小儿过敏性紫癜肾炎的预后影响因素

小儿过敏性紫癜性肾炎(henoch schonlein purpura nephritis,HSPN)是小儿时期最常见的继发性肾小球肾炎,虽然HSPN患儿大多预后良好,但迁延不愈、发展成肾衰竭的也为数不少,国外有报道约15%～20%[1,2]患儿最终发展成慢性肾衰竭.由于HSPN的预后未必良好,在了解每个HSPN患儿的病情之后都应进行全面评估,并且随着病情的发展不断加以修正,这不仅便于及时向家长进行必要的交待,而且医生自己也可做到心中有数,努力采取适当的治疗措施.根据近些年的研究发现HSPN的预后与其临床类型、病理改变程度、病程进展、发病年龄等因素密切相关.     

儿童毛细血管内皮细胞增生性紫癜性肾炎的临床病理及预后分析

目的 探讨以弥漫性毛细血管内皮细胞增生为主要病理表现的紫癜性肾炎（DEP-HSPN）的临床、病理及预后。 方法 回顾性分析本院近10年来经肾活检确诊的8例DEP-HSPN患儿临床、病理和预后资料,并分别与同病理级别或具有同等蛋白尿水平（肾病水平蛋白尿）的非DEP-HSPN患儿进行比较。 结果 （1）DEP-HSPN起病急,临床表现重,8例患儿中,4例临床表现为肾炎性肾病,3例表现为肾病水平蛋白尿伴血尿,1例呈急性肾炎综合征,4例患儿合并有肉眼血尿。病理分级均为Ⅲ-b级,光镜主要表现为弥漫性毛细血管内皮细胞和系膜细胞增生,常合并毛细血管袢坏死及肾小球内炎性细胞浸润,4例患儿合并细胞性新月体。（2）与病理为Ⅲ-b级的非DEP-HSPN患儿比较,DEP-HSPN患儿病程较短,临床多见肉眼血尿,24 h尿蛋白量高,更多呈肾炎性肾病表现。病理上,DEP-HSPN肾小球毛细血管袢坏死更常见。与具有肾病水平蛋白尿的非DEP-HSPN患儿相比,DEP-HSPN合并新月体的比例较低。（3）8例患儿均采用口服泼尼松联合静脉滴注环磷酰胺（CTX）冲击,病程早期给予2个疗程甲泼尼龙冲击治疗方案。平均随防（7.00±2.20）月,1例临床痊愈,5例持续镜下血尿,2例微量蛋白尿及持续镜下血尿。两组患儿预后差异无统计学意义。 结论 DEP-HSPN起病较急,临床以大量蛋白尿或肾炎性肾病为主要表现,并且常合并肉眼血尿。病程早期给予积极的免疫抑制剂治疗常能取得较满意的近期疗效。     

儿童过敏性紫癜肾炎幽门螺杆菌抗体的检测

过敏性紫癜性肾炎（HSPN）是由于过敏性紫癜（HSP）而导致的肾损害,是过敏性紫癜最严重的并发症,是影响过敏性紫癜病程、预后的决定性因素之一。HSPN发病机制尚未明确,但它属于自身免疫反应已为多数学者公认,越来越多的研究表明其发病诱因与细菌、病毒、支原体等感染后的免疫反应有关。HSPN是儿科常见的继发性肾小球肾炎,在儿童过敏性紫癜中高达20％～55％的患儿发生肾脏损伤。     

