46例成人肾病综合征临床与病理分析

目的探讨成人肾病综合征临床与病理分型特点,以及肾穿刺活检术在成人肾病综合征诊断中的意义。方法在B超或彩超引导下,应用半自动肾活检针单人操作行经皮肾穿刺活检术46例次,标本送福州总医院病理科行光镜、免疫组化及电镜等病理检查。结果46例肾病综合征按临床表现分单纯型15例、非单纯型31例,后者可再细分为血尿型12例,高血压型4例,肾炎综合征型7例和肾功能衰竭型8例。病理类型有：微小病变1例,系膜增生性肾小球肾炎11例,膜性肾病3例,局灶性节段性肾小球硬化3例,IgA肾病7例,增生硬化性肾小球肾炎1例,新月体肾炎1例,狼疮肾炎8例,乙肝相关性肾小球肾炎8例,糖尿病肾病1例,肾淀粉样变性1例,过敏性紫癜肾小球肾炎1例。结论肾病综合征临床表现差异性提示其病因、病理类型及严重程度不同,其治疗及预后也不同。肾穿刺活检对于成人肾病综合征的诊断、治疗和预后判断有重要的临床意义,如无禁忌证应积极开展此项检查以明确诊断。

Clinicopathologic analysis of adult nephrotic syndrome:Analysis of 46 cases

Objective To approach the clinical and pathological characteristics and evaluate the clinical significance of renal biopsy in adult nephrotic syndrome.Methods By the lead of B ultrasonography or color ultrasonography,46 cases of adult syndrome had been successfully taken renal biopsy with a semi-automatic punct set.The tissues had been fixed and posted to Fuzhou General Hospital for pathological examination including light microscope,immunohistochemistry and electron microscope inspection.Results Clinically,46 cases of adult nephritic syndrome could be divided into two types,simplex(15 cases)and non-simplex(31 case),and in the later including hematuria(12 cases),hypertension(four cases),nephritis(seven cases)and renal failure(eight cases)types.In the pathological types there were minimal-change(one case),mesanioproliferative glomerulonephritis(11 cases),membrane nephropathy(three cases),focal segmental glomerular sclerosis(three cases),IgA nephropathy(seven cases),proliferative sclerosing glomerulonephritis(one case),lupus nephritis(eight cases),hepatic B virus associated glomerulonephritis(eight cases),diabetic nephropathy(one case),renal amyloidsis(one case),and Henoch-Schonlein glomerulonephritis(one case).Conclusions Nephrotic syndrome has vary clinical presentations that based on their different pathogenesis,pathologic types and severity,also there are differ in therapy and prognosis.It is necessary to make renal biopsy to get the pathological diagnosis and prognosis in adult nephrotic syndrome patients if without any prohibition.