Shen Peicheng, Ding Xiaoqiang, Ten Jie, Ji Jun, Zou Jianzhou, Fang Yi
Department of Nephrology, Zhongshan Hospital, Shanghai Medical College, Fudan University, Shanghai, China.
Nephron Clin Pract. 2006;103(4):c149-56. doi: 10.1159/000092912. Epub 2006 Apr 24.
Patients with hematuria and/or proteinuria found during routine examination are commonly encountered. To define the clinicopathological characteristics and outcome of these patients, 142 patients with definite pathological diagnosis were studied retrospectively.
All the 142 patients were divided into three groups: pure hematuria (HU, n = 13), concomitant hematuria and proteinuria (HUPU, n = 79), and proteinuria alone (PU, n = 50).
At the time of renal biopsy, 26% of the patients had renal insufficiency and 48% of the patients had hypertension. Pathologically, IgA nephropathy (n = 67) was the most common. A total of 51 patients were enrolled into the follow-up group. Finally, urinary abnormalities disappeared in 18% of the patients, 22% of HU developed proteinuria, 21% of HUPU and 23% of PU appeared to have a distinct increase of proteinuria, and 15% of PU developed hematuria. Seven patients with normal blood pressure before became hypertensive and 6% of the patients with normal renal function initially developed renal insufficiency. The renal outcome was associated with proteinuria and tubulointerstitial lesions.
Because renal pathologic change does not always coincide with clinical manifestations, patients with hematuria and/or proteinuria found during routine examination do not necessarily imply a favorable outcome, so renal biopsy is quite important. Besides, early treatment and careful follow-up are helpful in these patients.
在常规检查中发现血尿和/或蛋白尿的患者很常见。为了明确这些患者的临床病理特征及预后,对142例有明确病理诊断的患者进行了回顾性研究。
142例患者分为三组:单纯血尿组(HU,n = 13)、血尿伴蛋白尿组(HUPU,n = 79)和单纯蛋白尿组(PU,n = 50)。
肾活检时,26%的患者有肾功能不全,48%的患者有高血压。病理上,IgA肾病(n = 67)最为常见。共有51例患者纳入随访组。最终,18%的患者尿异常消失,22%的HU患者出现蛋白尿,21%的HUPU患者和23%的PU患者蛋白尿明显增加,15%的PU患者出现血尿。7例血压正常的患者后来出现高血压,6%的肾功能正常的患者最初出现肾功能不全。肾脏预后与蛋白尿和肾小管间质病变有关。
由于肾脏病理改变并不总是与临床表现一致,常规检查中发现血尿和/或蛋白尿的患者不一定预后良好,因此肾活检非常重要。此外,早期治疗和密切随访对这些患者有帮助。