34例儿童IgM肾病临床与病理分析

Clinical-pathological characteristics of IgM nephropathy in 34 children

摘要:

目的：探讨儿童IgM肾病临床及肾组织病理的特点。方法：收集整理2008年4月至2009年8月郑州大学第一附属医院儿内科34例IgM肾病患儿病例，对其临床表现及肾组织病理进行分析。结果：34例IgM肾病临床表现为肾病综合征的患儿22例（64.7％）；病理改变类型：微小病变12例（35.3％），微小病变伴急性肾小管损伤3例（8.8％），轻微病变6例（17.6％），轻微病变伴缺血性损伤1例（2.9％），系膜增生型7例（20.6％），局灶节段硬化型4例(11.8％)，局灶增生型1 例(2.9％)；肾小球、肾血管及肾脏病理损害总积分随肾组织IgM沉积度增强而增加。结论：本组IgM肾病患儿大多临床表现为肾病综合征， 肾组织学病理类型多样,病理特点以系膜区IgM沉积为主，肾组织IgM沉积强度与肾脏病理损害程度有关。［中国当代儿科杂志，2010，12（5）：338-340］

Abstract:

OBJECTIVE: To investigate the clinicalpathologic characteristics of IgM nephropathy in children. METHODS: The data of 34 children with IgM nephropathy from the First Affiliated Hospital of Zhengzhou University were retrospectively reviewed. RESULTS: Of the 34 cases of IgM nephropathy, nephrotic syndrome (NS) was clinically presented in 22 cases (64.7%). The renal pathological classification was as follows: minimal change disease (12 cases, 35.3%), minimal change disease with acute renal tubular injury (3 cases, 8.8%), minimal change glomerulonephritis (6 cases, 17.6%), minimal change glomerulernephritis with ischemic renal injury (1 case, 2.9%), mesangial proliferative glomerulonephritis (7 cases, 20.6%), focal segmental glomerulosclerosis (4 cases, 11.8%), focal proliferative glomerulernephritis (1 case, 2.9 %). Glomerular injury score, renal vascular injury score and total renal injury score increased with the increasing IgM deposition. CONCLUSIONS: The majority of children with IgM nephropathy manifest clinically as nephrotic syndrome. The patterns of renal pathology may be varied in children with IgM nephropathy. IgM deposition in the mesenteric area is an important pathologic feature and is related to the degree of renal injury.［Chin J Contemp Pediatr, 2010, 12 (5):338-340］