34例儿童肾病综合征型紫癜性肾炎肾脏病理与临床分析

目的：探讨儿童肾病综合征型紫癜性肾炎肾脏病理及临床之间的关系。方法：对1997年～2010年我科34例临床以肾病综合征表现及肾活检病理诊断为紫癜性肾炎的患儿进行回顾性分析,肾小球病理分级根据ISKDC分类标准,肾小管间质病理分级参照Bohle方法。结果：（1）肾脏病理分级如下：Ⅰ级2例（5.88%）,Ⅱ级8例（23.53%）,Ⅲ级17例（50.00%）,Ⅳ级6例（17.65%）,Ⅴ级1例（2.94%）,其中Ⅲ级最常见;肉眼血尿组Ⅳ级和Ⅴ级比例较镜下血尿组高,差异有统计学意义（P〈0.05）。（2）肾小管间质病理分级：（-）级12例（35.30%）,（＋）级15例（44.12%）,（＋＋）级5例（14.71%）,（＋＋＋）级0例,（＋＋＋＋）级2例（5.88%）。（3）肾小管间质病变程度与病程呈正相关（r=0.643,P〈0.01）,与血肌酐呈正相关（r=0.577,P〈0.01）。结论：儿童肾病综合征型紫癜性肾炎肾小球病理损害较重,但肾小管间质损害轻,有肉眼血尿表现的临床及病理均较镜下血尿的重,需结合临床表现及肾脏病理进行综合评估,拟定治疗方案。

Clinical and Pathological Analysis of Childhood Henoch-Schonlein Purpura Nephritis with Nephritic Syndrome

Objective：To investigate the relationship between clinical and renal pathologic in childhood Henoch-Schonlein purpura nephritis with nephritic syndrome.Methods：A retrospective review of 34 cases of childhood Henoch-Schonlein purpura nephritis with nephritic syndrome who had been performed renal biopsy （from 1997 to 2010）,the pathological grade of glomeruli according to ISKDC classification,at the same time the pathological grade of tubulointerstitial according to Bohle classification.Results：（1）Among the pathological grading of glomeruli,we found grade Ⅰ（2 cases 5.88%）,grade Ⅱ（8 cases 23.63%）,grade Ⅲ （17 cases 50.00%）,grade Ⅳ（6 cases 17.65%）,grade Ⅴ（1 cases 2.94%）,and grade Ⅳ and Ⅴ in macrohematuria was higher than microhematuria（P0.05）.（2）Among the pathological grading of tubulointersitial,we found grade（-） （12 cases 35.30%）,grade （＋）（15 cases 44.12%）and grade （＋＋）（5 cases 14.71%）,grade（＋＋＋＋）（2 cases 5.88%）.（3）Pathological changes in nephric tubulointerstitial were correlated with the course of disease（r=0.643,P0.01）,and also correlated with the Serum Creatinine（r=0.577,P0.01）.Conclusion：The glomerular pathological lesion of Henoch-Schonlein purpura nephritis with nephritic syndrome is heavy,the tubulointerstitial lesion isminor.The macrohematuria was more severe than the microhematuria in not only clinical features,but also renal pathologic.The pathological changes of glomeruli and tubulointerstition could play an important role in the individual treatment.