成人与儿童紫癜性肾炎的临床病理特点及预后分析

目的：探讨成人与儿童紫癜性肾炎的临床病理特点及疾病转归的差异。方法：收集温州医学院附属第一医院肾内科住院确诊为紫癜性肾炎（HSPN）的成人患者（≥18岁）36例,38例紫癜性肾炎患儿为温州医学院附属儿童医院住院病人,分析比较二者的临床病埋改变及疾病的转归。结果：（1）所有患者均有血尿。成人紫癜性肾炎临床分型为单纯性血尿2例．血尿＋蛋白尿23例,肾病综合征11例;儿童患者单纯性血尿6例,血尿＋蛋白尿22例,肾病综合征10例;两组比较无统计学差异（P〉0．05）。成人紫癜性肾炎合并高血压14例,合并肾功能损害9例;而所有儿童患者均无高血压或肾功能损害。（2）成人紫癜性肾炎病理分级：Ⅰ级3例、Ⅱ级2例、Ⅲ级28例、Ⅴ级2例、Ⅵ级1例,而儿童患者Ⅱ级31例、Ⅲ级7例,两组比较具有统计学差异（P〈0．001）。（3）27例成人紫癜性肾炎患者随访结果A组10例、B组14例、C组3例,30例儿童紫癜性肾炎的随访结果A组15例、B组13例、C组2例,两组预后无统计学差异（P〉0．05）。结论：成人与儿童紫癜性肾炎临床分型以血尿＋蛋白尿最多见,与儿童患者相比,成人临床表现偏重,合并高血压及肾功能损害较多见。成人紫癜性肾炎病理分级以Ⅲ级多见,而儿童病理分级以Ⅱ级多见,提示成人紫癜性肾炎病理较儿童严重。在本研究观察期内,我们发现成人与儿童紫癜性肾炎的预后均较好,二者预后无统计学差异。     

过敏性紫癜性肾炎的遗传学研究进展

过敏性紫癜性肾炎(HSPN)是儿童时期继发性肾小球疾病中最常见的一种。Davin等经过20年随访发现超过20％的患儿发展成慢性肾衰竭。因此，近年来遗传因素在HSPN的发病机制、病理进展、治疗及预后中的作用研究越来越受关注，本文就遗传学的角度对近年来的研究进行综述。     

儿童紫癜性肾炎的临床和病理研究

目的：探讨儿童紫癜性肾炎（HSPN）的临床和肾组织病理改变特点及其关系。方法：回顾性分析1995年12月～2007年12月进行过肾活检的105例HSPN患儿的临床和肾组织病理改变情况。结果：105例HSPN患儿中,单纯血尿组18例（17.14%）,血尿及蛋白尿组61例（58.10%）,肾病综合征组26例（24.76%）;三组间的Scr、BUN、IgA、IgE、CRP和C3水平均无统计学差异（P均〉0.05）,血浆白蛋白在各组间存在统计学差异（P均〈0.01）。病理上ISKDC分级结果为：Ⅱa级8例（7.62%）,Ⅱb级21例（20.00%）,Ⅲa级33例（31.43%）,Ⅲb级38例（36.19%）,Ⅳ级5例（4.76%）;三组间比较有统计学差异（χ^2=44.51,P〈0.01）。肾小管间质病变的组织学分级结果为：（-）级34例（32.38%）,（＋）级64例（60.95%）,（＋＋）级6例（5.71%）,（＋＋＋）级1例（0.95%）,（＋＋＋＋）级0例（0%）;三组间比较有统计学差异（χ^2=40.59,P〈0.01）。结论：儿童HSPN临床表现多样,肾病理改变相对较轻,且两者之间存在密切关系。     

紫癜性肾炎伴高血压患儿临床病理特征及预后分析

目的 分析过敏性紫癜性肾炎(henoch-Sch?nlein purpura nephritis,HSPN)伴高血压患儿临床和病理特征及预后特点.方法 对2015年1月至2019年12月贵阳市妇幼保健院住院诊断为HSPN的148例患儿的临床及病理资料进行回顾性分析,根据患儿是否合并高血压分为HSPN血压正常组和HSPN...     

