Arapović Adela, Vukojević Katarina, Filipović Natalija, Glavina Durdov Merica, Ljubanović-Galešić Danica, Saraga-Babić Mirna, Prgomet Sandra, Simičić Majce Ana, Belavić Anja, Borić Škaro Dijana, Ljutić Dragan, Saraga Marijan
Department of Pediatrics, University Hospital Centre Split, 21000, Split, Croatia.
Department of Anatomy, Histology and Embryology, University of Split School of Medicine, Šoltanska 2, 21000, Split, Croatia.
BMC Nephrol. 2020 Feb 26;21(1):65. doi: 10.1186/s12882-020-01727-7.
Information about renal diseases in children is available from national registries of renal biopsies. Aim of the study was to compare the clinical presentation of glomerular diseases and tubulointerstitial space diseases with pathohistological diagnosis of indicated renal biopsies from pediatric population in the Croatian region of Dalmatia.
Out of 231 pediatric patients with suspected glomerular and tubulointerstitial diseases, 54 underwent ultrasound-guided renal biopsy at University Hospital of Split. Kidney allograft biopsy, and re-biopsy were excluded. The biopsy sections were examined under light microscopy, immunofluorescence and electron microscopy. The data was reviewed to determine the pathohistological spectrum and clinicopathologic correlations. We retrospectively analyzed kidney biopsy data from 2008 to 2017 and compared them to that between 1995 and 2005.
The mean age of patients was 9.84 ± 5.4 years. Male:female ratio was 1.2:1. The main indications for biopsy were pure nephrotic syndrome without hematuria (25.9%), non-nephrotic proteinuria with haematuria (22.2%), nephritic syndrome with nephrotic proteinuria (18.5%), and isolated hematuria (16.7%). The most common pathohistological findings were IgA nephropathy (IgAN, 24.1%), minimal change disease (MCD, 16.7%), Henoch-Schönlein purpura glomerulonephritis (HSPN, 14.8%), Alport syndrome and focal segmental glomerulosclerosis (AS and FSGS, 11.1% each), tubulointerstitial nephritis and membranous glomerulopathy (TIN and MGN, 3.7% each), while other cases were diagnosed rarely.
Changes in epidemiology of renal diseases in children between the analyzed periods showed an increasing trend of IgAN, MCD, HSPN, AS and FSGS, while mesangioproliferative glomerulonephritis (MesPGN) and endoproliferative glomerulonephritis (EDGN) showed a decreasing trend that can be explained with the new pathohistological classification.
儿童肾脏疾病的信息可从全国肾脏活检登记处获取。本研究的目的是比较达尔马提亚克罗地亚地区儿童人群中肾小球疾病和肾小管间质疾病的临床表现与所做肾脏活检的病理组织学诊断结果。
在231例疑似肾小球和肾小管间质疾病的儿科患者中，54例在斯普利特大学医院接受了超声引导下的肾脏活检。排除了肾移植活检和重复活检。活检切片在光学显微镜、免疫荧光和电子显微镜下进行检查。对数据进行回顾以确定病理组织学谱和临床病理相关性。我们回顾性分析了2008年至2017年的肾脏活检数据，并将其与1995年至2005年的数据进行比较。
患者的平均年龄为9.84±5.4岁。男女比例为1.2:1。活检的主要指征为无血尿的单纯肾病综合征（25.9%）、伴有血尿的非肾病性蛋白尿（22.2%）、伴有肾病性蛋白尿的肾炎综合征（18.5%）和孤立性血尿（16.7%）。最常见的病理组织学发现为IgA肾病（IgAN，24.1%）、微小病变病（MCD，16.7%）、紫癜性肾炎（HSPN，14.8%）、Alport综合征和局灶节段性肾小球硬化（AS和FSGS，各占11.1%）、肾小管间质性肾炎和膜性肾小球病（TIN和MGN，各占3.7%），而其他病例诊断较少。
分析期间儿童肾脏疾病的流行病学变化显示，IgAN、MCD、HSPN、AS和FSGS呈上升趋势，而系膜增生性肾小球肾炎（MesPGN）和内皮增生性肾小球肾炎（EDGN）呈下降趋势，这可以用新的病理组织学分类来解释。
