Shinohara Y, Mitsui H, Nasu T, Hayashida S
Department of Urology, Tokuyama Central Hospital.
Nihon Hinyokika Gakkai Zasshi. 1991 Jan;82(1):72-9. doi: 10.5980/jpnjurol1989.82.72.
We performed 308 series renal biopsies during 4 years (1985-1989) and 289 cases were examined by light microscopic, electron microscopic, or immunofluorescent study. Clinically, chronic nephritic syndrome was most frequent (55.4%), followed by nephrotic syndrome (15.1%), and recurrent or persistent hematuria (12.8%). Pathologically, IgA nephropathy was most popular (39.3%), followed by normal glomerulus (9.1%), and thin basement membrane disease (8.7%). Glomerulonephritis clinically recognized with recurrent or persistent hematuria, hardly showing proteinuria, in 81.6% of the cases, consisted of normal glomerulus, or thin basement membrane disease by electron microscopic and immunofluorescent examinations. The remainder (18.4%) was with IgA nephropathy, which was histologically mild. On the other hand, cases of chronic nephritic syndrome (latent type) with persistent proteinuria and hematuria were with glomerulonephritis of various types including IgA nephropathy in 78.8% of the total cases. Therefore, proteinuria is an important sign of glomerulonephritis. In investigation in different age groups, IgA nephropathy was seen in about 40% of both pediatric and adult cases, whereas minor glomerular abnormalities and thin basement membrane disease were more frequent in pediatric cases. Tubulo-interstitial lesions and glomerular lesions in vascular or metabolic diseases were recognized more in adults than in children. Membranous glomerulonephritis (17 cases including 4 pediatric cases), complicated with malignant tumors such as bladder or rectal cancers and hepatoma was found in 3 aged patients. Examination for malignant tumor would be necessary for aged patients with membranous glomerulonephritis. As for the prognosis of IgA nephropathy, because histological changes of IgA nephropathy varied widely from very mild state to severe state, the prognosis is not always good.(ABSTRACT TRUNCATED AT 250 WORDS)
我们在4年（1985 - 1989年）间进行了308例系列肾活检，其中289例接受了光镜、电镜或免疫荧光检查。临床上，慢性肾炎综合征最为常见（55.4%），其次是肾病综合征（15.1%）以及反复或持续性血尿（12.8%）。病理上，IgA肾病最为多见（39.3%），其次是正常肾小球（9.1%）和薄基底膜病（8.7%）。临床上以反复或持续性血尿为特征、几乎无蛋白尿的肾小球肾炎，经电镜和免疫荧光检查，81.6%的病例为正常肾小球或薄基底膜病。其余（18.4%）为组织学表现较轻的IgA肾病。另一方面，以持续性蛋白尿和血尿为特征的慢性肾炎综合征（隐匿型）病例中，78.8%的总病例为包括IgA肾病在内的各种类型肾小球肾炎。因此，蛋白尿是肾小球肾炎的一个重要征象。在不同年龄组的调查中，小儿和成人病例中约40%为IgA肾病，而小儿病例中轻微肾小球异常和薄基底膜病更为常见。成人血管或代谢性疾病中的肾小管间质病变和肾小球病变比儿童更多见。3例老年患者发现膜性肾小球肾炎（17例，包括4例小儿病例）合并膀胱癌、直肠癌或肝癌等恶性肿瘤。对于老年膜性肾小球肾炎患者，有必要进行恶性肿瘤检查。至于IgA肾病的预后，由于IgA肾病的组织学改变从非常轻微到严重状态差异很大，其预后并不总是良好。（摘要截选至250词）
