【摘要】 目的 通过分析6例左肾静脉压迫综合征合并IgA肾病患者的临床资料,提高临床医师对于左肾静脉压迫综合征合并IgA肾病的认识和诊治水平。方法 回顾性分析2012年1月至2014年1月我院的6例左肾静脉压迫综合征合并IgA肾病患者的临床资料。6例左肾静脉压迫综合征患者均由左肾静脉彩色多普勒诊断,其中1例患者同时行CT血管三维成像(computed tomography angiography,CTA)诊断;记录患者的性别、年龄、身高、体质量、尿常规、24 h尿蛋白定量、血常规、血肌酐、血白蛋白、血尿酸、补体C3、肾活检病理类型及影像学资料等。结果 6例患者均为男性,平均年龄(16.5±4.3)岁,平均体质量指数(body mass index,BMI)为17.8±1.3,以血尿、蛋白尿、腰痛为主要临床表现。病理级别为LeeⅠ级~LeeⅢ级;6例患者中1例患者为LeeⅠ级,4例患者为LeeⅡ级,1例患者为LeeⅢ级;1例患者有细胞性新月体形成(占肾小球总数比例的5.9%),1例患者有肾小球球性硬化(占肾小球总数比例的14.3)%。6例患者均有不同程度系膜增生(轻度~中度)及轻度肾小管萎缩、肾小管纤维化,所有患者均无间质血管炎;2例患者有间质灶性炎细胞浸润;免疫荧光检测,6例患者均有不同程度系膜区IgA沉积(++~+++)、IgG沉积(++)及补体C3沉积(+~++),6例患者均无系膜区IgM沉积。结论 对于BMI偏低的儿童和青少年出现血尿和(或)蛋白尿,行左肾静脉彩色多普勒检查和仰卧位/站立位尿液检查不仅有助于明确诊断,还有助于指导治疗,避免过度医疗。更多还原

【Abstract】 Objective To improve the ability of clinicians in diagnosis of left renal velncntrapment syndrome complicated with IgA nephropathy through analyzing the clinical data of patients.Methods Clinical data of six cases of left renal velncntrapment syndrome complicated with IgA nephropathy were analyzed retrospectively.Left renal velncntrapment syndrome was diagnosed by Doppler sonography and one case was also by computed tomography angiography(CTA).IgA nephropathy was diagnosed by renal biopsy.The clinical data,including age,sex,height,body mass,urinary protein,blood routine,serum creatinine(SCr),albumin(Alb),serum uric acid,complement C3,renal pathologic category and images,were analyzed in all 6 patients.Results All 6 patients were male with a mean age of(16.5 ± 4.3) years old.The body mass index(BMI) was 17.8 ± 1.3.Clinical presentation included proteinuria,haematuria and loin pain.Pathologic evaluation revealed Lee Ⅰ~Lee Ⅲ IgA nephropathy;one patient was Lee Ⅰ,four patients were Lee Ⅱ,one patient was Lee Ⅲ;One patient had cellular crescent(5.9%of total glomerular),one patients had glomerular sclerosis(14.3%of total glomerular).All 6 patientsexhibited mild to moderate mesangialhypercellularity,mild tubular atrophy,and mild tubular fibrosis,All 6 patients had no interstitial vasculitis;two patients had focal interstitial inflammation.In immunohistochemistry;all 6 patients showed dominant positive staining for IgA(++ ~ +++),IgG(++),and C3(+ ~++) in the mesangium,IgM was not found in all patients.Conclusions Supine/standing urinalysis combined with Doppler sonography should be considered in patients who are adolescents with low BMI manifesting intermittent proteinuria and/or haematuria,which can be helpful for differential diagnosis and treatment to avoid over-treatment.更多还原