慢性肾功能不全患者的病理类型分析

目的分析肾活检时表现为慢性肾功能不全患者（Scr≥130μmol/L）的患者病理类型及特点。方法选择我院2006年1月～2008年12月行肾脏活检时表现为血清肌酐升高（Scr≥130μmol/L）的所有慢性肾脏病患者共104例作为研究对象,分析其临床和病理特点。同时重点分析了增生硬化型IgA肾病的特点。结果 104例慢性肾脏病患者在肾活检时表现为肾功能异常,占同期肾活检患者的11.9%。这些患者的平均血清肌酐（235.11±114.4）μmol/L。临床诊断主要为：慢性肾小球肾炎63例,肾病综合征27例,系统性血管炎4例,系统性红斑狼疮3例。其中78例（75.0%）患者有高血压。病理类型主要表现为IgA肾病（46.2%,其中有70.8%的患者主要表现为增生硬化性肾炎）,其次是间质性肾炎,系膜增生性肾小球肾炎,新月体肾炎,局灶节段肾小球硬化,IV型狼疮性肾炎。其中,增生硬化型的IgA肾病患者血压升高更为突出,但是尿蛋白量更少。结论表现为慢性肾功能不全的患者病理上主要为IgA肾病,其中增生硬化性肾炎是主要病理表现,其次是肾小管间质病变。慢性病变是主要的病理特点。

The pathological types of patients with renal insufficiency

Objective To study the pathological types and features of patients with clinical chronic renal insufficiency（Scr≥130μmol/L）.Methods Total 104 patients who were admitted to our hospital with chronic renal insufficiency and received renal biopsy from January 2006 to December 2008 were enrolled in thte study.Clinical manifestations and pathological features were analyzed.Results There were 104 CKD patients with increased serum creatinine before renal biopsy,about 11.9% of all patients received renal biopsy in our department.The averageserum creatinine was（235.1±114.4）μmol/L.The original diseases were chronic glomerulonephritis（63 cases）,nephrotic syndrome（27 cases）,systemic vasculitis（4cases）,and systemic lupus erythematosus（3 cases）.There were 78 patients（75.0%）with hypertension.The pathological types were IgA nephropathy（46.2%,70.8% with proliferative sclerosing glomerulonephritis）,interstitial nephritis,mesangial proliferative glomemlonephritis,cresccntic glomerulonephritis,focal segmental glomerulosclerosis,and type IV lupus nephritis.The patients with proliferative sclerosing IgA nephropathy usually had more severe hypertention and lower proteinuria.Conclusion The main pathological type of chronic renal insufficiency patient is IgA nephropathy,of which proliferative sclerosing nephritis is the most,and interstitial nephritis is the sccond common type.Chronic kidney lesions are main pathological findings.