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1.
目的 探讨在彩超引导下对肾脏疾病患者进行经皮肾组织穿刺活检的临床价值。方法 采用PHILIPS非凡彩超诊断仪穿刺架自动活检枪及组织切割针对肾下极进行穿刺,穿刺组织分别送电镜、光镜及免疫学检查。结果 32例患者利用组织切割针进行肾穿刺,取出组织42条,电镜共检出466个肾小球,送病理学检查,检出弥漫性系膜增生性肾小球肾炎16例,IgA肾病6例,轻度系膜增生型IgM肾病5例,狼疮性肾炎2例,紫癜性肾炎1例,局灶增生性肾小球肾炎1例,轻度系膜增生型IgA肾病伴高血压肾脏损害1例。结论 经皮肾穿刺活检,对了解肾脏疾病的病理类型,指导临床治疗及判断预后有十分重要的意义,方法操作简便,成功率高,并发症少,值得推广。  相似文献   

2.
超声引导下经皮不同方式肾组织活检的临床应用   总被引:1,自引:0,他引:1  
目的 B型超声引导下对30例肾脏疾病患者进行经皮,肾组织穿刺活检的经验.方法采用东芝240 A型超声仪和穿刺探头,选择右肾下极穿刺.利用同步负压活检装置及组织切割针进行肾穿刺.分别送光镜、电镜及免疫组化检查.结果 30例患者,利用同步负压活检装置进行肾穿18例,利用组织切割针进行肾穿12例,取材率100%.并取出组织物35条,共检出肾小球306个.送病理学检查.结果为肾小球疾病者28例,肾小管疾病者2例.在肾小球疾病中,原发者24例,包括弥漫系膜增生性肾小球肾炎19例,IgA肾病4例,新月体肾小球肾炎1例,继发性者4例,即狼疮性肾炎4例.结论经皮肾穿刺活检,对了解肾脏疾病的病理类型、指导临床治疗、判断疾病预后具有十分重要的意义.  相似文献   

3.
岳丹  任燕 《中国误诊学杂志》2011,11(31):7732-7732
目的探讨超声引导下经皮肾组织穿刺活检术对肾脏疾病的应用价值。方法对36例肾脏疾病患者在超声引导下经皮对肾脏进行穿刺,取出组织行病理检查。结果 36例共穿刺50针,穿出组织50条,长度1~2cm,穿刺成功率100%,其中系膜增生性肾小球肾炎23例,Ⅱ型狼疮性肾炎3例,Ⅲ型狼疮性肾炎2例,Ⅳ型狼疮性肾炎4例,新月体肾炎1例,系膜增生性肾小球肾炎伴局限性肾小球硬化3例。结论经皮肾组织穿刺活检术对了解肾脏疾病的病理类型,指导临床治疗及判断预后具有重要意义。  相似文献   

4.
为探讨肾炎超声图象与病理类型的关系,在无创性检查方面寻求确定肾炎病理类型的路子,我们立题对60例原发性肾小球肾病患者B超切面象与病理进行了研究及对比分析。超声图象主要分析肾脏大小(长径×宽径×厚径),肾实质回声强度、皮髓质分界。肾被膜轮廓线是否完整。60例均经肾穿刺活检确诊病理类型。结果显示:3例轻微肾小球病变与25例系膜增生性肾小球肾炎的超声图象均正常,11例硬化型肾炎,  相似文献   

5.
目的:肾组织活检是肾脏疾病检查的~项重要诊断,为探讨国产自动同步负压肾穿装置的临床应用价值。方法:应用该装置对165例肾病患进行彩超引导下肾穿活检效果满意。本组165例,男116例,女49例,年龄6—66岁。使用仪器为ACUSON 128及SEQOIA 512型彩超仪,探头频率2.5~4.0MHz,配有穿刺引导器。穿刺枪及穿刺针选用南京军区福州总医院肾病中心研制的自动同步负压肾穿装置,由自动同步负压器、20号导管针、16G穿刺针组装构成。取材部位选肾下极实质部。结果:肾活检165例,一次取材成功156例,二次取材成功7例,总取材成功率100%,平均取材长度1.6cm,经病理诊断有系膜增生性肾小球肾炎59例,膜性增生性肾小球肾炎26例,IgA肾病38例.局灶性硬化性肾小球肾炎17例,毛细血管内膜增生性肾炎9例,轻度病变性肾小球肾病10例,狼疮性肾炎6例。结论:血尿、蛋白尿在临床上是肾弥漫性病理改变的常见症状,二维及彩色能量图对其诊断的敏感性较差,超声引导下穿刺活检完全不受肾功能及年龄限制,凡声像图能清晰显示肾脏及其周围组织解剖结构均可行肾穿刺活检。并且安全、准确可靠,取材质量高.并发症少。术中穿刺应具备熟练的穿刺技术,做到准确定位与患密切配合,均能保证穿刺成功并取材满意。本组165例均采用国产自动同步负压肾穿装置,在操作程序、穿刺成功率和取材质量上均可与进口穿刺枪相媲美,可谓价廉物美,应予推广。  相似文献   

