37例儿童IgA肾病临床与病理分析

为了探讨IgA肾病的临床与病理改变的关系，对37例IgA肾病进行临床分型并与肾小球、肾小管间质改变及免疫病理特点的关系进行比较。结果：临床分型中单纯血尿（血尿）18例占49%，肾百闻不如一见 综合征（肾病）14例占38%，血尿和蛋白尿3例占8%，肾炎综合征（肾炎）2例占5％，肾小球病理损害以Ⅲ级为主占厮４％，临床各型与肾小球病理损害无相关性。肾小管间质改变２４例，血尿组７例占３９％，其中Ｉ级为４３％，Ⅱ级为５７％，肾病组均有改变，其中Ⅱ级１１例占７８％，Ⅲ级３例占２２％，血尿和蛋白尿组2例占66%，肾炎组1例占50%，免疫病理改变为IgA16例，IgAG6例，IgAM10例，IgAGM5例，血尿组以单纯IgA沉积为主占66%，肾病组则以IgAM型为主占50%，提示IgA肾病临床以单纯血尿为主，其次为肾病综合征；肾小球病理损害程度与临床分型无相关性，但肾病组肾小管间质均有改变且程度也较血尿组为重。免疫病理血尿组以单纯IgA为主，而肾病组以IaAM为主。

Clinical and pathological features of 37 children with IgA nephropathy

To explore the relationship between clinical findings and pathological changes of IgA nephropathy (IgAN), 37 children with IgAN were undertaken clinical classification and renal-pathological comparison including glomerulus change, renal tubule-interstitial change and immunopathology. The results showed that there were 18 (49%) cases with hematuria, 14 (38%) cases with nephrotic syndrome, 3(8%) cases with both of hematuria and proteineuria, and 2 (5%) cases with nephritic syndrome in the clinical classification. 54% of cases with glomerulus changes was as class III. No significant relationship was found between clinical classification and glomerulus changes. There were 24 cases with renal-tubule interstitial changes and 7 cases with hematuria. 43% of them were classified as class I and 57% as class II.All cases with nephrotic syn-drome developed renal tubule-interstitial change. 78% (11 cases) of them were as class II and 22% (3 cases) as class III. Besides, 2 of 3 cases with both of hematuria and proteineuria and 1 of 2 cases with nephritic syndrome also manifested renal tubule-interstitial change. There were four phenotypes were observed in immunopathology including 16 cases of them as IgA, 6 cases as IgAG, 10 cases as IgAM and 5 cases as IgAGM, respectively. 66% of cases with hematuria was found as IgA and 50% of cases with nephrotic syndrome as IgAM. It is concluded that hematuria can be a main clinical finding in both of IgAN and nephrotic syndrome. Glomerulus changes is usually not correlated with clinical classification. There is a significant renal tubule-interstitial change in cases with nephrotic syndrome. Hematuria is usually as IgA and nephrotic syndrome as IgAM in immunopathology.