急性局灶性细菌性肾炎17例诊治体会

急性局灶性细菌肾炎又称急性大叶性肾炎和肾炎性假瘤 ,由细菌感染所致 ,影像学上显示肾实质局灶性占位病变。99 2年 8月～ 2 0 0 1年 12月 ,我院共收治肾炎性假瘤患者 17例。现报告如下 ,并阐述其诊断与治疗体会。临床资料 :本组 17例患者中 ,男 11例 ,女 6例 ;年龄 16～5 4岁     

肝脏局灶性结节性增生46例临床分析

目的 研究肝脏局灶性结节性增生(FNH)临床及病理组化表现,旨在提高其诊断治疗水平.方法 回顾分析2000～2005年第二军医大学东方肝胆医院46例经病理证实FNH病例的临床、影像学、病理和免疫组化资料.结果 共46例FNH患者,均为单发;男性28例,女性18例,平均年龄35.5岁;病灶位于右叶28例,左叶13例,中肝叶4例,尾状叶1例;病灶直径1.3～10 cm,平均4.34 cm;术前诊断与术后病理相符者15例(32.61%),2例经肝脏穿刺活检病理诊断为FNH;术前误诊为原发性肝细胞癌24例(52.17%),误诊为肝细胞腺瘤2例(4.35%),误诊为肝血管瘤3例(6.52%);免疫组化:CD 34、CK 18、pCEA、Hep-1均为阳性,CA 19-9、P53均为阴性,CK 19阳性21例,PCNA阳性18例.结论 多数FNH不需手术治疗,但由于与HCA、HCC等疾病难以鉴别,大部分患者经外科手术切除后病理证实,故术前鉴别诊断十分重要,合理检查提高疾病诊断率是关键.     

肝局灶性结节性增生

1 定义和流行病学 肝局灶性结节性增生(focal nodular hyperplasia,FNH)是一种发病率仅次于肝血管瘤的常见肝脏良性疾病,其特点为结节性增生性肝损害。FNH以妇     

肝细胞局灶性结节性增生一例

患者女性，２５岁。体检发现肝占位病变３周收住院。Ｂ超、ＣＴ均证实肝占位病变，６ｃｍ ｘ ６ｃｍ大小。ＭＲＩ报告：肝左叶占位，考虑肝腺瘤或血管瘤。患者曾服用避孕药“马福隆”半年。术中见肿物位于肝左内叶，直径约６ｃｍ，质硬，部分已突至肝被膜表面。 病理检查巨检：不整形肝组织一块，大小１０ｃｍｘ８ｃｍ ｘ ７ｃｍ，切面见一肿物，直径约 ６ｃｍ，边界清，无包膜，浅棕色，较周围正常肝组织颜色淡。病灶中间为星形疤痕组织，纤维间隔从中央向周围将病灶分隔成结节状。镜检：病变由中心的星状疤痕和周围增生的肝细胞结节构成，…     

老年原发性局灶性节段性肾小球硬化的临床及病理特点

目的了解老年原发性局灶性节段性肾小球硬化(PFSGS)的临床及病理特点。方法回顾性分析该院近10年来行肾活检诊断为PFSGS的老年患者(老年组)的临床及病理资料,并与同期年龄60岁患者(对照组)资料进行比较。结果 1两组患者性别构成差异无统计学意义(P0.05);2在病程短、血尿、蛋白尿、高血压、血浆白蛋白、肾功能、血Ig G、Ig A、Ig M、C3、C4浓度、肾脏免疫病理、疾病危险度方面两组无差异(P0.05),但老年组水肿发生率高于对照组(P0.05)。两组临床表现均以慢性肾炎常见,但老年组肾病综合征较对照组更常见(P0.05);3病理方面:两组均以Ig M沉积为主,两组间无差异(P0.05)。结论 1PFSGS好发于中青年,男性多于女性;2老年患者较对照组易发生水肿;3老年患者肾病综合征较年轻患者相对常见。     

局灶性节段性肾小球硬化的病理诊断

局灶性节段性肾小球硬化(focal segmental glomerulosclerosis,FSGS)是一个临床和病理均具特点的肾小球疾病.临床以大量蛋白尿或肾病综合征为特征,病理以局灶和节段分布的硬化性病变为主要变化的肾小球疾病.根据病因发病机制分为原发性和继发性2大类,继发性FSGS是指多种肾小球疾病所导致的局灶肾小球的节段硬化性病变,而原发性FSGS则在病因、发病机制、病变特点、临床表现和预后诸方面均具特点的肾小球疾病,是本文讨论的重点.     