6.
由于肾穿刺活检术易导致感染、出血和腰痛等严重并发症。为了能安全地进行该项检查 ,自 2 0 0 1年 12月我院选用切割肾穿刺活检针 ,对 5 3例俯卧位肾脏病人进行了切割肾穿刺活检。穿刺前后采取了各种护理措施 ,有效地防止了各种并发症的发生。1 临床资料1 1 一般资料。 2 0 0 1年 12月~ 2 0 0 2年 8月我院经皮肾穿刺活检共 5 3例 ,其中男 2 3例 ,女 30例 ,年龄 15~ 67岁。慢性肾功能不全尿毒症期 1例 ,IGA肾病 12例 ,原发性肾病综合征 2 1例 ,慢性肾炎6例 ,过敏性紫癜性肾炎 2例 ,慢性肾小球肾炎 4例 ,急性肾小球肾炎 1例 ,系统性红…  相似文献   

7.
黎伟  赵铖  薛超  廖蕴华  杨桢华 《新医学》2007,38(12):789-790
目的:总结老年肾脏病患者的临床与病理类型分布特点.方法:总结121例的肾穿刺活组织检查(活检)病理资料,分析不同临床表现[包括尿常规检查异常(有蛋白尿、血尿或管型细胞,但达不到肾病综合征诊断标准,亦无肾功能不全)、肾病综合征、肾功能不全]患者的病理类型.结果:121例的肾脏疾病病理分布以原发性肾小球病为主,其中前3位分别是系膜增生性肾炎、微小病变性肾小球肾炎、膜性肾小球肾炎.继发性肾小球疾病的主要病理类型为狼疮肾炎,其次是显微镜下多血管炎、肾淀粉样变.尿常规异常21例,肾病综合征61例,肾功能不全53例.尿常规检查异常患者以原发性肾小球疾病为主,占76%,病理类型前3位分别为系膜增生性肾小球肾炎、微小病变性肾小球肾炎,IgA肾病.老年肾病综合征以原发性为主,占84%,病理类型前3位为系膜增生性肾小球肾炎、膜性肾小球肾炎、微小病变性肾小球肾炎.急性肾功能不全患者以微小病变性肾小球肾炎为主(7例).慢性肾功能不全以原发性肾小球疾病为主,前3位依次为硬化性肾炎、系膜增生性肾小球肾炎和IgA肾病.结论:老年患者的肾小球疾病以原发性多见,病理类型以系膜增生性肾炎、微小病变性肾小球肾炎、膜性肾小球肾炎为主;在继发性肾小球疾病中则以狼疮肾炎为主,显微镜下血管炎次之.  相似文献   

8.
107例IgA肾病的临床表现与病理分析   总被引:1,自引:0,他引:1  
随着肾穿刺病理活检的开展,IgA肾病越来越被人们所认识,该病临床表现多样化、组织形态学轻重不一,预后各不相同,本文就107例IgA肾病的临床与病理关系报告如下。1资料与方法1.1病例选择资料来源于1992~1998年107例肾穿制病理活检证实的IgA肾病。1.2方法临床上分为4组:(l)单纯血尿组(分为肉眼血尿与镜下血尿),(2)单纯蛋白尿组(分为轻、中皮蛋白尿与肾病综合症);(3)血尿同时伴蛋白尿组;(4)肾功能不全组。肾组织活检分别作光镜、免疫荧光及电镜检查,病理上肾脏病变分为:(1)微小病变型;(2)系膜增生型肾小球肾炎…  相似文献   

9.
62例移植肾穿刺活组织检查的病理及临床分析   总被引:3,自引:0,他引:3  
目的:探讨肾移植后肾损害的病理及可能的相关因素,评价移植肾穿刺活组织检查(肾活检)的诊断价值。方法:回顾性分析62例移植肾肾活检的病理及临床资料。结果:62例中发生总性排斥反应24例(39%),慢性移植性肾病21例(34%),加速排斥反应1例,IgA肾病5例(8%),系膜增生性肾炎样改变3例(5%),新月体肾炎2例,膜性肾病1例,环抱素中毒1例,肾结核1例,急性肾小管坏死1例,慢性排斥反应、慢性肾小球肾炎各1例。排斥反应病例肾移植术前的人类白细胞抗原配型和群体反应性抗体明显差于非排斥反应病例,巨细胞病毒感染发生率较高。移植肾穿刺活检未发生明显的不良反应。结论:移植肾肾活检安全可靠,对于肾移植术后发生肾损害的病因诊断具有很高的价值。  相似文献   

