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儿童无症状尿检异常IgA肾病的临床病理和预后分析 总被引:2,自引:0,他引:2
目的 探讨儿童无症状尿检异常的IgA肾病的临床病理特征和预后。 方法 对54例IgA肾病儿童的临床和病理特征进行分析。根据起病时有无临床症状分为无症状尿检异常组和有症状肾炎组。组织病理学分级参照Lee氏和Katafuchi氏半定量积分法。 结果 无症状尿检异常组18例,有症状肾炎组36例。有症状肾炎组尿蛋白量(24 h)明显高于无症状尿检异常组[(2.3±2.2) g比(0.4±0.3) g,P < 0.05]。无症状尿检异常的IgA肾病儿童表现为镜下血尿者,87%有尿微量白蛋白增高。无症状尿检异常IgA肾病患儿病理表现以Lee 氏Ⅰ~Ⅱ级为主,2例表现为Lee氏Ⅳ~Ⅴ级和 5例发生Katafuchi Ⅱ~Ⅲ级肾小管间质病变。有症状肾炎组Lee氏病理分级以Ⅱ~Ⅲ级为主,两者病理分级分布差异无统计学意义(P > 0.05)。全组患儿平均随访(26.9±8.8)月后,1例病理为Lee 氏Ⅴ级患儿进入终末期肾衰竭,其余患儿Scr均无升高1倍以上。 结论 无症状尿检异常的儿童IgA肾病虽临床症状轻微,但可出现病理损害严重的病例,并影响其预后。 相似文献
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小儿肾脏疾病血,尿内皮素的变化 总被引:9,自引:0,他引:9
目的研究小儿肾脏疾病血、尿内皮素(PET、UET)的水平及其相互关系。方法采用同位素放免方法检测了肾病综合征(NS),肾小球肾炎(GN),肾功能衰竭(RF)共72例患儿血及尿中ET,血心钠素(ANP)水平。结果NS,GN,RF三组的PET及UET值明显高于对照组,尤其RF组(P<005,P<0.01)。ANP值在GN组和RF组明显高于对照组(P<001)。8例ARF患儿恢复期血ET水平下降,6例CRF患儿虽经治疗,但血ET水平不降或上升。结论ET在小儿肾脏疾病发病机理及病情进展中可能起重要作用,其值高低与病情严重程度及预后有关。 相似文献
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Occupational hydrocarbon exposure and chronic nephropathy 总被引:2,自引:0,他引:2
P. Hotz 《Toxicology》1994,90(3):163-283
This review aims at discussing the questions raised by the hydrocarbon-related chronic nephropathy and its possible consequence, the hydrocarbon-related chronic renal failure. It has been attempted to adopt the point of view of the clinician. Therefore, the most important part of the review is devoted to a presentation and an analysis of the available data on humans. The main features of the available studies on human subjects are presented, their conclusions discussed in the light of the possible methodological flaws, and practical conclusions drawn. After a discussion of the main difficulties encountered for selecting the suitable exposure indicator, the studies are discussed in order of decreasing quality of the study design (cohort, case-control, cross-sectional studies, and the case reports). It is concluded that a great deal of controversies about chronic hydrocarbon-related nephropathy is explained by differences in the study design and that hydrocarbon-induced nephropathy is probably more than a mere hypothesis, although a causal relationship has not yet been proven. Finally, some practical consequences for dealing with a hydrocarbon-exposed patient diagnosed with a kidney disease and the need for further research are discussed. 相似文献
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三种实验性IgA肾病模型的比较 总被引:4,自引:0,他引:4
目的探讨建立一种理想的IgA肾病(IgAN)动物模型方法。方法分别采用葡聚糖G200、大肠杆菌外膜蛋白和金葡菌的细胞膜20肽抗原决定簇诱导小鼠IgA肾病模型。用分子生物学和病理学方法对3组IgAN模型小鼠进行鉴定和比较。结果(1)葡聚糖组尿蛋白增高,伴有血尿;免疫荧光显示部分肾小球大量IgA沉积;光镜下肾小球系膜细胞增多,肝和脾可见弥漫性的粉染物质沉积;电镜下肾小球系膜区少量低电子密度的致密沉积物,肝和脾可见淀粉丝样物质沉积。(2)大肠杆菌外膜蛋白组尿蛋白增高,伴有血尿;免疫荧光显示肾小球有少量IgA沉积;光镜下肾小球系膜细胞轻度增多,间质炎细胞浸润明显;电镜下肾小球系膜区无电子致密沉积物。(3)金葡菌细胞膜20肽抗原决定簇组尿蛋白增高,伴有血尿;免疫荧光显示多数肾小球均可见大量IgA沉积;光镜下肾小球系膜细胞增多,伴系膜基质轻度增生;电镜下肾小球系膜区和基底膜的内皮细胞下可见高电子密度的致密沉积物。结论金葡菌细胞膜20肽抗原决定簇组诱导的IgAN模型从临床表现和病理学变化与人IgAN极其相似,是3种IgAN模型中最理想的IgAN模型。 相似文献
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造血干细胞移植后慢性移植物抗宿主病相关的膜性肾病一例 总被引:2,自引:0,他引:2
目的 总结造血干细胞移植后慢性移植物抗宿主病(cGVHD)相关的膜性肾病的诊疗体会。方法 为1例急性淋巴细胞白血病患者施行HLA全相合的无关供者外周血造血干细胞移植,术后应用甲氨喋呤和他克莫司(FK506)预防GVHD。术后第19d发生急性GVHD,经甲泼尼龙治疗逆转。分别于术后182d、235d停用FK506和泼尼松,5d后患者出现cGVHD表现,肝功能异常,并伴肾病综合征的相关表现,病理诊断为膜性肾病Ⅱ期,遂给予FK506和泼尼松治疗,同时辅以利尿、降脂等措施。结果发生膜性肾病时,患者的尿蛋白++++,白细胞75个/μl,上皮细胞359.5个/pl,病理性管型+,管型计数为167个/μl,24h尿蛋白定量为4.28g;肾组织活检,无肾小球硬化,肾小球体积稍大,部分血管袢受压,开放欠佳,肾小球基底膜轻微增厚,外观呈僵硬感,系膜基质轻、中度增殖;间质区部分肾小管扩张,肿胀、变性,未见明显间质纤维化和炎症细胞浸润;Masson染色可见基底膜上皮侧嗜复红物沉积;免疫荧光检查,IgG+++,C3+++,IgA++,沿毛细血管袢呈颗粒状节段性分布,系膜区呈团块状分布;IgM、Clq、CA均阴性。电镜下可见肾小球基底膜上皮下沉积物,并有基膜增厚,毛细血管系膜基质轻度增生。经泼尼松和FK506治疗,2个月后尿蛋白转阴。结论 造血干细胞移植后出现肾病综合征或蛋白尿,应考虑GVHD相关膜性肾病的可能,肾穿刺活检有助于诊断,糖皮质激素和FK506治疗有效。 相似文献
