小儿血尿343例病因分析及随访观察

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目的探讨小儿血尿的病因及随访病情转归.方法对2010年1月1日至2011年6月30日以血尿为主要表现收治入院的343例患儿的病因进行回顾性分析,并随访1年观察病情转归.结果343例患儿中肾小球性血尿232例(67.6%),非肾小球性血尿111例(32.4%).在232例肾小球性血尿中,以孤立性血尿(52例,15.2%)、迁延性肾小球肾炎(37例,10.8%)、急性肾小球肾炎(37例,10.8%)最常见.而在非肾小球性血尿中,以泌尿系感染最常见(75例,21.9%),少见病因包括髓质海绵肾(1例,0.3%),肾母细胞瘤(1例,0.3%).40例肾小球性血尿患儿行肾穿刺活组织检查,提示IgA肾病29例,系膜增生性肾小球肾炎6例,膜性肾病1例,局灶性节段性肾小球肾炎1例,微小病变型3例.1年随访期结束,在52例孤立性血尿患儿中,血尿消失者28例,占53.8%,无肾功能不全.结论小儿血尿病因复杂多样,以肾性血尿居多,其中孤立性血屎、迁延性肾小球肾炎和急性肾小球肾炎最常见;而泌尿系感染仍是非肾性血尿的主要原因.对于孤立性血尿患儿,肾活检在指导治疗及预后方面作用有限,要严格掌握肾活检的适应症,而长期随访是关键.“,”Objective: To investigate the etiology of hematuria in children and folow up the outcome.Methods: Retrospective analysis and folow-up for 343 cases of children with hematuria admitted to hospital from January 2010 to June 2011. Results: 343 cases included 232 cases of glomerular hematuria(67.6%)and non- glomerular hematuria(32.4%). In 232 cases of glomerular hematuria, the most common types were isolated hematuria(52 cases, 15.2%), persistent glomerulonephritis (37 cases,10.8%) and acute glomerulonephritis(37 cases, 10.8%). While In 111 cases of non-glomerular hematuria, the most common type was urinary infection(75 cases, 21.9%), and uncommon types included medulary sponge kidney(1 case, 0.3%) and nephroblastoma(1 case, 0.3%). Renal biopsy was performed in 40 children with glomerular hematuria. The pathological types included 29 cases of IgA nephropathy, 6 cases of mesangial proliferation glomerulonephritis, 1 case of membranous glomerulopathy, 1 case of focal segmental glomerulonephritis and 3 cases of minimal change glomerulopathy. At the end of the folow-up period, of 52 cases with isolated hematuria, 28 were free from hematuria.Conclusion: Our data demonstrate that the etiology of hematuria in children was complex as wel as various, and the children with glomerular hematuria were in the majority. The most common types of glomerular hematuria were isolated hematuria, persistent glomerulonephritis, acute glomerulonephritis. Urinary infection was stil the main cause of non-glomerular hematuria. Renal biopsy was not indicated for its limited value in treatment and prognosis of children with isolated hematuria. Folow-up in a long time was the key point.
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