小儿单纯性血尿84例临床分析

目的探讨小儿单纯性血尿的病因及诊治过程.方法参照单纯性血尿诊断标准,对84例行普通显微镜尿涂片染色,观察红细胞形态学变化,鉴别肾性血尿和非肾性血尿.结果小儿单纯性血尿84例中,肾性血尿28例(33.3%),其中急性肾炎19例,紫癜性肾炎7例,肾炎性肾病综合征4例;非肾性血尿47例(56%),其中药物性血尿32例,感冒通致血尿13例,尿路结石9例,运动性血尿4例;两者并存血尿9例.结论肾性血尿和非肾性血尿需早期诊断和早期病因治疗,急性期卧床休息,血尿治疗效果满意.     

免疫荧光染色、超高倍相差显微仪鉴别血尿的方法对比

肾性血尿与非肾性血尿的区别对临床诊断和治疗有重要价值.检查尿中红细胞形态已经被作为肾性与非肾性血尿的一个常用诊断指标.尿中异形红细胞达到三种以上,同时变异率70%以上代表肾性血尿(非均一性血尿),而红细胞形态一致则说明标本是非肾性血尿(均一性血尿);但是,这种方法有时受到尿液标本的理化性质影响.一些研究表明,尿的渗透压、pH值、离子比等因素都可影响红细胞的形态和大小.我们认为,尿中红细胞上的Ig染色,是鉴别肾性与非肾性血尿的一个很好的方法;用荧光标记的兔抗人Ig抗体(抗IgA抗体,抗IgG抗体)对尿中红细胞上Ig染色(简称免疫荧光染色)的方法来区别肾性与非肾性血尿,同时和超高倍相差显微仪尿沉渣形态学检查(简称形态学检查)结果相比较.     

小儿非肾性血尿与血管紧张素转换酶基因多态性相关性研究

目的探讨儿童非肾性血尿与血管紧张素转换酶基因多态性的关系。方法用PCR方法检测了2004年1~12月长春市儿童医院泌尿内科51例非肾性血尿患儿ACE基因,并分析ACE基因多态性与非肾性血尿临床表现的相关性。结果非肾性血尿患儿ACE-DD基因频率为0.25,ACE-II基因频率为0.59,ACE-DI基因频率为0.16,非肾性血尿患儿ACE基因多态性与正常对照组存在明显差异;ACE-II基因型与非肾性血尿的遗传易感性相关联,OR=2.77。结论ACE-II基因可能是发生非肾性血尿的危险因子。检测儿童ACE基因,对于早期发现和及时防治儿童非肾性血尿有重要意义。     

以血尿为主要表现患者的临床与病理分析

目的探究以血尿为主要临床表现患者的病理类型分布及临床特点,以为临床治疗提供科学依据。方法选取我院2012年5月~2014年7月收治入院的100例肾活检患者为研究对象,回顾性分析其临床及肾脏病理学资料,按照尿红细胞位相结果将患者分为对照组(非肾小球源性血尿)与研究组(肾小球源性血尿)各50例,比较两组患者临床及病理差异。结果通过回顾性分析两组患者肾脏病理学资料集临床检测报告,肾小球源性血尿患者肾损害情况更为多见,与对照组相比较,差异经统计学处理具有统计学意义(P<0.05)。结论 IgA肾病是以血尿为主要表现患者中常见病理类型,肾脏病理改变情况较为严重,需要临床中予以重点关注,以提高患者临床治疗效果。     

测定尿红细胞平均体积鉴别血尿来源

用自动血细胞分析仪检测血尿中红细胞平均体积,评价对血尿来源鉴别的价值.实验分2组,肾小球性血尿组,均经肾活检确诊,共12例,非肾小球性血尿组6例.结果显示 肾小球性血尿红细胞平均体积为40.08±28.00 fl,非肾小球性血尿红细胞平均体积为66.58±16.04 fl,差异显著(P<0.05),表明可通过测定血尿中红细胞平均体积鉴别血尿来源,该方法简便、快速,可靠,可克服检验者的主观判断误差.可作为门诊及基层医院对血尿快速筛选手段之一.     