30例紫癜性肾炎的临床病理及预后的关系

我科收集了经临床及肾活检确诊的紫癜性肾炎30例，现将其临床病理及与预后的关系分析如下。     

儿童IgA肾病伴过敏性紫癜性肾炎二例

儿童原发性IgA肾病与过敏性紫癜性肾炎临床表现不同，但肾脏病理改变十分相似，本院收治了2例患儿，兼有2种疾病的表现，报告如下。     

儿童毛细血管内皮细胞增生性紫癜性肾炎的临床病理及预后分析

Objective To investigate the clinicopathological characteristics and prognosis of Henoch-Schonlein purpura nephritis with diffused endothelial cell proliferation (DEP-HSPN) in children. Methods Data of 8 DEP-HSPN cases in Nanjing Children's Hospital within recent ten years were retrospectively reviewed. The clinicopathological features, efficacy and prognosis were compared between DEP-HSPN cases and 48 cases of non-DEP-HSPN. Non-DEP-HSPN cases were divided into two groups according to the clinical classification or the pathological classification.Results (1) In DEP-HSPN, HSP developed nephritis within 4 to 15 days after the initial onset of purpuric rashes. Hematuria was present in all the 8 patients. The main clinical manifestation of DEP-HSPN was nephritic-nephrotic syndrome (4 cases), nephrotic level proteinuria (3 cases) and acute nephritic syndrome (1 case). Four cases had macrohematuria. Six cases had abdominal symptoms and two cases had arthritis. Pathology of all the cases showed grade Ⅲ-b lesion with diffused endocapillary proliferation and segmental necrotizing lesion of the capillary wall, always accompanied with intraglomerular inflammatory cell infiltration. Crescent was found in 4 cases. (2)Compared to non-DEP-HSPN grades Ⅲ, DEP-HSPN showed a shorter course of disease.Macrohematuria, heavy proteinuria, nephritic-nephrotic syndrome, and segmental necrotizing lesion of capillary wall were more common in DEP-HSPN. Compared to non-DEP-HSPN with nephrotic level proteinuria, DEP-HSPN had a lower rate of crescent. (3) Methylprednisolone pulse therapy in early stage, then prednisone combined with cyclophosphamide were used in the treatment of DEP-HSPN.After an average follow-up period of seven months, one patient showed complete remission, five showed persistent microhematuria, and two showed persistent microhematuria accompanied with minor proteinuria. No significant difference of prognosis was found between DEP-HSPN and nonDEP-HSPN. Conclusions DEP-HSPN has an acute onset. The main clinical manifestation of DEP-HSPN is nephritic-nephrotic syndrome and nephrotic level proteinuria, always accompanied with macrohematuria. Immunosuppressant treatment in the early stage of disease is effective for a short-term outcome.     

儿童毛细血管内皮细胞增生性紫癜性肾炎的临床病理及预后分析

Objective To investigate the clinicopathological characteristics and prognosis of Henoch-Schonlein purpura nephritis with diffused endothelial cell proliferation (DEP-HSPN) in children. Methods Data of 8 DEP-HSPN cases in Nanjing Children's Hospital within recent ten years were retrospectively reviewed. The clinicopathological features, efficacy and prognosis were compared between DEP-HSPN cases and 48 cases of non-DEP-HSPN. Non-DEP-HSPN cases were divided into two groups according to the clinical classification or the pathological classification.Results (1) In DEP-HSPN, HSP developed nephritis within 4 to 15 days after the initial onset of purpuric rashes. Hematuria was present in all the 8 patients. The main clinical manifestation of DEP-HSPN was nephritic-nephrotic syndrome (4 cases), nephrotic level proteinuria (3 cases) and acute nephritic syndrome (1 case). Four cases had macrohematuria. Six cases had abdominal symptoms and two cases had arthritis. Pathology of all the cases showed grade Ⅲ-b lesion with diffused endocapillary proliferation and segmental necrotizing lesion of the capillary wall, always accompanied with intraglomerular inflammatory cell infiltration. Crescent was found in 4 cases. (2)Compared to non-DEP-HSPN grades Ⅲ, DEP-HSPN showed a shorter course of disease.Macrohematuria, heavy proteinuria, nephritic-nephrotic syndrome, and segmental necrotizing lesion of capillary wall were more common in DEP-HSPN. Compared to non-DEP-HSPN with nephrotic level proteinuria, DEP-HSPN had a lower rate of crescent. (3) Methylprednisolone pulse therapy in early stage, then prednisone combined with cyclophosphamide were used in the treatment of DEP-HSPN.After an average follow-up period of seven months, one patient showed complete remission, five showed persistent microhematuria, and two showed persistent microhematuria accompanied with minor proteinuria. No significant difference of prognosis was found between DEP-HSPN and nonDEP-HSPN. Conclusions DEP-HSPN has an acute onset. The main clinical manifestation of DEP-HSPN is nephritic-nephrotic syndrome and nephrotic level proteinuria, always accompanied with macrohematuria. Immunosuppressant treatment in the early stage of disease is effective for a short-term outcome.     

