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目的探讨持续性单纯性蛋白尿患儿肾脏临床与病理特点。方法对31例单纯性蛋白尿且持续3个月以上的患儿进行肾组织活检。依据检测结果分别使用泼尼松、霉酚酸酯及雷公藤多甙等治疗,均口服潘生丁,按疗程治疗后随访1～6年。结果 31例肾活检病理组织学检查:微小病变2例,轻微病变8例,系膜增生性肾炎13例,局灶节段肾小球硬化3例,局灶增生性肾炎5例。MsPGN中免疫病理分型IgA肾病(IgA GN)6例,IgM肾炎病(IgM GN)1例。中度系膜增生性肾炎4例和3例局灶节段肾小球硬化见间质小管病变。患儿经治疗后尿蛋白均转阴,其中初治泼尼松疗程<3个月12例中,3例随访中偶发蛋白尿,定性均不超过+;疗程>3个月者19例中,7例发现蛋白尿,定性均未超过++。结论持续性单纯性蛋白尿病因复杂,应尽早进行肾活检。消除蛋白尿仍以口服泼尼松治疗为主,患者病理改变为局灶节段肾小球硬化或IgA肾病在治疗上颇感棘手,对局灶节段肾小球硬化病例以及在随访中蛋白尿频繁者建议在隔日口服泼尼松基础上联用霉酚酸酯。
Objective To investigate the clinical and pathological features of kidney in patients with persistent simple proteinuria. Methods Thirty-one patients with simple proteinuria who had more than 3 months of age underwent renal biopsy. According to the test results were used prednisone, mycophenolate mofetil and Tripterygium glycosides and other treatment, are oral dipyridamole, according to the treatment of follow-up of 1 to 6 years. Results 31 cases of renal biopsy histopathological examination: minimal change in 2 cases, slight lesions in 8 cases, mesangial proliferative glomerulonephritis in 13 cases, focal segmental glomerulosclerosis in 3 cases, focal proliferative glomerulonephritis in 5 cases. MsPGN immunopathological classification IgA nephropathy (IgA GN) in 6 cases, IgM nephritis (IgM GN) in 1 case. Mesangial proliferative glomerulonephritis in 4 cases and 3 cases of focal segmental glomerulosclerosis, interstitial tubulopathy. Urine protein was negative in children after treatment, of which 12 cases of prednisolone treatment <3 months, 3 cases of occasional proteinuria follow-up, qualitative no more than +; treatment> 3 months in 19 cases, 7 cases found proteinuria, qualitative no more than ++. Conclusions The causes of persistent simple proteinuria are complex and renal biopsy should be performed as early as possible. Elimination of proteinuria is still dominated by oral prednisone, pathological changes in patients with focal segmental glomerulosclerosis or IgA nephropathy in the treatment of quite difficult, focal segmental glomerulosclerosis cases and in the follow-up of protein Frequent urines suggest oral mycophenolate on the basis of oral prednisone on alternate days.