摘要
目的通过对12例进展型(重症)IgA肾病患者临床和病理资料的分析,试图发现IgA肾病进展的危险因素。方法选取我院近年来行肾穿刺活检时即出现肾功能减退和(或)随访过程中肾功能进行性减退的IgA肾病患者12例进行分析。结果12例患者中就诊原因分别为眼睑、下肢水肿,尿中泡沫增多或反复发作无痛性肉眼血尿或体检发现蛋白尿和(或)高血压及肾功能减退。病程20天~9年,平均病程3年。所有患者均有蛋白尿、其中肾病综合征5例;病程中反复发作肉眼血尿5例,其中伴肾病综合征和大量蛋白尿3例;蛋白尿+镜下血尿6例。肾功能损害轻度~重度,CKD(慢性肾脏疾病)1~4级;Ccr94ml/min^25.9ml/min;病理所见均为IgANⅣ级,以增生、硬化及新月体为主。完全缓解1例,进展为终末期肾衰竭2例,部分缓解3例,1例5年前肾活检时肾功能基本正常,病理改变较轻,失访5年后再次就诊时肾功能已减退,其余病例正在治疗随访中。结论部分IgA肾病患者病情进展迅速,尤其是反复发作肉眼血尿伴大量蛋白尿和(或)肾病综合征(NS)及免疫复合物在血管襻沉积者,可能是IgA肾病进展的危险因素。一旦确诊,应根据病理所见进行相应的免疫抑制治疗。积极治疗可以有效的控制IgA肾病的进展。
Objective To discover the risk factors of the progression of IgA nephropathy by analyzingthe clinical and pathological data. Methods Twelve patients with IgA nephropathy were analyzed, who were discovered renal failure when doing renal biopsy or during the follow-up. Results The reasons for the 12 patients to visit doctors of were as follows：edema of the legs or eyelids,increased urinary bubble, recurrent painless macrohaematuria and proteinuria with （or without） hypertension and renal failure after the health examination. The course was from 20 days to 9 years, and the average course was 3 years. All the 12 patients had proteinuria,including 5 cases with nephritic syndrome,5 cases with recurrent macrohaematuria（3 cases with nephritic syndrome and proteinuria meanwhile） ,and 6 cases with both proteinuria and microscopic hematuria. Their renal function insufficiency were mild or severe, with stage 1-4of CKD and Ccr from 94 to 25.9 ml/min. The pathological diagnosis were all IgA nephropathy Ⅳ periods, which were predominantly hyperplasia, sclerosis and crescentic glomerulonephritis. One case was complete remission, two cases had developed to the end - stage renal faiure, cases were partial remission. The renal function of one case was almost normal five years ago, and the pathological changes were mild, after 5-year lost follow-up visit it was diagnosed renal dysfunction. The others were treating or following-up. Conclusion Some of IgA nephropathy are with a rapid progress. So once diagnosed ,give an appropriate immunosuppressive therapy according to the pathological diagnosis. Aggressive treatment can control the progress of IgA nephropathy effectively.
出处
《临床内科杂志》
CAS
2006年第11期734-736,共3页
Journal of Clinical Internal Medicine
关键词
IGA肾病
进展
预后
IgA nephropathy
Prognosis
Progression