西那卡塞与甲状旁腺切除术治疗肾性甲旁亢 患者疗效的Meta分析

目的 采用Meta分析探讨西那卡塞与甲状旁腺切除术治疗肾性甲旁亢的疗效,为临床上治疗肾性甲旁亢的方案选择提供参考。方法 检索PubMed、EMBASE、Cochrane、Webof Science电子数据库,筛选出符合纳入标准的文献,使用Cochrane中心推荐的方法进行文献偏倚风险评估。提取最终纳入文献的相关效应量,使用RevMan5.2软件进行数据合并及分析,评价两种治疗方案的疗效。结果 共检出文献1289篇,纳入符合要求文献共5篇,其中1篇RCT,4篇队列研究,共计肾性甲旁亢患者370例。Meta分析结果示,西那卡塞组与甲状旁腺切除术组血甲状旁腺素（MD=135.48,95% CI:-123.85~394.80,P=0.31）、血钙（MD=-0.08,95% CI:-0.27~0.10,P=0.37）、血磷（MD=-0.02,95% CI:-0.16~0.12,P=0.78）、血碱性磷酸酶（MD=56.66,95% CI:-75.42~188.75,P=0.40）比较,差异均无统计学意义（P＜0.05）。结论 西那卡塞与甲状旁腺切除术治疗肾性甲旁亢相比,在控制血甲状旁腺素、血钙、血磷、血碱性磷酸酶的效果上无差异,疗效相当。     

用尿红细胞前向散射光(Fsc)综合指标鉴别血尿来源

血 尿是临床常见症状之一 ,血尿的诊断一般用普通光学显微镜检查尿中红细胞 ,1977年Ｂｉｒｃｈ和Ｆａｉｒｌｅｙ等应用相差显微镜观察尿红细胞形态变化 ,籍以鉴别肾小球性及非肾小球性血尿。但此法易受主观因素的影响。 1986年Ｓｈｉｃｈｉｒｉ等报告用自动分析仪测定尿红细胞体积鉴别血尿来源 ,认为较显微镜法更为准确。作者用ＵＦ 10 0尿沉渣流式细胞仪[1] 检测了 76例肾病医院住院病人尿标本 ,并与 2 0例非肾小球性疾病血尿标本进行了比较 ,根据尿红细胞平均前向散射光强度 (ＲＢＣ ＭＦｓｃ)、尿红细胞前向散射光分布宽度(ＲＢＣ Ｆｓｃ…     

肾炎清片对无症状性血尿患者IL-6和VEGF水平的影响

目的 探讨肾炎清片对无症状性血尿患者IL-6和VEGF水平的影响.方法 将76例临床诊断为无症状性血尿患者随机分为治疗组和对照组各38例,对照分析肾炎清片治疗前和治疗后无症状血尿患者的IL-6和VEGF的水平.结果 肾炎清片治疗组无症状性血尿患者的IL-6和VEGF的水平较对照组明显降低,结果显示组间的差异具有统计学意义(P＜0.05).结论 肾炎清片能够改变无症状性血尿患者IL-6和VEGF的水平,可能对无症状性血尿患者血尿症状的改善具有一定的作用.     

不同尿沉渣检测方法在检测尿红细胞形态及参数中的价值分析

目的 探究全自动尿沉渣分析仪联合尿干化学分析法在尿沉渣检测中的价值.方法 随机选取118份从住院患者处收集的血尿样本,根据临床诊断结果将其分为肾小球疾病组(肾小球性血尿组,n =72)及非肾小球疾病组(非肾小球性血尿组,n=46).比较两组血尿样本尿平均红细胞体积(MCV)、尿平均红细胞血红蛋白(MCH)水平差异.每份尿样均分为2管(15mL/管),分别予以显微镜人工镜检法及全自动尿沉渣分析仪+尿干化学检测法检测(尿液收集后2h内完成).记录两种检测方法的尿红细胞(RBC)阳性检出率;以临床诊断结果为依据评估其尿RBC形态参数测定结果差异.结果 肾小球性血尿组患者尿MCV、尿MCH水平均明显低于非肾小球性血尿组患者,差异有统计学意义(P＜0.05).118份血尿样本经全自动尿沉渣分析仪+尿干化学检测法测得尿RBC阳性率为76.3％ (90/118),显微镜人工镜检法测得尿RBC阳性率75.4％ (89/118);两组尿RBC阳性检出率比较,差异无统计学意义(P＞0.05).显微镜人工镜检法鉴别灵敏度为97.2％(70/72)、特异性为84.8％ (39/46);全自动尿沉渣分析仪+尿干化学检测法鉴别灵敏度为94.4％ (68/72)、特异性为80.4％(37/46),两种方法灵敏度及特异性比较,差异无统计学意义(P均＞0.05).结论 全自动尿沉渣分析仪+尿干化学检测法对血尿来源的定位诊断准确性较高且操作性强,临床可将其作为一种可行性途径,为后续治疗工作的顺利开展提供依据.     

