临床表现为肾功能异常患者肾活检的病理分析及风险评估

目的：通过分析临床表现为肾功能异常患者肾活检的病理构成与并发症发生情况,明确肾活检在肾功能异常中的诊断价值及风险。方法：回顾性分析行肾活检的311例临床表现为肾功能异常（急性或慢性）患者和同期1717例肾功能正常患者的临床资料、超声影像与实验室检查数据,分析急性或慢性肾功能异常的肾活检病理结果以及肾活检并发症发生情况,并对影响因素进行多因素分析。结果：肾功能异常患者中急性89例、慢性222例。急性肾功能异常前3位病理类型为ANCA相关性肾炎、急性肾小管坏死和急性间质性肾炎;慢性肾功能异常前3位为IgA肾病、慢性肾小管间质损害和高血压肾损害。急、慢性肾功能异常的肾活检并发症分别为2.2%和5.8%,高于肾功能正常的发生率1.3%。但是没有肾脏切除、死亡等严重并发症。多因素分析显示肾小球滤过率与并发症发病率明显相关（P〈0.05）。结论：对肾功能异常患者谨慎肾活检,有助于明确病因和病理诊断,指导治疗。肾小球滤过率与并发症的发生密切相关。

Pathological Analysis and Risk Assessment of Renal Biopsy in Patients with Renal Dysfunction

Objective：To analyze renal pathology and complications of renal biopsy in patients with renal dysfunction and its diagnostic value and risk factors.Methods：We retrospectively analyzed clinical data,ultrasound imaging and laboratory data of 311 patients clinically manifestating as renal dysfunction（acute or chronic）.1 717 cases with normal renal function over the same period were as control.The pathological results and complications,of renal biopsy as well as the risk factors were analyzed by multivariate analysis method.Results：89 patients with acute renal dysfunction and 222 with chronic renal dysfunction were enrolled.The top three pathological types of acute renal dysfunction were ANCA associated glomerulonephritis,acute tubular necrosis and acute interstitial nephritis.The top three pathological types of chronic renal dysfunction were IgA nephropathy,chronic tubulointerstitial damage and hypertensive nephropathy.Incidence of renal biopsy complications in acute or chronic renal dysfunction were 2.2% and 5.8%,respectively,which were higher than those with normal renal function（1.3%）.However,there was no nephrectomy,death or other serious complications.Multivariate analysis showed that glomerular filtration rate was significantly associated with incidence of complications（P0.05）.Conclusion：Performance of renal biopsy carefully in patients with renal dysfuntcion brings benefit for pathological diagnosis and therapeutic strategy.Glomerular filtration rate is closely related with occurrence of the complications.