摘要
目的提高对儿童不典型感染后肾小球肾炎(PIGN)临床和病理的认识。方法回顾性分析2015年10月至2019年6月本院21例儿童不典型PIGN临床和病理资料。结果21例均急性起病。肉眼血尿17例,其中9例病程4周后仍然持续或反复肉眼血尿。16例肾病水平蛋白尿,其中9例达肾病综合征诊断标准。肾活检病理系膜增生为主肾小球肾炎8例、毛细血管内增生肾小球肾炎13例。免疫荧光系膜区和毛细血管襻C3和IgG共沉积8例,以C3沉积为主或仅C3沉积13例。12例患儿采用了泼尼松和/或环磷酰胺或吗替麦考酚酯治疗。6个月~3年的追踪观察,全部患儿肾功能正常,11例患儿镜下血尿,2例感染后有微量蛋白尿,感染控制后正常。结论不典型PIGN临床可表现为持续肾病水平蛋白尿甚至肾病综合征表现,病理免疫荧光可C3沉积为主,给予包括糖皮质激素和/或免疫抑制剂在内的相应治疗后预后良好。
Objective To improve the clinical and pathological understanding of atypical post-infectious glomerulonephritis(PIGN)in children.Method From October 2015 to June 2019,21 cases of children with atypical post-infectious glomerulonephritis were retrospectively analyzed.Results All 21 cases had acute onset.There were 17 cases of gross hematuria,9 cases of whom had continuous or recurrent gross hematuria more than 4 weeks.16 patients had nephrotic-range proteinuria,9 cases of whom could be diagnosed as nephrotic syndrome.There were 8 cases with dominant mesangial proliferation and 13 cases with intra-capillary hyperplastic glomerulonephritis.It showed IgG combined with C3 deposition on capillary loop and mesangial region in 8 cases,dominant C3 deposition or only C3 deposition on capillary loop and mesangial region in 13 cases by immunofluorescence(IF).12 cases were treated with glucocorticoid and/or cyclophosphamide or mycophenolate mofetil.At last follow-up(ranged from 6 months to 36 months),all children had normal renal function,11 cases had microscopic hematuria,and 2 cases had microalbuminuria after infection.Conclusions The atypical post-infectious glomerulonephritis had clinical manifestations of persistent nephrotic-range proteinuria or even nephrotic syndrome,and mainly dominant C3 deposition by pathological immunofluorescence,which had good renal outcomes after the corresponding treatment including glucocorticoid and/or immunosuppressants was adopted.
作者
谭梅
邓会英
杨华彬
陈椰
李颖杰
钟桴
邓慧
Tan Mei;Deng Huiying;Yang Huabin;Chen Ye;Li Yingjie;Zhong Fu;Deng Hui(Department of Nephrology,Guangzhou Women and Children Medical Center,Guangzhou 510210,China)
出处
《国际医药卫生导报》
2020年第21期3250-3253,共4页
International Medicine and Health Guidance News
关键词
感染后肾小球肾炎
儿童
肾病综合征
蛋白尿
补体C3
Post-infectious glomerulonephritis(PIGN)
Children
Nephrotic syndrome
Proteinuria
Complement C3