微通道经皮肾镜碎石取石术治疗结石性脓肾的效果

目的 分析微通道经皮肾镜碎石取石术（PCNL）治疗结石性脓肾的效果。方法 选取2018年1月~12月我院收治的结石性脓肾患者78例,按照随机数字表法分为观察组和对照组,每组39例。对照组行标准通道PCNL治疗,观察组行微通道PCNL治疗,比较两组手术治疗指标（Ⅰ期结石取净率、手术时间、术中出血量、住院时间）和术后并发症总发生率（出血、高热、肾周积液感染、尿培养阳性）。结果 两组Ⅰ期结石取净率比较,差异无统计学意义（P＞0.05）;观察组术中出血量少于对照组,手术时间、住院时间短于对照组,差异有统计学意义（P＜0.05）。观察组术后并发症总发生率为7.69%,低于对照组的20.51%,差异有统计学意义（P＜0.05）。结论 微通道PCNL治疗结石性脓肾疗效显著,能有效减少术中出血量,缩短手术时间、住院时间短,降低术后并发症的发生率,优于标准通道PCNL治疗。     

表现为孤立性血尿的IgA肾病36例临床分析

目的探讨表现为孤立性血尿的IgA肾病的临床特点及相关因素的影响。方法分析36例经肾活检确诊为孤立性血尿的IgA肾病患者的临床表现特点、病理特征及相关因素。结果孤立性血尿的IgA肾病患者以镜下血尿为主要临床表现,伴有腰痛、咽干咽痛、疲劳者较多。病理特征以系膜增生性肾小球肾炎为主,Lee病理分级分布以Ⅱ～Ⅲ级为主。结论孤立性血尿的IgA肾病患病率较高,全身症状较轻,易被忽视,容易造成漏诊,应引起临床诊治的足够重视。     

Hematuria and dysuria in the self-diagnosis of urinary schistosomiasis among school-children in Northern Cameroon

The present study was designed to assess the value of self reported hematuria and dysuria in the diagnosis of urinary schistosomiasis at the individual level. A sample of 964 school children of grade 5 and 6 from 15 schools of the French speaking educational system in the Sudano-sahelian zone of northern Cameroon were submitted to a questionnaire related to hematuria and dysuria, and provided a urine sample each. The urine samples were processed using the dip stick and sedimentation methods, and the degree of microhematuria and oviuria determined. In all 964 questionnaires were collected, 843 urine samples examined for microhematuria and 871 for oviuria. The percentage of children reporting hematuria increased with the degree of microhematuria and the intensity of infection. Among the various indicators of urinary schistosome infection, microhematuria had the highest sensitivity (76%), followed by self reported hematuria or dysuria (65%), and dysuria (52%). The specificity was highest for self reported hematuria, and lowest for self reported hematuria or dysuria. The efficiency of self reported hematuria or dysuria increased with the intensity of infection and was highest (100%) for heavy infections (> 400 eggs/ml g urine). We advocate the use of self reported hematuria or dysuria for the assessment of S. haematobium at the individual level.     

Hematuria

Haematuria represents an important clinical sign, which is easely detected by the test-stripe method. In the differential diagnosis between haematuria, haemoglobinuria and myoglobinuria, however, urine microscopy is essential. Evaluation of urinary red cell morphology (glomerular and nonglomerular erythrocytes) is often helpful in the aetiopathogenetic classification of haematuria by distinguishing glomerular bleeding from haematuria due to urological disorders. The various renal and extrarenal causes of haematuria are demonstrated.     

The analysis of erythrocyte morphologic characteristics in urine using a hematologic flow cytometer and microscopic methods

Three methods for the examination of erythrocyte morphology in urine are described: phase contrast microscopy, microscopy of cytocentrifuged and stained preparations, and erythrocyte analysis with the Technicon H1. Analysis with the H1 has not been described until now. All methods can be used to discriminate between dysmorphic and isomorphic erythrocytes. The red cell distribution width was the best H1 parameter for this discrimination. The authors have found a good correlation between the microscopic methods. The clinical impact of the three methods was studied with urine samples from patients with a confirmed diagnosis. The discrimination between renal and nonrenal hematuria is similar with phase contrast microscopy and cytocentrifuged preparations. The use of the H1 for this discrimination is not recommended.     

Renal Manifestations in 2007 Korean Patients with Beh?et's Disease

Purpose

Behçet''s disease (BD) theoretically affects all sizes and types of blood vessels and results in multi-organ involvement. However, renal BD has not been fully characterized, though the kidneys are histologically rich in blood vessels.

Materials and Methods

A total of 2007 patients who fulfilled the diagnostic criteria for BD were enrolled in this study. We reviewed the medical records and test results of the BD patients and used univariate and multivariate logistic regression analyses to determine the clinical significance of renal involvement in BD.

Results

Among the 2007 BD patients, we noted hematuria in 412 (20.5%) and proteinuria in 29 (1.4%). Univariate analysis showed that the BD patients with hematuria were predominantly female and older, had higher erythrocyte sedimentation rates (ESRs), and more frequently presented with genital ulcerations. BD patients with proteinuria had higher ESR levels compared to BD patients without proteinuria. In the multivariate analysis, age, sex, and ESR were found to be significantly associated with hematuria in BD patients, whereas only ESR was associated with proteinuria in BD patients. We also found that IgA nephropathy was the most common pathologic diagnosis in 12 renal BD patients who underwent renal biopsies.