肝脏局灶性结节增生1例

肝脏局灶性结节状增生(focal nodularhyperplasia,FNH)临床少见,本文报道1例女性患者,因“体检发现肝脏占位4 d多”入院,常规体检行计算机断层扫描检查提示肝脏占位:肝细胞腺瘤?行手术探查及术后病理检查提示局灶性结节状增生,术后随访9mo,无复发及转移.本文系统探讨FNH的病因、发病机制、鉴别诊断及治疗等.     

局灶性心房颤动的研究进展

过去认为 ,心房颤动 (房颤 )是双侧心房同时存在多个不断迁移的折返波阵面无序运动的结果 [1 ]。局灶性房颤 ( focalatrial fibrillation)概念的提出使房颤的研究进入了一个新的阶段 ,房颤的消融思路也发生了改变。兹就局灶性房颤的研究进展作回顾。　　 1.概念及可能的机制　　局灶性房颤是指心房或与心房相连的组织 (如肺静脉 )内存在异位的致心律失常的兴奋灶 (局灶 ) ,该兴奋灶所发放的冲动或其所引起的房性早搏、房性心动过速与房颤的发生有直接的因果关系 [2 ]。起源于局部兴奋灶的心房电活动首先在心外膜标测中被发现 ,但被认为是偶…     

原发性局灶节段性肾小球硬化的临床病理及预后

目的:分析114例原发性局灶节段性肾小球硬化(FSGS)患者的临床、病理、免疫病理特点及预后.方法:回顾性分析1985～1996年12年间,114例原发性FSGS患者的临床表现,病理,免疫病理特点,以及其中45例长期随访结果. 结果:1985～1996年12年间,原发性FSGS占同期肾活检的2.62%,平均发病年龄28.54±12.34岁.临床表现为蛋白尿者占93.0%(肾病综合征范围蛋白尿占21.9%),血尿51.8%(肉眼血尿14.9%,镜下血尿36.8%),高血压43.8%.肾活检时已发生肾功能不全者占47.4%,随访中22.2%发展至尿毒症,激素治疗有效率小于10%.肾功能不全者与肾功能正常者相比,前者高血压更为常见(P＜0.05),小管间质病变重[尿渗量明显降低(P＜0.05),尿溶菌酶升高(P＜0.001)].肾小球全球硬化的比率显著升高(P＜0.001),节段性硬化病变更为明显,并伴有更为显著的小管间质损伤,大量炎细胞浸润. 结论:①原发性FSGS好发于中青年,病程隐匿,进展较快;②临床上蛋白尿最为常见,其次是血尿,高血压和肾功能不全.高血压,肾小球全球/节段性硬化及肾小管间质病变,肾组织细胞浸润的程度与预后相关;③对激素治疗反应差,临床治疗应着重控制高血压,保护肾功能.     

48例儿童系膜IgM肾病的临床病理分析

本文分析４８例儿童系膜ＩｇＭ肾病（ＩｇＭＮ）的临床表现与病理改变，占同期原发性肾小球疾病肾活检总数的２１．５％。作者随访３５例，多数预后良好，仅３例患儿有轻度肾功能减退。     

Protein S and C antigen levels in proteinuric patients: dependence on type of glomerular pathology

The cause of the thrombotic tendency in nephrotic patients is unknown. Recent reports of thrombotic complications in patients with deficiencies of protein C or protein S (natural inhibitors of coagulation) have raised the possibility that decreased levels of these proteins may play a role in the hypercoagulable state of nephrotic patients. We measured the levels of protein C, total protein S, and free protein S antigens in 42 patients (21 nephrotic and 21 non-nephrotic) with one of four types of glomerular pathology: diabetic nephropathy (DM), focal glomerular sclerosis (FGS), membranous glomerulonephritis (MGN), and chronic renal failure due to hypertension (CRF). Protein C and total protein S antigen levels were significantly higher in FGS and MGN than they were in DM or CRF. Free protein S levels were lower in DM than they were in MGN. Protein C, total protein S, and free protein S levels did not significantly correlate with either serum albumin or degree of proteinuria. The mean levels of the three proteins did not differ between nephrotic and non-nephrotic patients. Free protein S and protein C were, however, significantly correlated (P less than .005 and P less than .002, respectively) with the type of glomerular pathology, independent of differences in age, sex, serum albumin, or degree of proteinuria. These data suggest that abnormalities of free protein S and protein C are related to the nature of the underlying renal disease, rather than to the degree of proteinuria.     

