以血尿为主要表现患者的临床与病理分析

目的 回顾性分析以血尿为主要表现患者的临床和病理情况,了解肾小球源性血尿与非肾小球源性血尿患者肾脏病理类型的分布及临床特点.方法 回顾性分析2000～2006年间,因体检发现血尿同时尿蛋白定量＜0.5 g/24 h,在排除了结石、炎症、肿瘤等外科情况而入院进行肾活检患者的临床及肾脏病理资料,根据尿红细胞位相结果将这些患者分为肾小球源性血尿组和非肾小球源性血尿组,比较两组之间的临床及病理异同点.结果 收集到310例符合条件的患者资料,肾小球源性血尿患者209例,其中IgA肾病97例(46.41%)、肾小球微小病变47(22.49%)、非IgA肾病的系膜细胞增殖性肾小球肾炎30例(14.3%),非肾小球源性血尿101例,其中IgA肾病66例(65.34%)、非IgA肾病的系膜细胞增殖性肾小球肾炎22例(21.78%)、肾小球微小病变9例(8.91%).两组之间在性别构成、年龄、肾活检前病程、是否伴有高血压方面无差异(P＞0.05),但肾小球源性血尿患者伴有肾损害的情况更多见(P＜0.05).结论 血尿患者的病理类型中以IgA肾病居多,即使在非肾小球源性血尿患者中,仍然存在较严重的肾脏病理改变.

Clinical and pathological characteristics of patients with glomerular hematuria as the major manifestation

Objective To compare the clinical and pathological characteristics between patients with and without glomerular hematuria.Methods Totally 310 patients with isolated microscopic hematuria and 24-hour urinary protein <0.5 g were enrolled in this study,who were free of renal calculi,infections,or tumors.These patients were divided into glomerular hematuria group and non-glomerular hematuria group according examination by phase-contrast microscope,and their clinicopathological data were retrospectively analyzed.Results Of the 209 patients identified to have glomerular hematuria,46.41% had IgA nephropathy,22.49% had small glomerular lesions,and 14.35% had non-IgA mesangioproliferative glomerulonephritis.In the patients with non-glomerular hematuria,65.34% had IgA nephropathy,21.78% had non-IgA mesangioproliferative glomerulonephritis,and 8.91% had small glomerular lesions.No significant differences were found in the patients' gender,age,course of disease or hypertension between the two groups(P>0.05),but renal insufficiency was more common in patients with glomerular hematuria.Conclusion IgA nephropathy is still the most frequent pathological finding in patients with hematuria,and even in non-glomerular hematuria patients severe renal pathological changes can be common..