10.
目的:检测小儿常见肾脏疾病尿电导率的变化,探讨该指标的临床意义。方法选择2011年3月至2012年3月本院小儿肾脏内科收治的首次诊断为肾脏疾病患儿986例及同期健康体检儿童350例的尿液,利用 Sysmex 公司的全自动尿液分析仪 UF-1000i 分别测定其尿电导率的变化。根据临床诊断将肾脏疾病患儿分为肾病综合征组、肾小球肾炎组、肾功能不全组、紫癜性肾炎组和狼疮性肾炎组。其中216例进行肾穿刺活检。根据肾穿刺活检病理诊断结果将患儿分为系膜增生性肾小球肾炎组、毛细血管内增生性肾小球肾炎组、膜性肾病组、IgA 肾病组、IgM 肾病组、过敏性紫癜性肾炎组和狼疮性肾炎组。结果1.肾病综合征组、肾小球肾炎组、肾功能不全组、紫癜性肾炎组、狼疮性肾炎组患儿的尿电导率明显低于健康对照组,差异具有统计学意义(P <0.05)。2.系膜增生性肾小球肾炎组、毛细血管内增生性肾小球肾炎组、膜性肾病组、IgA 肾病组、过敏性紫癜性肾炎组和狼疮性肾炎组患儿尿电导率明显低于健康对照组,差异具有统计学意义(P <0.05)。3.IgM 肾病组与健康对照组相比,尿电导率差异无统计学意义(P >0.05)。结论尿电导率可以作为小儿肾脏功能和尿液浓缩功能的重要指标。  相似文献   

11.
The aim of this study was to apply a decision forest to analysis of the ultrasound characteristics and laboratory test indices of four types of primary glomerulopathy, and quantitative analysis of the four pathologic types using a combination of these two methods. The decision trees were derived from 41 clinical indices and 5 characteristic sonographic indices obtained for the left kidney. Fifty-six patients who had undergone ultrasound-guided renal biopsy were reviewed retrospectively, and on pathologic examination, the patients were diagnosed with primary glomerulopathy, which includes mesangial proliferative glomerulonephritis, membranous nephropathy, immunoglobulin A nephropathy and minimal change disease. In this study, eight characteristic indicators were correlated with pathologic type in the 56 cases of primary glomerulopathy. The order calculated by decision forests, from high to low, is proteinuria, length of kidney, serum creatinine, plasma albumin, area of kidney, total protein, thickness of renal parenchyma, 24-h urine protein. The glomerulopathy with the highest ++++ proteinuria is membranous nephropathy, which accounts for 39.2% (22/56) of the total sample; this was followed by minimal change disease, mesangial proliferative glomerulonephritis and immunoglobulin A nephropathy. On the basis of our analysis of 41 clinical indices, the key indices for quantitative analysis of primary glomerulonephritis are laboratory tests, and these include urine protein, serum creatinine, plasma albumin, total serum protein and 24-h urine protein. The three key sonographic features are measurement indices: renal length, renal area and renal parenchymal thickness. From the eight characteristic indicators, we observed that with respect to severity (from most severe to least severe), the four types of glomerulopathy are membranous nephropathy, minimal change disease, mesangial proliferative glomerulonephritis and immunoglobulin A nephropathy.  相似文献   

12.
目的:探讨老年人原发性肾小球疾病及继发性肾脏疾病肾活检病理类型及临床特点。方法:回顾分析2003年—2005年123例年龄≥65岁,资料完整,并经临床和肾活检确诊为原发性肾小球疾病或继发性肾脏疾病患者的肾脏活组织病理和临床资料,并与同期367例中青年患者的肾脏活组织检查和临床资料进行对比。结果:①老年患者原发性肾小球疾病中膜性肾病最为常见,占原发肾脏疾病的31.46%,其次为IgA肾病(25.84%)。中青年患者原发肾脏疾病中以IgA肾病最为常见,占39.49%,其次为系膜增生性肾小球肾炎,占22.88%。②老年IgA肾病患者病理以局灶节段性肾小球硬化(FSGS)为主,占21.74%,而中青年患者以弥漫系膜增生为主,占30.95%。③糖尿病肾病是老年人最常见的继发性肾脏疾病,占32.35%,狼疮性肾炎是中青年患者最常见的继发性肾脏疾病,占58.33%。④老年肾脏疾病患者尿蛋白定量(3.60±0.78g.24h^-1)显著高于中青年组(2.19±0.68g.24h^-1),P〈0.05。高血压的发生率显著增高(73.98%比30.51%,P〈0.01)。结论:老年患者肾脏病理类型与中青年患者不一致,老年原发性肾小球疾病以膜性肾病为主,IgA肾病的病理类型以FSGS为主;中青年患者原发性肾小球疾病以IgA肾病为主,IgA肾病的病理类型以弥漫系膜增生为主。老年患者继发性肾脏疾病的发生率高,以糖尿病肾病最为常见。肾脏病理类型的不同,是老年肾脏病患者临床表现中尿蛋白多和高血压的发生率增高的原因之一。  相似文献   

