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[匈牙利经活检诊断的肾脏疾病发病率]

[The incidence of renal diseases as diagnosed by biopsy in Hungary].

作者信息

Sipiczki Tamás, Ondrik Zoltán, Abrahám György, Pokorny Gyula, Túri Sándor, Sonkodi Sándor, Kemény Eva, Iványi Béla

机构信息

Szegedi Tudományegyetem, Szent-Györgyi Albert Orvos- és Gyógyszerésztudományi Centrum, Altalános Orvostudományi Kar, Pathologiai Intézet, Szeged.

出版信息

Orv Hetil. 2004 Jun 27;145(26):1373-9.

Abstract

AIM AND METHODS

The authors analysed the incidence of renal diseases as diagnosed by biopsy in the population living on the southern Great Hungarian Plain. 798 biopsy specimens were examined between 1990 and 2002.

RESULTS

The most common diseases in decreasing order of frequency were IgA nephropathy (15%), membranous nephropathy (12%), thin-basement-membrane nephropathy (8%), minimal change nephropathy (7%), lupus glomerulonephritis (7%), focal sclerosis (6%), hypertensive kidney disease and arteriolosclerosis (5%), diabetic nephropathy (5%), and crescentic glomerulonephritis (4%). The most frequent diseases in decreasing order of frequency in children were minimal change nephropathy, thin-basement-membrane nephropathy, Henoch-Schönlein nephropathy and IgA nephropathy; in adults were IgA nephropathy, membranous nephropathy, lupus glomerulonephritis and thin-basement-membrane nephropathy; and in the elderly were membranous nephropathy, amyloidosis, crescentic glomerulonephritis and diabetic nephropathy. The incidence of the diseases differed significantly between the genders in IgA nephropathy, thin-basement-membrane nephropathy, lupus glomerulonephritis, chronic sclerosing nephropathy and Alport nephropathy. At the time of the biopsy, 69 patients were suffering from diabetes mellitus. 37 patients were diagnosed as having diabetic nephropathy, and 32 as having non-diabetic nephropathy. In 6 cases, the diabetic nephropathy was accompanied by other glomerular disorders. In more than half of the diabetic patients with non-diabetic nephropathy, membranous nephropathy or focal sclerosis was diagnosed. Crescentic glomerulonephritis was diagnosed on 30 occasions, which was due to vasculitis in 20 cases, proliferative glomerulonephritis in 7 cases and anti-glomerular-basement-membrane nephritis in 3 cases. In the middle-aged and the elderly, the renal disease was relatively often a consequence of systemic disease.

CONCLUSION

The incidence and the gender distribution of renal diseases diagnosed by biopsy were similar to those reported by other European kidney biopsy centres. IgA nephropathy was the most frequent disease in the biopsy registry of the authors. The high incidence of thin-basement-membrane nephropathy seems to be related to consequent biopsy examinations of glomerular haematuria. In diabetics and the elderly, the diagnosis of the renal disease may be challenging.

摘要

目的与方法

作者分析了生活在匈牙利大平原南部人群中经活检确诊的肾脏疾病发病率。1990年至2002年间共检查了798份活检标本。

结果

按发病率从高到低排序,最常见的疾病依次为IgA肾病(15%)、膜性肾病(12%)、薄基底膜肾病(8%)、微小病变肾病(7%)、狼疮性肾炎(7%)、局灶节段性肾小球硬化(6%)、高血压肾病和小动脉硬化(5%)、糖尿病肾病(5%)以及新月体性肾小球肾炎(4%)。儿童中发病率从高到低排序最常见的疾病依次为微小病变肾病、薄基底膜肾病、过敏性紫癜性肾病和IgA肾病;成人依次为IgA肾病、膜性肾病、狼疮性肾炎和薄基底膜肾病;老年人依次为膜性肾病、淀粉样变性、新月体性肾小球肾炎和糖尿病肾病。IgA肾病、薄基底膜肾病、狼疮性肾炎、慢性硬化性肾病和奥尔波特综合征的发病率在性别间存在显著差异。活检时,69例患者患有糖尿病。3例患者被诊断为糖尿病肾病,32例为非糖尿病肾病。6例患者的糖尿病肾病伴有其他肾小球疾病。在半数以上患有非糖尿病肾病的糖尿病患者中,诊断为膜性肾病或局灶节段性肾小球硬化。共诊断出30例新月体性肾小球肾炎,其中20例由血管炎引起,7例由增生性肾小球肾炎引起,3例由抗肾小球基底膜肾炎引起。在中年人和老年人中,肾脏疾病相对常见是全身性疾病的后果。

结论

经活检确诊的肾脏疾病的发病率和性别分布与其他欧洲肾脏活检中心报告的相似。IgA肾病是作者活检登记中最常见的疾病。薄基底膜肾病的高发病率似乎与随后对肾小球性血尿的活检检查有关。在糖尿病患者和老年人中,肾脏疾病的诊断可能具有挑战性。

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