重复肾活检在儿童频繁复发性肾病中的意义

目的了解儿童频繁复发性难治性肾病的病理类型变化情况。方法对30例用激素治疗不敏感且频繁复发的难治性肾病患儿进行重复肾活检,观察对比2次肾活检的病理类型变化及临床症状和实验室检查结果。结果第1次肾活检至重复肾活检的时间为2~67个月,平均24·5个月。临床诊断为原发性肾病综合征22例,继发性肾病8例。病理类型发生改变者11例,改变率为36·7%,复发次数最多9次,最少3次,平均3·5次。结论对临床治疗不敏感且频繁复发的难治性肾病患儿,如果临床疗效不佳,应调整治疗方法以观察疗效,在采用新的治疗方案后疗效仍不确切者,提倡尽早进行重复肾活检,以便及时了解病理类型的变化,从而及时调整并制定相应的治疗方案。

Significance of Repeat Renal Biopsies in Children with Frequently Relapsing Nephrotic Syndrome

Objective To observe the pathological diversification in children with frequently relapsing and refractory nephrotic syndrome.Methods 30 children with repeat renal biopsies,who exhibited frequently relapsing nephrotic syndrome and had no sensitivity with steroid,were analyzed to study the pathological diversification,clinical manifestation and laboratory examination.Results The interval between biopsies was from 2 months to 67 months,the mean interval was 24.5 months.22 cases were diagnosed as primary nephrotic syndrome,8 cases were secondary nephrotic syndrome.11 cases(36.7%) had a pathological diversification;the times of relapse were from three to nine times,the mean of which was 3.5 times.Conclusion If the curative effects are not satisfactory for children with frequently relapsing and refractory nephrotic syndrome,the therapy method should be adjusted.After a new treatment protocol failed,it is advocated to perform the repeat biopsies early in order to learn the pathological diversification and regulate the treatment protocol in time.