13.
Abstract. IgD deposits have been investigated by an indirect immunofluorescence technique in 180 renal biopsies carried out on patients with various renal diseases. IgD was not present in nephrotic syndrome with minimal changes or focal glomerulosclerosis, in mesangial proliferative glomerulonephritis, in chronic advanced glomerulonephritis, in rheumatoid purpura and in other various nephropathies with predominant non-glomerular lesions. Significant deposits of IgD were identified in 12 out of 16 cases of membranoproliferative glomerulonephritis, in 15 out of 23 cases of membranous nephropathy, in 11 out of 21 cases of focal proliferative glomerulonephritis with mesangial IgA deposits, in 2 out of 5 cases of proliferative glomerulonephritis with crescents and in 1 out of 6 cases of proliferative exudative glomerulonephritis. All cases of lupus nephritis and nephritis associated with mixed cryoglobulinaemia showed IgD deposits. In diabetic glomerulosclerosis, IgD was found in 1 out of 4 biopsies and only in the exudative lesions. In 5 out of 8 cases of amyloidosis anti-IgD serum stained the amyloid substance irregularly. In such cases IgD was found in association with other immunoglobulins and complement with the same localization. These findings suggest that IgD may participate in the immunological processes which lead to the development of glomerular deposits, mainly in cases of chronic glomerular diseases.  相似文献   

14.
Abstract. IgD deposits have been investigated by an indirect immunofluorescence technique in 180 renal biopsies carried out on patients with various renal diseases.
IgD was not present in nephrotic syndrome with minimal changes or focal glomerulosclerosis, in mesangial proliferative glomerulonephritis, in chronic advanced glomerulonephritis, in rheumatoid purpura and in other various nephropathies with predominant non-glomerulor lesions.
Significant deposits of IgD were identified in 12 out of 16 cases of membranoproliferative glomerulonephritis, in 15 out of 23 cases of membranous nephropathy, in 11 out of 21 cases of focal proliferative glomerulonephritis with mesangial IgA deposits, in 2 out of 5 cases of proliferative glomerulonephritis with crescents and in 1 out of 6 cases of proliferative exudative glomerulonephritis.
All cases of lupus nephritis and nephritis associated with mixed cryoglobulinaemia Bhowed IgD deposits.
In diabetic glomerulosclerosis, IgD was found in 1 out of 4 biopsies and only in the exudative lesions.
In 5 out of 8 cases of amyloidosis anti-IgD serum stained the amyloid substance irregularly. In such cases IgD was found in association with other immunoglobulins and complement with the same localization. These findings suggest that IgD may participate in the immunological processes which lead to the development of glomerular deposits, mainly in cases of chronic glomerular diseases.  相似文献   

15.
目的探讨乙型肝炎病毒(HBV)相关性肾炎临床病理特点。方法分析17例HBV相关性肾炎的临床表现及肾活检病理、免疫荧光和超微病理特点。结果17例HBV相关性肾炎临床表现以肾病综合征最常见10例(58.82%),肾炎综合征7例(41.18%)。病理类型多样化,其中膜性肾病(MN)8例(47.06%),系膜增生性肾炎(MsPGN)7例(41.18%),系膜毛细血管性肾炎(MPGN)1例(5.88%),IgA肾病(IgAN)1例(5.88%)。免疫荧光检查5.88%的病例呈"满堂亮"现象;电镜观察HBV相关性膜性肾病易见电子致密物系膜沉积。结论HBV-GN的病理类型以HBV-MN为主,多见于中青年人,肾组织HBVAg免疫组化标志为诊断HBV-GN的重要指标。鉴于HBV相关性肾炎的一些病理特点与狼疮性肾炎相似,有必要结合临床对二者进行鉴别。  相似文献   

