IgA肾病伴部分性新月体形成的临床病理分析

目的：探讨原发性IgA肾病伴部分性新月体形成的临床和病理特点。方法：选取79例经肾活检确诊伴部分性新月体形成IgA肾病患者,分析其临床和病理特点,并根据新月体形成所累及肾小球的比例分组：≥10%为A组,31例;≤10%为B组,48例。结果：（1）临床表现：79例均有血尿＋蛋白尿,蛋白尿〉1g/24h者48例（60.8%）;两组比较,A组蛋白尿〉1g/24h28例（89.3%）,B组蛋白尿〉1g/24h20例（41.7%）,A组大量蛋白尿、肉眼血尿、高血压、肾衰竭发生率均高于B组（P〈0.05）。（2）病理表现：79例新月体形成累及肾小球3.3%～29.0%,均以细胞性为主,几乎均有肾小球硬化、内皮细胞及系膜细胞增生、球囊黏连、灶性肾小管萎缩、以及炎性细胞浸润;两组比较A组中、重度系膜细胞及内皮细胞增生、炎性细胞浸润,细胞新月体所占比例均较B组明显;病理改变硬化肾小球占55例（69.6%）。结论：IgA肾病伴部分性新月体形成患者临床均有血尿＋蛋白尿,尤其大量蛋白尿;病理改变以局灶节段性肾小球硬化常见;炎性细胞浸润、内皮细胞及系膜细胞增生等活动性病变易见并影响新月体形成;新月体的多少及纤维化程度影响临床病理表现,≥10%较≤10%严重。

Clinicopathological Analysis of IgA Nephropathy with Partial Crescentic Formation

Objective-To study the Clinical and pathological features of IgA nephropathy （IgAN） with partial crescentic formation, Methods：Clinical and pathological characteristics of 79 patients with IgA nephropathy accompanied by partial crescentic formation were reviewed. These patients were divided into two roups according to the percentage of glomeruli affected by crescents more or less than 10% ,and their data were compared. Results：Clinial features：All the patients had hematuria and proteinuria,proteinuria excreted in urine was more than 1 g/24 h in 89.3% of the patients in Group A,as well as 41.7% of the patients in Group B, significantly more cases in Group A （P 〈 0.05）. The rate of the patients with hyperproteinuria,gross hematuria, hypetension,renal insufficiency and edema were higher in Group A. Renal pathology：The glomeruli were affected by crescents from 3.3% --29. 0 %, mainly were cellular crescents. Nearly all the cases had mesangial proliferation and glomerulosclerosis and tuft adhesions and inflammatory cell infiltrate to differnet degree. Severe mesangial proliferation, inflammatory cell infiltrate, cellular crescents and endothelial proliferation were significantly more often seen in Group A （P 〈 0.05）. Glomerulosclerosis was about 69.6 %. Conclusion： The main clinial feature of IgA nephropathy with with partial crescentic formation were hernaturia combined with proteinuia, especially severe proteinuria, The main type of pathology was focal segmental glomerulosclerosis（FGGS）. And it is easy to see inflammatory cell infiltrate.endothelial proliferation and mesangial proliferation,all of them affect crescent formation. The clinical manifestation and renal lesiond of IgAN with glomeruli affected by crescents more than 10% were worse than crescents less than 10%.