MCNS) accounts for the great majority of INS and is characterized in most cases by a selective proteinuria, the absence of hematuria, a good response to steroids and a good prognosis. However, in some instances, renal biopsy reveals either diffuse mesangial proliferation (DMP) or focal glomerular sclerosis (which may be superimposed on MCNS or on DMP). In both instances, hematuria may be present and 50--75% of patients do not respond to steroids and have a poor prognosis. There is still considerable controversy about the exact relationship between these 3 patterns. We believe that they are not distinct entities but represent variants of the same disease. In addition to these 2 major categories of NS, there are, in infancy, 2 conditions associated with a NS of poor prognosis: congenital NS of Finnish type and infantile mesangial sclerosis. Since steroid-sensitive nephrosis is by far the commonest cause of NS especially in young children up to 8 years, a renal biopsy should be performed only in 2 instances: (a) when the clinical symptoms suggest diffuse glomerular lesions, and (b) when steroid resistance has been demonstrated.     

肾脏疾病患儿急性肾损伤的临床分析

目的 了解儿童肾脏疾病中是否存在急性肾损伤(AKI),儿童肾脏疾病基础上AKI的发生率和病因构成,探讨AKI与肾脏疾病患儿住院时间、住院费用和短期预后的关系.方法 对我科住院的部分肾脏疾病患儿进行前瞻性的临床研究.病例入选标准:①确诊(原发性)肾病综合征(NS)、紫癜性肾炎(HSPN)和狼疮性肾炎(LN)的2～18岁住院患儿;②发病或复发≤3个月.AKI的诊断采用成人的AKI诊断标准.结果 共有95例患儿入选本研究,包括原发性NS 65例、HSPN 15例和LN 15例,其中33例(34.7%)符合AKI的诊断标准.LN、HSPN患儿伴发的AKI,100%表现为血肌酐升高;NS伴发的AKI中,65.4%的患儿表现为尿量减少,其中只有19.2%的患儿同时伴有血肌酐升高.AKI的病因:①NS基础上发生的AKI中,只有少数存在明确病因(26.9%),且多由肾外因素导致(15.4%),包括环孢素A的副作用、低血容量和肾小管间质损害;②LN和HSPN基础上发生的AKI,均由基础肾小球疾病导致.AKI组的住院时间和住院费用显著高于非AKI组[住院时间分别为28(6～94)、21(7～100)d;Z=-1.971,P=0.049;住院费用分别为12 035.7(1561.7～94 783.1)、8594.3(1390.1～98 876.5)元;Z=-1.993,P=0.046];随访6个月和12个月时,AKI组和非AKI组的血肌酐水平差异无统计学意义[随访6个月时分别为(60.4±91.8)、(42.8±12.2)μmol/L,t=0.937,P=0.358;随访12个月时分别为(48.7±18.1)、(47.7±14.2)μ,mol/L,t=0.197,P=0.845].结论 在儿童肾脏病急性期,34.7%的病例发生AKI;原发性NS中,非肾性因素是导致AKI发生的主要原因,而在LN和HSPN中,AKI的常见病因为基础肾小球疾病.AKI组的住院时间和住院费用高于非AKI组,但6个月和12个月随访时的血肌酐水平与非AKI组的患儿相比无显著差异.

Abstract：

Objective Acute kidney injury (AKI) was recently proposed for early recognition of renal function impairment and prompt interventions. Previous study revealed that AKI was highly associated with the prognosis. However, there was rare report of AKI in renal diseases, especially in children cohorts.Therefore, we performed the prospective clinical research in children with renal diseases in our hospital,aiming to study the prevalence, the clinical characteristics and the short-term prognosis of AKI. Method The study was designed as a prospective, single-center observational study. Inclusion criteria: ① the primary diagnosis was primary nephrotic syndrome (NS), Henoch-Schoenlein purpura nephritis (HSPN) or lupus nephritis ( LN), ② the duration from the onset of the renal diseases to the admission was less than 3 months. The serum creatinine and urine output of the subjects would be prospectively monitored. AKI was defined by the adult criteria and stratified by Acute Kidney Injury Network (AKIN) criteria. The patients were followed up at 6 months and 12 months after enrollment. Result Between October 2007 and April 2009, a total of 95 children were included, including 65 cases with NS, 15 HSPN and 15 LN. Mean age was (8. 9 ±3. 9) years (range 2-16 years). Thirty-three of the 95 patients (34. 7% ) fulfilled the AKI criteria,13 patients (13.7%) were diagnosed as acute renal failure (ARF). All the AKI in children with LN and HSPN presented with serum creatinine elevation. However, 65.4% of AKI in NS presented with decreasing urine output, only 19. 2% accompanied with increasing creatinine, with higher stages of urine output.Regarding the etiology, only 26.9% of AKI in NS had definite cause, most of which resulted from side-effect of cyclosporine, hypowlemia or tubule-interstitial damage, independent of glomerular diseases. In contrast,the AKI in LN and HSPN were exclusively caused by glomerular diseases. The length and costs of hospitalization of AKI group were significantly higher than non-AKI[length of hospitalization ( d), 28 (6 to 94) vs. 21 ( 7 to 100 ), Z = - 1. 971, P = 0. 049; cost of hospitalization ( yuan), 12 035.7 ( 1561.7 to 94 783.1) vs. 8594.3 (1390.1 to 98 876.5), Z= - 1.993, P=0.046]. There was no significant difference in the serum creatinine at 6-month and 12-month follow-up between AKI group and non-AKI[6-month, (60.4 ±91.8) μmol/L vs. (42. 8 ± 12. 2) μmol/L, t =0. 937, P =0. 358; 12-month, (48. 7 ±18.1) μmol/L vs. (47.7±14.2) μmoL/L, t=0.197, P=0.845]. Conclusion Theprevalence of AKI (34.7%) was higher than that of ARF ( 13.7% ) in children with renal diseases. Most of the AKI in NS resulted from non-glomerular diseases. In contraat, most AKI in LN and HSPN were caused by underlying glomerular diseases. The length and costs of hospitalization were significantly higher in AKI group.However, there was no significant difference in serum creatinine between AKI and non-AKI group in the follow-up at 6 months and 12 months. Further investigations on criteria for the diagnosis of AKI in children with renal diseases are still needed.     

