复发肾病综合征重复活检肾脏组织学改变与糖皮质激素疗效的关系

目的了解复发肾病综合征患者重复肾活检其肾脏组织学变化特点及其对糖皮质激素疗效的影响。方法回顾性收集21例曾经标准糖皮质激素治疗完全缓解后复发并行重复肾活检患者的病理和临床资料,分析前后肾脏组织学变化与糖皮质激素疗效之间的关系。结果21例患者首次肾脏病理有IgA肾病10例,系膜增生性肾小球肾炎10例,膜增生性肾小球肾炎1例。共有9例患者肾脏组织学出现明显变化。重复活检有4例IgA肾病和1例系膜增生性肾小球肾炎病理亚型发生改变并伴有肾小管间质损害TIL分级改变,3例IgA肾病和1例膜增生性肾小球肾炎出现TIL分级改变,12例无明显组织学改变。5例重复活检病理亚型改变的患者均出现糖皮质激素抵抗,无改变者1例。结论肾病综合征复发后应尽早重复肾活检,IgA肾病易发生肾脏组织学改变,易出现难治性肾病综合征和糖皮质激素抵抗。

Effects of renal histological changes of cases with recurrent nephritic syndrome on curative effect of glucocorticoid

Objective To investigate the renal histological changes of cases with recurrent nephritic syndrome after repeated renal biopsy and their effects on curative effect of glucocorticoid.Methods Pathological and clinical data of 21 cases,who had been fully relieved after standard treatment of glucocorticoid,then recurred and accepted repeated renal biopsy,were retrospectively selected to analyze the relationship between renal histological changes and curative effect of glucocorticoid.Results In all of the 21 cases,there were 10 cases found with IgA nephropathy in the first-time renal biopsy,10 cases with mesangial proliferative glomerulonephritis,1 case with membranoproliferative glomerulonephritis.4 cases with IgA nephropathy and 1 case with membranoproliferative glomerulonephritis present sub-pathological changes and TIL grading changes of nephric tubule interstitial injury.3 cases with IgA nephropathy and 1 case with membranoproliferative glomerulonephritis present TIL grading changes of nephric tubule interstitial injury.there were 6 cases with glucocorticoid resistant,among whom there were 5 cases with sub-pathological changes,and 1 case with none change.Conclusion Repeated renal biopsy should be carried out in cases immediately after recurrence of nephritic syndrome.Cases with IgA nephropathy are always accompanied with renal histological changes and glucocorticoid resistant.