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目的分析无症状尿检异常患儿的肾脏病理,了解无症状尿检异常患儿的病理改变和临床表现的关系。方法回顾性分析上海交通大学医学院附属新华医院儿内肾脏科2004年1月至2010年12月172例无症状尿检异常患儿临床资料,根据尿检结果分为单纯性血尿组(149例,86.6%)、单纯性蛋白尿组(7例,4.1%)和血尿合并蛋白尿组(16例,9.3%),所有患儿排除感染、结石、肿瘤及继发性肾炎并进行肾活检作光镜、免疫病理和电镜检查。结果 172例患儿的病理分型显示:肾小球轻微病变115例(66.9%)、局灶节段性肾小球硬化22例(12.8%)、IgA肾病13例(7.6%)、局灶球性肾小球硬化11例(6.4%)、薄基膜病4例(2.3%)、其他7例(4.1%)。血尿合并蛋白尿组中肾小球轻微病变占31.3%,IgA肾病占50%。单纯性血尿组中肉眼血尿患儿的肾脏病理中肾小球轻微病变和局灶节段性肾小球硬化分别占56.3%和25.0%。结论幼儿园入园尿检和入学尿检有利于早期发现慢性肾脏疾病。尿检异常中单纯性血尿需要密切随访,血尿合并蛋白尿和肉眼血尿患儿的应尽早进行肾组织穿刺活检。

Clinical and pathological analysis of children with asymptomatic abnormal findings in urinalysis

Objective To investigate the relationship between clinical characteristics and renal pathological types. Methods Renal biopsies were performed on 172 children. The patient’s history,physical examination,routine biochemical tests,including immunological analyses immunoglobulin,complement,renal function,liver function,hepatitis virus markers],kidney ultrasound,Doppler ultrasonography and routine urine cultures were obtained to exclude urinary tract infection,urinary calculi,renal tumor and secondary glomerulonephritis. Apart from light microscopy of the urine sediment,phase-contrast microscopy was also performed for the detection of dysmorphic erythrocytes. Results In 172 children who were investigated,149 cases(86.6%) had isolated haematuria (IH),7 cases(4.1%) had isolated proteinuria (IP) and 16 cases(9.3%) had combined haematuria and proteinuria (CHP). In total of 172 patients,minor abnormalities were in 66.9% cases;focal segmental glomerulosclerosis (FSGS) was in 12.8% cases;IgA nephropathy was in 7.6% cases;focal glomerulosclerosis(FGS) was in 6.4% cases;Thin basement membrane nephropathy (TBMN) was diagnosed in 2.3% cases. While in patients with CHP,minor abnormalities were in 31.3% cases;IgA nephropathy was diagnosed in 50% cases. In patients with gross haematuria,minor abnormalities were in 56.3% cases and FSGS was diagnosed in 25% cases. Conclusion A school urine screening program can detect chronic renal disease in its early stage. A regular follow-up for those children with microhematuria is certainly warranted. Renal biopsy is recommended to those children with combined hematuria and proteinuria and massive haematuria.