肾脏疾病患儿血清免疫球蛋白及其亚类的变化

目的通过对儿童各类肾脏疾病进行血清免疫球蛋白(Ig)及亚类测定,探讨不同肾小球疾病体液免疫功能的变化。方法采用酶联免疫吸附法(ELISA)分别对急性肾炎26例、肾病综合征(NS)30例、紫癜性肾炎(HSPN)28例进行Ig及其亚类测定,20例正常儿童作为对照组。结果NS、急性肾炎、HSPN患儿IgG1和IgG2亚类明显低于正常对照组,差异有显著意义;IgG、IgG3、IgG4降低不明显,而急性肾炎组IgG3明显高于NS组及对照组,差异有显著意义(P<0.05)。结论小儿不同肾小球疾病具有不同的免疫特点,尤其是在总Ig无明显变化的状况下,各亚类的变化在其疾病的发生发展过程中占有重要地位。     

江西地区肾脏病儿童757例肾活检的病理与临床资料分析

目的 探讨儿童肾脏疾病的病理特点及其与临床表现的关系.方法 回顾性分析2002年2月-2010年6月在江西省儿童医院行肾活检的757例肾病患儿的病理及临床资料.将肾活检组织分别行光镜、免疫荧光、免疫组织化学及电镜检查.肾活检组织均作苏木精-伊红(HE)、过碘酸雪夫反应(PAS)、六胺银(PASM)及Masson染色;免疫荧光检测IgG、IgA、IgM、C3、C4、C1q.有乙型肝炎病毒感染证据者肾组织同时行乙型肝炎表面抗原(HBsAg)、乙型肝炎e抗原(HBeAg)、乙型肝炎核心抗原(HBcAg)免疫组织化学.参照中华医学会肾脏病分会2000年制定的标准进行病理分型,结合临床和病理资料进行统计分析.结果 1.肾活检病例757例中原发性肾小球疾病537例(70.97%),其中肾病综合征265例(49.35%),孤立性血尿99例(18.44%);继发性肾小球疾病211例(27.84%),其中紫癜性肾炎144例(68.25%),乙肝相关性肾炎47例(22.27%);遗传性肾小球疾病9例(1.19%).2.原发性肾小球疾病病理类型最多的是系膜增生性肾小球肾炎277例(51.58%);继发性肾小球疾病中紫癜性肾炎最多,为144例(68.25%),其病理分级以Ⅱb～Ⅲb为主,占79.17%;遗传性肾小球疾病中Alport综合征8例;薄基底膜肾病1例.结论 江西地区儿童肾脏疾病以原发性肾小球疾病为主,病理改变以系膜增生性肾小球肾炎占绝大多数;继发性肾小球疾病中除以紫癜性肾炎为主外,乙肝相关性肾炎并不少见.     

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目的分析儿童自身免疫性肝炎与药物性肝病的发病机制、临床特点和预后。方法2006年5月至2008年4月华中科技大学同济医学院附属同济医院收治儿童自身免疫性肝炎3例、药物性肝病5例,对其病因、临床表现、实验室检查、治疗方案和预后进行回顾性分析和总结,并复习相关文献进行临床比较。结果3例自身免疫性肝炎患儿病史6个月至3年、肝脾中至重度增大、血清IgG水平升高、自身抗体阳性、肝组织病理学检查示肝细胞水肿变性、间质及汇管区炎性细胞浸润、皮质激素治疗有效;5例药物性肝病患儿曾应用过相关药物、病史3～20d、4例肝脏轻至中度肿大、3例急性期天冬氨酸转移酶1000U/L以上、2例血清IgG水平升高、自身抗体阴性、4例对症处理好转、1例淤胆型肝病皮质激素治疗有效。结论儿童期急性或慢性严重肝病除外感染、代谢等因素者,应重点追踪患儿用药史、肝功能动态变化、免疫球蛋白、自身抗体及肝组织病理学检查,早期正确诊断和处理有利于疾病恢复,并可避免肝脏不可逆性损害。     