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M. Myslak H. Amer P. Morales M. E. Fidler J. M. Gloor T. S. Larson M. D. Stegall F. G. Cosio 《American journal of transplantation》2006,6(7):1660-1665
Increasing numbers of patients receive kidney transplants before initiation of dialysis or shortly thereafter. Some of these patients have significant proteinuria pre-transplant making the interpretation of post-transplant proteinuria problematic. In this study, we evaluated post-transplant proteinuria in 115 patients who had urine protein measured within 3 months of transplant and assessed the association of proteinuria with allograft pathology. Proteinuria declined rapidly from 3650 +/- 3702 mg/day pre-transplant to 550 + 918 at 3 weeks (p < 0.0001) and continued to decline until 1 year post-transplant (472 +/- 1116, p < 0.0001 vs. 3 weeks). Proteinuria greater than 3000 mg/day was present in 48 patients (42%) pre-transplant, in 1 patient (1%) at 3 weeks and in 4 patients (4%) at 1 year. Surveillance graft biopsies were done at 1 year in 93% of patients. Proteinuria > or = 1500 mg/day and/or an absolute increase in proteinuria > 500 mg/day after 3 weeks post-transplant was associated with allograft glomerular pathology. In conclusion, pre-transplant proteinuria, even when high grade, declines rapidly after transplantation. Failure to decline or persistence of proteinuria greater than 1500 mg/day is indicative of allograft pathology. 相似文献
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Alvestrand A.; Gutierrez A.; Bucht H.; Bergstrom J. 《Nephrology, dialysis, transplantation》1988,3(5):624-631
The effect of blood pressure reduction on the progression rateof chronic renal failure (CRF) was studied in 28 patients withCRF of diverse aetiology entering a prospective study (observationtime 724 months, mean 16 months). Endogenous creatinineclearance was 1266 ml/mm (mean 30±3 ml/mm). Weaimed to keep the blood pressure below 160/90 mmlHg. Dietaryprotein was not restricted. The progression rate of CRF wasassessed from the regression coefficients of the regressionsof creatinine clearance and the inverse of s-creatinine, respectively,on time. Progression rate and the means of all recordings ofmean arterial blood pressure (MAP) and urinary protein excretion,respectively, in each patient during the prospective phase werecompared with retro spective data from the proceeding period(observation time 425 months, mean 19 months). The patientsreceived various combinations of antihypertensive drugs includingdiuretics, beta-blockers and vasodilatory drugs. In 19 patientsMAP decreased from 109±2 to 102±2 mmHg (groupI), whereas MAP increased from 105±2 to l08±2mmHgin nine patients (group II). In group I proteinuria was significantlylower (P<0.05) and the progression of CRF was approximately50% slower (P.<0.01) in the prospective phase than in theretrospective phase; no changes were observed in group II. Calculatedfor all patients, significant correlations were observed betweenthe change in MAP and the change in progression rate and proteinexcretion, respectively. These results indicate that loweringof blood pressure results in decreased proteinuria and retardationof the progression of CRF irrespective of the aetiology. 相似文献
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