Hepatitis B virus-associated glomerular nephritis in East Asia: progress and challenges

Background

Hepatitis B virus-associated glomerular nephritis (HBV-GN) is the most common secondary glomerulonephritis in East Asia. Part of the patients developed to renal insufficiency within 10 years, which cause a great burden for patients' family and society.

Methods

We reviewed basic and clinical research work in China, Japan, Korea, and Mongolia, eastern part of Asia. Comparisons between data from East Asia and those from other regions were made.

Results

The genetic variations conferring susceptibility to HBV-GN and disease progression as well as the pathogenic role in HBV-GN progression were investigated. Clinical features of HBV-GN in East Asia were different from that of other regions in the world. Clinical trials showed that treatment with anti-viral agents was effective to promote the disease remission.

Conclusion

HBV-GN remains a great challenge to East Asian nephrologists. In-depth basic studies and multi-centered clinical trials are needed in the future.     

Collapsing focal segmental glomerulosclerosis in a patient with oral cavity cancer: A case report

Rationale:Focal segmental glomerulosclerosis (FSGS) is one of the most common glomerular diseases, leading to end-stage renal disease. Among the 5 variants of FSGS, the collapsing variant is rare and has the worst prognosis. Solid and hematologic malignancies are associated with glomerular diseases, such as membranous nephropathy, minimal change disease, and FSGS. However, squamous cell carcinoma of the oral cavity is rarely associated with nephrotic syndrome, especially FSGS.Patient concerns:A 55-year-old woman diagnosed with oral cavity cancer presented with generalized edema with heavy proteinuria and renal dysfunction after neoadjuvant chemotherapy and wide surgical excision.Diagnosis:Renal biopsy shows segmental or global collapse of glomerular capillaries with marked hyperplasia and swelling of overlying epithelial cells, suggesting a collapsing variant of FSGS.Interventions:After the renal biopsy, we prescribed oral prednisolone at a dose of 1 mg/kg/day. Despite immunosuppressive treatment, renal function deteriorated, and hemodialysis was started.Outcomes:After 23 sessions of hemodialysis and high-dose oral glucocorticoid treatment, renal function gradually improved, and oral glucocorticoid therapy was discontinued after 8 months. Currently, this patient is in a cancer-free state and has normal renal function without proteinuria.Lessons:Unusual collapsing FSGS might be associated with neoadjuvant chemotherapy and wide surgical excision in patients with oral cavity cancer. Proper diagnostic workup, such as renal biopsy and high-dose glucocorticoid therapy, might have helped recover from nephrotic syndrome and acute renal injury in cancer patients.     

58例狼疮性肾炎病理与临床分析

目的 分析肾活检及相关实验室检测结果，探讨狼疮性肾炎（LN）病理类型与临床表现的关系。方法 对58例LN患者进行肾活检及常规实验室检查。根据WHO 1982年标准进行病理分型，并分别进行活动性指数（AI），慢性指数（CI）和肾小管间质病变（TIL）评分。结果 病理类型以Ⅳ型LN最多，占38％，其次Ⅱ型（26％）和Ⅴ型（24％），Ⅱ型与Ⅲ型多表现为肾炎综合征，Ⅳ型和Ⅴ型多表现为肾病综合征。Ⅳ型和LN的血,高血压，肾功能不全发生率最高，其AI亦显著高于其他类型。LN肾间质受累以Ⅳ型最为显著。血Cr水平与肾间质受累程度呈正相关。与TIL0－1级相比，2－3级病程相对要长。1－2级者尿蛋白排泄较0级与3级为高。结论 LN的病理类型与临床表现有一定关系，根据其临床表现和实验室检查可大致推测其病理类型。肾活检对判断疾病活动性，指导治疗与估计预后有重要意义。     