肾小球系膜区IgM沉积在儿童原发性肾小球疾病中的意义

目的：探讨肾小球系膜区IgM沉积在儿童原发性肾小球疾病中的意义。方法：选取2005年6月至2011年6月于北京大学第一医院儿科住院并行肾穿刺活检的原发性肾小球疾病患儿作为研究对象。根据免疫荧光下肾小球系膜区有无IgM沉积进行分组,将肾小球系膜区IgM沉积≥+且IgM免疫荧光强度≥其他免疫球蛋白荧光强度的患儿作为IgM沉积组,其余患儿为对照组。回顾性分析两组的临床、病理特点和随访等情况。结果：125例原发性肾小球疾病患儿进入分析,其中IgM沉积组76例,对照组49例。①两组在发病年龄、血总蛋白、血白蛋白、血总胆固醇、肌酐清除率、肾早期损伤指标、高血压和肾功能不全发生率等方面差异无统计学意义。IgM沉积组24 h尿蛋白定量及血IgM水平显著高于对照组（P分别为0.025和0.038）。②IgM沉积组肾小球硬化及小动脉病变发生率显著高于对照组(P分别为0.002和0.039),基底膜增厚发生率显著低于对照组（P=0.000）。③对激素治疗反应两组差异无统计学意义（P=0.364）。④随访2~78个月,两组肾功能不全及ESRD发生率差异无统计学意义。⑤IgM沉积组3/76例男性患儿行重复肾活检。除1例首次肾活检已诊断为局灶节段性肾小球硬化外,余2例在第2次肾活检时均由系膜增生性肾小球肾炎转化为局灶节段性肾小球硬化。结论：伴系膜区IgM沉积的原发性肾小球疾病患儿蛋白尿程度更重,肾脏病理改变亦更突出。对于伴系膜区IgM沉积的原发性肾小球疾病患儿应格外关注并密切随访,警惕其进展为局灶节段性肾小球硬化的可能。     

1 316例小儿肾脏病临床与病理分布特点

目的：了解小儿肾小球疾病肾脏病理改变的特点及其与临床表现的关系。方法：对近20年间该院的1 316例患儿的肾活检资料,进行了回顾性分析。结果：1 316例患儿中临床主要表现为肾病综合征(383例,占29.09% )、急性肾炎综合征(291例,占22.00%)、孤立性血尿(224例,占17.21%)、紫癜性肾炎（209例,占15.87%）、乙型肝炎病毒相关肾炎(96例,占7.30% )等。病理改变主要为系膜增生(756例,占57.45%)、IgA肾病(113例,占8.59% )、毛细血管内增生（112例,占8.51%）、膜性肾病(66例,占5.02%)、微小和轻微病变(59例,占4.48%)等。通过超微结构检查,使Alport综合征、薄基底膜病、先天性肾病、纤维样肾小球病、Fabry病等,得以明确诊断。通过肾活检组织免疫病理学检查,使IgA肾病、IgM肾病及C1q肾病得以确诊。肾活检患儿中原发性肾小球疾病最为常见（915例,占69.53%）。原发性肾小球疾病病因以原发性肾病综合征为最常见（375/915例,占41.0%）,而继发性肾小球疾病病因以紫癜性肾炎为最常见（209/344例,占60.8%）。结论： 在该次调查的肾活检资料中,原发性肾小球疾病最常见,肾病综合征是最常见的临床诊断,病理改变则以系膜增生最为多见。［中国当代儿科杂志,2007,9（2）：117-121］     

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??Objective??To explore and conclude the pathological categories and clinical data of childhood renal diseases and understand the importance of renal biopsy in childhood renal diseases. Methods??Totally 753 patients who underwent percutaneous renal biopsy from 1995 to 2015 were selected as study subjects??and their clinical and pathological information was analyzed retrospectively. Results??Among 753 patients who underwent percutaneous renal biopsy??428 cases??56.84%?? had primary glomerular disease??306 cases??40.64%?? had secondary glomerular disease??17 cases??2.26%?? had heritage glomerular disease??and 2 cases??0.27%?? had renal tubular interstitial disease. The most common clinical diagnosis were primary nephritic syndrome. The most common clinical diagnosis and pathological category in primary glomerulary disease were primary nephritic syndrome and IgA nephropathy respectively?? and in secondary glomerulary disease they were purpura nephritis and mesangial proliferative glomerulonephritis respectively. Thin basement membrane disease and Alport’s syndrome are the most common pathological category of the heritage glomerular disease. The 8 repeated renal biopsies showed pathological and clinical progression. Conclusion??The primary glomerulary disease is the main type of childhood glomerulary diseases??The most common clinical diagnosis and pathological category are primary nephrotic syndrome and mesangial proliferative glomerulonephritis respectively. The repeated renal biopsy is beneficial to control the transformation of pathological types and adjust new treatments timely.