16.
The frequency of hepatitis B surface antigen (HBsAg) was studied in the sera of 311 patients with various forms of primary glomerulonephritis and 43 patients with lupus nephritis. HBs antigenaemia was detected in 69 of the 311 patients (22 per cent) with primary glomerulonephritis and this prevalence of HBsAg carrier was significantly higher than that in the general population (p less than 0.001). These patients had no clinical or biochemical findings to suggest acute or chronic liver disease. A higher HBs antigenaemia carrier rate was not observed in patients with lupus nephritis. Three glomerulopathological entities, membranous nephropathy, IgA nephropathy, and mesangial proliferative glomerulonephritis, were found to be associated with a higher prevalence of HBs antigenaemia compared with the general population (p less than 0.001). Glomerular deposits of HBsAg and/or hepatitis core antigen (HBcAg) were detected in 41, 61, and 60 per cent of renal biopsy specimens from patients with membranous nephropathy, IgA nephropathy, and mesangial proliferative glomerulonephritis associated with persistent HBs antigenaemia respectively. During the mean study period of 40 months (range 12-180), 14 per cent of these patients with hepatitis-associated glomerulonephritis developed progressive renal failure, although none required maintenance dialysis. Our study suggests that hepatitis B virus antigenaemia may play a significant role in the development of specific forms of glomerulonephritis and that these hepatitis B virus-associated glomerulonephritides can run an indolent but relentless progressive clinical course.  相似文献   

17.
2444例肾活检临床病理分析   总被引:3,自引:0,他引:3  
目的:分析近5年2 444例肾活检患者肾脏疾病构成比及不同年龄段肾脏疾病构成比变化的特点。方法:回顾分析2005年1月—2009年12月2 444例肾活检患者肾脏疾病的构成比及每年肾脏疾病构成比的变化,并根据年龄分为4个年龄段,分析每个年龄段患者肾脏疾病构成比的特点。结果:原发性肾小球疾病仍为目前最主要的肾脏疾病(占79.58%),其每年所占比例无明显改变。IgA肾病是最常见的原发性肾小球疾病,占47.97%。局灶节段增生性肾炎每年所占的比例不一(P〈0.01),系膜增生性肾炎比例逐年减少(P〈0.001),膜性肾病比例有升高趋势,但差异无统计学意义(P〉0.05)。继发性肾脏疾病中,糖尿病肾病、高血压肾损害逐年增高(P均〈0.01)。不同年龄段患者无论是原发性肾小球疾病还是继发性肾脏疾病的构成比都有显著差异(P=0.000)。97.0%的IgA肾病患者年龄位于18~45岁,微小病变好发于18岁以下,而65岁以上患者最常见膜性肾病(33.59%)。18岁以下患者最常见的继发性肾脏疾病为紫癜性肾炎(64.29%),中青年患者最常见的继发性肾脏疾病是狼疮性肾炎(65.42%)。结论:肾脏疾病构成比逐年变化,不同年龄患者肾脏疾病构成比各有特点。  相似文献   

18.
[目的]探讨超声引导下肾活检所致出血并发症的相关因素,对出血原因进行分析,以减少并发症的发生.[方法]在超声引导下以美国Bard 16G自动活检装置对520例肾脏病患者行肾穿刺活检,从肾实质厚度、肾穿刺次数、肾穿时血压水平、肾脏病理改变几方面进行分析.[结果]在520例肾穿活检中,肾实质厚度在0.80~1.5 cm、肾...  相似文献   

19.
Nephrotic syndrome was the commonest clinical presentation among2827 consecutive adult Indian patients from whom adequate kidneydiopsies were obtained for suspected renal disease. In 83 percent of cases the nephrotic syndrome was due to minimal changedisease, focal segmental glomerulosclerosis, mesangiocapillaryglomerulonephritis, membranous glomerulonephritis, lupus glomerulonephritisor diabetic glomerulosclerosis. Amyloidosis, usually secondaryto tuberculosis or leprosy, was present in only 34 patients.Acute nephritis, the next most frequent clinical presentation,was due to diffuse endocapillary proliferative, crescen-ticor mesangial proliferative glomerulonephritis in 88 per centof cases, almost half of whom had elevated serum streptococcalantibody titres. Eosinophilia showed a highly significant associationwith diffuse endocapillary proliferative and mesangiocapillaryglomerulonephritis. Idiopathic IgA nephropathy was present inonly 10, and antiglomerular basement membrane antibody diseasein only one, of the 238 patients whose biopsies were studiedby immunofluorescence. Complications of pregnancy accounted for 70 per cent of casesof cortical necrosis. Acute gastroenteritis, septicaemia, abortions,snake bite and allopathic and indigenous medicines were importantcauses of acute tubular necrosis.  相似文献   

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