类风湿性关节炎肾损害的组织病理改变——附4例报告及文献复习

目的　探讨类风湿性关节炎 (RA)肾损害的组织病理学改变特点。方法　总结 4例RA肾损害的临床病理资料 ,并结合文献进行分析。结果　 4例均呈蛋白尿伴血尿 ,其中 3例肾功能不全 ,组织病理为IgA肾病 2例、节段系膜增生性肾炎及局灶节段性肾小球硬化各 1例 ,文献报道临床表现以蛋白尿、血尿为主 ,可呈肾病综合征或伴肾功能不全 ,病理类型以系膜增生性肾炎 (包括IgA肾病 )、膜性肾病和肾淀粉样变性多见。结论　类风湿性关节炎的组织病理学改变以系膜增生性肾炎最常见 ,临床表现多样化

HISTOPATHOLOGICAL MANIFESTATIONS OF RENAL DAMAGE IN PATIENTS WITH RHEUMATOID ARTHRITIS:A REPORT OF 4 CASES AND LITERATURE REVIEW

Objective To investigate the histopathological changes of renal demage in rheum atoid arthritis.Methods The clinical pathological data of 4 cases with rheuma to id arthritis who developed glomerulonephritis was analysed and associated litera tures were reviewed.Result Proteinuria and hematuria were present in the 4 pa tients. Renal insufficiency was found in 3 cases.Renal histology showed glomeru lonephritis IgA(2 patients),focal segmental mesengial proliferative nephritis( 1 patient) and focal segmental glomerulosclerosi (1 patient).The literatures r eported proteinuria,hematuria or both abnormalities were recognized in most RA p atients with renal demage.Some patients showed nephrotic syndrome or renal insu fficiency.Mesangial proliferative glomerulonephritis(including glomerulonephrit is IgA),membranous nephropathy and renal amyloidosis were common pathological t ypes.Conclusion In the patients with RA who have renal demage,mesangial prol iferative glomerulonephritis is most common histopathological type,but their cl inical manifestations are diverse.