肾活检在非典型狼疮性肾炎诊断中的价值

目的探讨肾活检在非典型狼疮性肾炎（LN）诊断中的价值。方法对23例非典型LN患者的临床和病理资料进行回顾性分析。结果23例患者肾活检前均未达到ACR诊断标准，其中误诊为原发性肾病综合征13例，慢性肾炎4例．无症状性血尿或（和）蛋白尿、过敏性紫癜、特发性膜性肾病各2例；所有病例经肾活检确诊为LN，病理分型为：Ⅱ型2例，Ⅲ型3例，Ⅳ型6例，Ⅴ型11例，Ⅲ型±Ⅴ型1例；临床表现为肾病综合征者肾脏病理分型多为Ⅴ型和Ⅳ型，慢性肾炎综合征者病理分型呈多样化。结论非典型LN临床表现无特异性，易误诊误治，肾活检对非典型LN的诊断具有重要价值。

Value of Renal Biopsy in Diagnosis of Atypical Lupus Nephritis

Objective To explore the clinical value of renal biopsy in the diagnosis of atypical lupus nephritis （LN）. Methods The clinical and renal pathological data of 23 cases with atypical LN were analyzed retrospectively. Results All 23 patients could not fulfill the ACR diagnostic criterion, Misdiagnosed as primary nephritic syndrome 13 cases, chronic glomerulonephritis syndrome 4 cases, asymptomatic bematuria and/or proteinuria, Henoch-Schonlein purpura and idiopathie membranous nephropathy 2 cases. All renal biopsy showed changes consistent to lupus nephritis. Pathological types ：2 cases were class Ⅱ ,3 cases were class Ⅲ,6 cases were class Ⅳ, Ⅱcases were class Ⅴ, 1 case was class Ⅲ＋ Ⅴ lupus nephritis. The clinical manifestations of nephritic syndrome were mostly pathological type Ⅳ and Ⅴ, the chronic glomerulonephritis syndrome showed diversification of pathological type. Conclusions Clinical manifestations of atypical LN is no specific and easy to be misdiagnosed. Renal biopsy has great value in the diagnosis of atypical LN.