Yuen L K, Lai W M, Lau S C, Tong P C, Tse K C, Chiu M C
Department of Paediatrics and Adolescent Medicine, Princess Margaret Hospital, Laichikok, Hong Kong.
Hong Kong Med J. 2008 Oct;14(5):348-55.
To study the childhood renal disease pattern based on the renal biopsy histology in a local paediatric tertiary renal centre.
Retrospective study.
Department of Paediatrics and Adolescent Medicine, Princess Margaret Hospital, Hong Kong.
All patients who underwent real-time ultrasound-guided closed renal biopsy from 1 April 1997 to 31 March 2007 were included.
A total of 209 renal biopsies were performed, 162 on native kidneys and 47 on grafts. In the native group, major indications were renal manifestations secondary to systemic diseases (34%), followed by idiopathic nephrotic syndrome (28%) and haematuria (27%). In 94% the histopathology revealed glomerular diseases. Among the primary glomerular diseases, thin glomerular basement membrane disease, immunoglobulin A nephropathy, minimal change disease, and focal segmental glomerulosclerosis accounted for most. In all, 37% of patients with steroid-resistant nephrotic syndrome had focal segmental glomerulosclerosis and its relative incidence was increased when compared to previous studies. Minimal change disease and minimal change disease with mesangial immunoglobulin M deposits accounted for the majority of steroid dependent and frequent relapsers. Among patients with isolated microscopic haematuria, 73% had thin glomerular basement membrane disease, while patients with concomitant haematuria and proteinuria had a wide variety of pathology. In the kidney graft group, acute graft dysfunction was due to acute rejection in 38% of the patients, followed by calcineurin inhibitor toxicity in 14%. Chronic allograft nephropathy caused chronic allograft dysfunction in the majority of cases. Post-transplant proteinuria was caused by recurrence of the primary renal disease in all of our patients.
This study provides updated epidemiological information for childhood renal disease and a change in the pattern of disease was observed.
基于香港一家本地儿科三级肾脏中心的肾活检组织学研究儿童肾脏疾病模式。
回顾性研究。
香港玛嘉烈公主医院儿科及青少年医学部。
纳入1997年4月1日至2007年3月31日期间接受实时超声引导下闭合肾活检的所有患者。
共进行了209例肾活检，其中162例为自体肾活检，47例为移植肾活检。在自体肾组中，主要指征是全身性疾病继发的肾脏表现（34%），其次是特发性肾病综合征（28%）和血尿（27%）。94%的组织病理学显示为肾小球疾病。在原发性肾小球疾病中，薄肾小球基底膜病、免疫球蛋白A肾病、微小病变病和局灶节段性肾小球硬化症占大多数。总体而言，37%的激素抵抗性肾病综合征患者患有局灶节段性肾小球硬化症，与以往研究相比其相对发病率有所增加。微小病变病和伴有系膜免疫球蛋白M沉积的微小病变病占激素依赖型和频繁复发型的大多数。在孤立性镜下血尿患者中，73%患有薄肾小球基底膜病，而伴有血尿和蛋白尿的患者则有多种病理类型。在移植肾组中，38%的患者急性移植肾功能障碍是由于急性排斥反应，其次是14%的患者是由于钙调神经磷酸酶抑制剂毒性。慢性移植肾肾病在大多数病例中导致慢性移植肾功能障碍。我们所有患者的移植后蛋白尿都是由原发性肾脏疾病复发引起的。
本研究提供了儿童肾脏疾病的最新流行病学信息，并观察到疾病模式的变化。