狼疮性肾炎患者40例临床病理分析

目的 探讨狼疮性肾炎(LN)的病理类型与临床及实验室检查的关系.方法 对40例狼疮性肾炎患者进行肾活检(其中9例重复肾活检)及病理分型,分析各病理类型的临床特点、实验室检查特点、临床活动性及肾脏病理活动性.结果 所有患者均有病理学异常,Ⅳ型最多见(占42.5%),Ⅳ型LN高血压、肾功能不全及血液系统损害发生率高,血清补体C3下降明显;临床活动性及肾脏病理活动性明显;Ⅳ型、Ⅴ型LN肾病综合征发生率高.结论 狼疮性肾炎的病理类型与临床表现、实验室检查有一定联系;根据狼疮性肾炎的临床表现、实验室检查可以大致推测其病理类型,估计肾损害的严重程度;恰当地治疗可以缓解病情,改善预后.     

乙型肝炎病毒引起局灶节段性肾小球硬化1例

1病历资料患者女,33岁。于2002年7月感冒后出现颜面及双下肢水肿、肉眼血尿,无发热、寒战、尿频、尿急、尿痛,无潮热、盗汗、咯血、胸痛、呼吸困难,无心悸、心累、端坐呼吸及夜间呼吸困难,无光过敏、脱发、口腔溃疡、关节红肿疼痛、皮肤黏膜瘀斑,无腹痛、腹泻、解黑大便等。在当地医院就诊,查     

药物致急性间质性肾炎的临床及病理特征

目的观察药物相关性急性间质性肾炎(DAIN)患者的临床及病理特征。方法选取2003年1月至2009年12月经我院肾活检诊断为急性间质性肾炎的患者72例。根据病程分为急性恢复组(肌酐在3个月之内即恢复至正常水平)和慢性化组(超过3个月肌酐未恢复至正常)。比较2组患者临床及病理特点。结果抗生素是DAIN最常见的因素,其次为非甾体类抗炎药。大多数患者以消化道症状为主诉。慢性化组和急性恢复组在起病时肌酐、病因及临床表现上差异无统计学意义,但慢性化组发病年龄较大(48.8岁对40.6岁,P=0.009),视黄醇结合蛋白(RBP)明显升高[(32.2±19.6)mg/L对(17.1±14.9)mg/L,P<0.01],开始就诊时间明显长于恢复组(34.7 d对14.5 d,P<0.001)。病理上小管病变未见明显差异,但慢性化组间质弥漫细胞浸润的发生率明显大于恢复组。结论抗生素是DAIN最常见病因。发病年龄越大、间质浸润细胞多,易演变为慢性化,预后相对越差。故对年龄较大的急性间质性肾炎患者应更早更积极进行干预治疗。     

雷公藤红素对狼疮鼠肾小球硬化的防治作用

目的　探讨雷公藤红素对狼疮性肾炎肾小球硬化的防治作用。方法　在不同发病时间、用不同剂量的雷公藤红素对BWF1小鼠进行连续 2 0周腹腔注射。运用考马斯亮蓝法检测 2 4h尿蛋白量 ;ELISA法检测血清抗dsDNA抗体水平 ;免疫组化法检测肾小球中纤维连接蛋白 (FN)、Ⅳ型胶原和基质金属蛋白酶 (MMP) 1、 2、 3与基质金属蛋白酶组织抑制剂 (TIMP) 1、 2的表达 ;逆转录 巢式PCR法检测小鼠肾组织中TGF β1的表达。结果　 (1)雷公藤红素能抑制小鼠蛋白尿产生 ,降低其血清抗dsDNA抗体水平 ,增加肾小球中MMP 1、 2而减少FN、Ⅳ型胶原和TIMP 1、 2与TGF β1的表达 ,改善小鼠组织学病变。 (2 )雷公藤红素于蛋白尿发生前较发生后使用疗效更为显著。 (3)于蛋白尿发生前使用雷公藤红素 3mg·kg-1·w-1和 6mg·kg-1·w-1的疗效差异无显著性。 (4)用药后各组间MMP 3的表达差异亦无显著性。结论　雷公藤红素对狼疮模型鼠的肾小球硬化具有明确保护作用 ;其降低肾脏FN、Ⅳ型胶原的沉积可能是通过增加肾组织局部MMP 1、 2而抑制TGF β1及TIMP 1、 2的表达而实现的。雷公藤红素对MMP 3的作用可能不及对MMP 1、 2的疗效明显。