紫癜性肾炎55例的临床病理分析及治疗预后探讨

目的：探讨紫癜性肾炎的临床病理、治疗及预后。方法：选择55例紫癜性肾炎患者，对其临床及病理资料进行回顾性分析和研究，并分析其治疗方法及预后。结果：发病年龄〉18岁者46例，病理类型以Ⅲa型多见，Ⅳ、Ⅵ型病理较重，经治疗大部分患者尿蛋白减轻及肾功能好转，预后良好。结论：紫癜性肾炎在成人中并不少见，其预后与病理分级相关。早期诊断、及时治疗后大部分患者预后较好，对发病时尿检正常的患者应密切随访，曾患过敏性紫癜的妇女妊娠期间应加强监测。     

儿童过敏性紫癜肾炎的临床治疗分析

目的:探讨儿童过敏性紫癜肾炎的临床特点和治疗.方法:选择本院50例过敏性紫癜肾炎患儿,分析其临床表现、临床分型.给予抗组胺药、盐酸贝那普利及维生素C、维生素E、钙剂、双密达莫等综合治疗,同时给予肾上腺皮质激素和复方丹参注射液治疗.结果:50例患儿治疗后,总的有效率为96％(48/50).结论:儿童过敏性紫癜肾炎的治疗复杂,需综合分析病情,制定合理的治疗方案,联合应用丹参注射液及肾上腺皮质激素能够提高儿童过敏性紫癜肾炎的治疗效果.     

肾炎康复片治疗小儿紫癜性肾炎30例临床观察

过敏性紫癜性肾炎是儿科常见的继发性肾小球疾病，其临床表现多样性，且病程较迁延，常常表现为反复血尿、蛋白尿，影响患儿的生长、发育。我科使用肾炎康复片治疗紫癜性肾炎患儿30例，结果表明该药在减轻或消除血尿、蛋白尿方面具有较好的疗效，现总结如下。     

儿童紫癜性肾炎的肾脏病理分型及个人建议

紫癜性肾炎(henoch schonlein purpura nephritis, HSPN)是儿童临床肾脏专业最常见的继发性肾小球疾病之一。儿童HSPN肾脏病理分型标准较多,其中国际儿童肾脏疾病研究组分型最为经典和常用,儿童IgA肾病的牛津分型次之,但更为全面、可能更有应用前景。本文综述了儿童HSPN的不同病理分型,并提出笔者个人观点。     

紫癜性肾炎的临床表现和病理改变分析

过敏性紫癜是一种以皮肤、关节、胃肠道和肾脏损害为主的多系统疾病,其中肾脏损害对过敏性紫癜预后的影响尤为重要.紫癜性肾炎临床表现、病理改变及预后个体间差异很大,为探讨紫癜性肾炎的临床病理特点及其与预后的关系,对我科近年来收治的99例紫癜性肾炎进行了回顾性分析.     

于家菊教授治疗过敏性紫癜性肾炎的经验

于家菊教授是山西省中医药研究院肾内科教授，名肾病专家，率先在国内开展肾小球疾病的中西医结合疗法，业医几十年，学验俱丰。于老不仅医术精湛而且医德高尚，现将于家菊教授治疗过敏性紫癜性肾炎的经验总结报告如下。     

紫癜性肾炎患儿肾脏病理程度评分与临床关系的探讨

紫癜性肾炎（ａｎａｐｈｙｌａｃｔｏｉｄ ｐｕｒｐｕｒａｎｅｐｈｒｉｔｉｓ, ＡＰＮ）是儿童继发性肾脏疾病中最常见疾病之一,以全身坏死性小血管炎为主要病变,决定 ＡＰＮ 临床发生发展重要指标为肾脏病理改变程度及病理进展情况。以往研究均为 ＡＰＮ肾脏病理定性分析,缺乏定量标准,我们制定肾脏病理改变评分标准,对３０例 ＡＰＮ肾小球、肾小管病理改变进行定量分析,探讨其与临床表现预后之间的关系,为ＡＰＮ治疗提供依据。 一、对象与方法 １．病例选择与诊断标准：本组３０例,均为我科 １９９３年 ５月～ １９９９年 ２月住…