儿童肾活检的适应证与结果:来自摩洛哥的单中心经验
Indications and results of renal biopsy in children: A single-center experience from Morocco.
作者信息
Souilmi Fatima Zohra, Houssaini Tarik Sqalli, Alaoui H, Harmouch T, Atmani S, Hida M
机构信息
Department of Pediatrics, Hassan II University Hospital; Faculty of Medicine and Pharmacy, Sidi Mohamed Ben Abdellah University, Fez, Morocco.
出版信息
Saudi J Kidney Dis Transpl. 2015 Jul-Aug;26(4):810-5. doi: 10.4103/1319-2442.160225.
The contribution of renal biopsy (RB) is of major importance in the management of many renal diseases in children. Specific indications for performing biopsy in children include steroid-resistant nephrotic syndrome (NS) and secondary nephropathies. The aim of our study was to report the common histological varieties of kidney diseases in children in Morocco. In this retrospective and descriptive study, we included all renal biopsies performed in patients under 16 years in the Department of Pediatrics of Hassan II University Hospital, Fez, Morocco from July 2009 to December 2013. Biopsy samples without glomeruli and those with less than five glomeruli or repeat biopsies on the same patient were excluded from our study. We performed 112 RBs during this period; the average age at the time of RB was 10.05 ± 4 years and the sex-ratio was 1.07. The indications for RB were NS with hematuria and/or renal failure (RF) in 32.1%, active urinary sediment in 21.4%, isolated NS in 15.2%, RF in 13.4% and steroid-resistant NS in 10.7% of cases. Primary nephropathies represented 59.8% of cases, with a predominance of minimal change disease (MCD) seen in 40.2% of the cases. Secondary nephropathies accounted for 27.7% of the cases, with a predominance of lupus nephritis (11.6%), followed by Henoch-Schonlein purpura nephritis (6.2% of cases) and post-streptococcal glomerulonephritis (3.6%). There was one case of hepatitis B virus-associated membranous glomerulonephritis. Chronic glomerulonephritis accounted for 12.5% of the cases. Vascular and tubulo-interstitial nephritis were rare. Our study confirmed that primary glomerular nephropathy was the most common renal disease in children. The most common lesion was MCD. Secondary nephropathies were less frequent, with a predominance of lupus nephritis.
肾活检(RB)对儿童多种肾脏疾病的管理具有重要意义。儿童进行肾活检的特定指征包括激素抵抗型肾病综合征(NS)和继发性肾病。我们研究的目的是报告摩洛哥儿童肾脏疾病常见的组织学类型。在这项回顾性描述性研究中,我们纳入了2009年7月至2013年12月在摩洛哥非斯哈桑二世大学医院儿科对16岁以下患者进行的所有肾活检。无肾小球的活检样本、肾小球少于五个的样本或同一患者的重复活检样本被排除在我们的研究之外。在此期间我们进行了112例肾活检;肾活检时的平均年龄为10.05±4岁,性别比为1.07。肾活检的指征为:32.1%的病例是伴有血尿和/或肾衰竭(RF)的NS,21.4%是活动性尿沉渣,15.2%是孤立性NS,13.4%是RF,10.7%是激素抵抗型NS。原发性肾病占病例的59.8%,其中微小病变病(MCD)占40.2%最为常见。继发性肾病占病例的27.7%,其中狼疮性肾炎占主导(11.6%),其次是过敏性紫癜性肾炎(占病例的6.2%)和链球菌感染后肾小球肾炎(3.6%)。有1例乙型肝炎病毒相关性膜性肾小球肾炎。慢性肾小球肾炎占病例的12.5%。血管性和肾小管间质性肾炎很少见。我们的研究证实原发性肾小球肾病是儿童最常见的肾脏疾病。最常见的病变是MCD。继发性肾病较少见,以狼疮性肾炎为主。