Conclusion

We suggest that routine urinalysis and serum renal function tests be performed for the early detection of renal BD, especially in older female BD patients with recurrent hematuria, high ESR levels, and frequent genital ulcers, as well as in BD patients with proteinuria and high ESR levels.     

Hematuria of Tubular Origin

Hematuria (HU) of tubular origin is described on the basis of ultrastructural investigations of two rejected human renal allografts. The red blood cells IRBC) got into the interstitium through the walls of the damaged intertubular capillaries, and, via ruptures of the tubular basement membrane (BM), they may pass from the interstitium into the tubular lumen, causing HU. Rupture of the tubular BM may develop owing to the enzymes released by interstitial inflammatory cells or to the difference in the interstitial and intratubular pressures. Some of the RBC already in the tubular lumen may penetrate between the epithelial cells and even between the epithelium and the BM, probably because of the locally increased intraluminal pressure. If the RBC reach the BM, the epithelial cells produce a new, thin BM above them, with disintegration of the outer older one, and, thus, the RBC may pass into the interstitium again. This phenomenon is called the tubulointerstitialis circulation of RBC.     

Hematuria and acanthocyturia in patients with diabetes

It has been suggested that the finding of acanthocyturia in patients with hematuria points to the presence of glomerulonephritis. However, little attention has been paid to the finding of acanthocyturia in diabetic patients with hematuria. Here we studied 93 consecutive diabetic patients and explored the prevalence of microscopic hematuria and acanthocyturia in association with normoalbuminuria (NO; urinary albumin excretion (UAE) of < 30 mg/g x creatinine), microalbuminuria (MI; UAE of 30-299mg/g x creatinine), macroalbuminuriaMA; UAE of > or = 300mg/g x creatinine), or chronic renal failure (CRF; serum creatinine levels of > or = 1.1mg/dl for male and > or = 0.9mg/dl for female). We defined microscopic hematuria as > or = 5 erythrocytes per high-power field and acanthocyturia as > or = 5% acanthocytes (erythrocytes of doughnut-like appearance with vesicle-shaped protrusions) among 100 erythrocytes in the centrifuged urinary sediment. Microscopic hematuria was found in 12 (24%) out of 49 patients with NO, in 9 (43%) out of 21 patients with MI, in 6 (75%) out of 8 patients with MA, and in 7 (47%) out of 15 patients with CRF. Patients with microscopic hematuria showed a significant increase in urinary albumin excretion as compared to those without (836 +/- 265 vs. 135 +/- 56, p < 0.01). Of patients with microscopic hematuria, acanthocyturia was observed only in 2 (22%) out of 9 patients with MI and in 2 (33%) out of 6 patients with MA. Two of 4 patients with acanthocyturia had elevated serum levels of IgA and chronic tonsillitis, which indicated the occurrence of IgA nephropathy in these patients. Thus, microscopic hematuria was common and associated with elevated UAE, while acanthocyturia was rare and observed only in patients with elevated UAE. We propose that more attention should be paid to the finding of acanthocyturia in diabetic patients with hematuria and albuminuria.     

桂西地区珠蛋白生成障碍性贫血的红细胞参数筛查价值探讨

目的研究红细胞参数在不同类型珠蛋白生成障碍性贫血筛查中的诊断价值,为珠蛋白生成障碍性贫血患者提供敏感度和特异度高而又经济快捷的筛查方法。方法选取经我院基因诊断确诊的不同类型的珠蛋白生成障碍性贫血患者149例,正常对照51例,采用HORIBA ABX PENTRA DX 120全自动血细胞分析仪进行以下红细胞参数测定：血红蛋白（HGB）、红细胞平均体积（MCV）、红细胞平均血红蛋白含量（MCH）、红细胞平均血红蛋白浓度（MCHC）和红细胞分布宽度（RDW）,并进行分析统计。结果地贫各组红细胞参数与正常对照组比较差异均有统计学意义（P〈0.05）。HGB、MCV、MCH、MCHC和RDW筛查α、β和α＋β珠蛋白生成障碍性贫血的灵敏度分别是69.6%、83.3%和72.7%,84.8%、97.9%和100%,88.6%、100%和100%,78.5%、77.1%和77.3%,57.0%、64.6%和63.6%,HGB、MCV、MCH、MCHC、RDW筛查珠蛋白生成障碍性贫血的特异度分别是76.5%、96.1%、70.6%、49.0%和80.4%。结论红细胞参数MCV〈80 fl作为桂西地区珠蛋白生成障碍性贫血的筛查指标是最佳的。