少量蛋白尿IgA肾病患者的临床、病理特点分析

目的:总结少量蛋白尿IgA肾病(IgAN)患者的临床病理特点,探讨影响其肾功能减退的可能因素。方法:对412例少量蛋白尿IgAN患者的临床、实验室及病理表现(包括病理半定量检查)进行回顾性对比分析。结果:5年间少量蛋白尿IgAN患者占全部肾活检病例的10.2%。其中,肾功能正常者占87.1%,肾功能异常者占12.9%。肾功能异常组高血压患病率、蛋白尿和血尿酸水平均显著高于肾功能正常组(P<0.01,P<0.05)。肾功能异常组肾小球硬化程度显著重于肾功能正常组(P<0.01),同时肾小管间质病变及血管病变亦较重(P<0.05)。结论:少量蛋白尿IgAN患者的肾功能及病理损伤亦可能较重。蛋白尿、高血压及高尿酸血症均可能影响患者的预后。临床中应积极行肾穿刺,及早发现有治疗价值的病变。

Clinicopathological analysis of IgA nephropathy patients with minimal proteinuria

Objective:To study the clinicopathological features of IgA nephrology(IgAN)patients with minimal proteinuria and investigate the risk factors associated with renal injury.Methods:The clinical,laboratory and pathological manifestations of all IgAN patients with minimal proteinuria were retrospectively analyzed and compared.Results:Of all the renal biopsy cases in the past five years,IgAN with minimal proteinuria consisted of 10.2%,359(87.1%)patients had normal renal function and 53(12.9%)patients had abnormal renal function.Higher hypertension,higher level of serum uric acid and more proteinuria were found in cases with renal insufficiency(P<0.01,P<0.05)compared with those of normal renal function.The glomerular,tubulointerstitial and vascular damage index were more higher in patients with abnormal renal function.Conclusion:Severe renal histological injury and decrease of renal function may be seen in some IgAN patients with minimal proteinuria.Proteinuria,hypertension and serum uric acid effect the prognosis of these patients.Renal biopsy is important in these patients.