移植肾穿刺活检83例临床病理分析

目的研究移植肾在术后出现合并症时穿刺活检的病理结果,探讨其对临床的指导意义。方法对83例移植肾进行活组织检查,并进行病理学诊断与分类,结合移植后情况进行分析。结果移植肾慢性排斥反应42例（50.6%）,急性排斥反应14例（16.9%）,肾小球肾炎12例（14.5%）,肾小管药物中毒4例（4.8%）,血管性排斥反应2例（2.4%）,IgA肾病2例（2.4%）,急性肾小管损伤1例,间质纤维化1例,移植肾肾梗死1例,未见排斥反应4例。急性排斥反应14例中有6例肾小管周毛细血管C4d（＋）,阳性率达42.8%。结论移植肾活检安全可靠,是诊断术后多种合并症的有效手段;常规活检有助于及早发现不良因素。

Renal allograft biopsies:a clinopathological study of 83 cases

Objective To investigate the pathological changes in allograft kidney(post-transplant biopsy). Methods 83 renal allograft biopsies were performed.All biopsies were systematically diagnosed and evaluated according to the Banff 97 or Banff 2003 schema. Results After transplantation,chronic allograft nephropathy was developed in 42 cases(50.6%),acute rejection occurred in 14 cases(16.9%),grafting glomerular nephritis occurred in 12 cases(14.5%);4 cases had drug poisoning of nephric tubulecones(4.8%),2 cases of vascellum rejection(2.4%),2 cases of IgA nephronia(2.4%),1 case of acute nephric tubule damage,1 case of interstitial fibrosis,and 1 case of renal infarction.4 cases were normal,and 6 cases with C4d in 14 cases of acute rejection. Conclusion Renal graft biopsy is safe and reliable.Biopsy is an effective approach for the renal complications after transplantation.Routine biopsy of donor renal graft is helpful in finding abnormalities at early stage.