不典型急性链球菌感染后肾小球肾炎3例报告

目的提高对急性肾小球肾炎特殊临床和肾脏病理的认识。方法回顾性分析3例具有不典型急性肾小球肾炎临床表现患儿的临床和病理资料。结果 3例患儿均以急性肾小球肾炎表现起病,例1和例3在病程中出现肾病综合征表现;例2在6周后肉眼血尿方转为镜下血尿;例1于病程11周时仍为肾病水平蛋白尿、直至病程30周时尿蛋白消失;例2和例3分别于病程5周和4周恢复肾功能。例2和例3血清补体C3于病程6周内恢复,例1于病程11周恢复。例2和例3抗链球菌溶血素O(ASO)滴度增高。3例患儿的肾活检组织光镜和电镜改变均符合毛细血管内增生性肾小球肾炎的特点,免疫病理改变例1以IgM和C3沉积为主,例2和例3以C3沉积为主。结论上述3例患儿均诊断为急性链球菌感染后肾小球肾炎,但临床和病理特点具有不典型性。

Three cases of atypical acute poststreptococcal glomerulonephritis in children

Objective To improve the recognition of special clinical and pathological features of acute glomerulonephritis in children.Methods The clinical and pathological data of children with atypical acute glomerulonephritis was analyzed retrospectively.Results All 3 cases presented with symptoms of acute glomerulonephritis at onset of disease.Both case 1 and case 3 manifested nephrotic syndrome during the course of the disease.In case 2,gross hematuria turned to microscopic haematuria 6 weeks after the onset.Case 1 had nephrotic-level proteinuria lasting for 11 weeks,and the proteinuria did not disappear until 30 weeks.For case 2 and case 3,renal function recovered at 5 weeks and 4 weeks,respectively.Serum C3 level recovered within 6 weeks for case 2 and case 3,and 11 weeks for case 1.Anti-streptolysin O(ASO)titer increased for case 2 and case 3,whereas unchanged for case 1.All 3 cases showed characteristic features of endocapillary proliferative glomerulonephritis under light microscopy and electron microscopy.However,both IgM and C3 staining were seen in case 1,but only C3 was see in case 2 and case 3 by immunofluorescence microscopy.Conclusions All 3 cases diagnosed with acute post-streptococcal glomerulonephritis had atypical clinical and pathological presentations.