儿童肾小球疾病的评估
- Author
- Patrick Niaudet, MD
Patrick Niaudet, MD
- Section Editor — Pediatric Nephrology
- Professor of Pediatrics
- Hôpital Necker-Enfants Malades, Paris, France
- Section Editor
- F Bruder Stapleton, MD
F Bruder Stapleton, MD
- Editor-in-Chief — Pediatrics
- Section Editor — Pediatric Nephrology
- Professor and Chair, Department of Pediatrics
- University of Washington School of Medicine
- Deputy Editor
- Melanie S Kim, MD
Melanie S Kim, MD
- Senior Deputy Editor — UpToDate
- Deputy Editor — Pediatrics
- Boston University School of Medicine
- Translators
- 唐政, 主任医师，教授
唐政, 主任医师，教授
- 南京军区南京总医院肾脏病科
引言
多种病因可导致儿童肾小球疾病。其中，许多疾病的表现不一，轻则仅有轻微的症状或没有症状，而严重的肾脏疾病可出现危及生命的并发症。因此，儿童中特定肾小球疾病的诊断具有挑战性但非常重要，这样就可以开展有益且必要的治疗。
本文将总结儿童肾小球疾病的诊断性评估。非肾小球原因引起的儿童孤立性血尿或蛋白尿的评估将单独讨论。 (参见“儿童镜下血尿的评估”和“儿童肉眼血尿评估”和“儿童蛋白尿的评估”)
概述
许多原发性疾病(仅为肾脏疾病)和继发性疾病(由于系统性自身免疫性疾病、血管炎或感染)都可导致肾小球疾病(表 1)。将儿童期肾小球疾病分为两大临床类型(尽管一些疾病可能存在重叠)是有用的，这样能使评估集中于最有可能的基础疾病上。初始评估确定肾小球疾病的类型，而第二阶段的评估则取决于已确定的肾小球疾病的初始类型(肾炎型或肾病型)。
- 肾炎型患者的组织学检查有炎症表现，尿沉渣镜检有活动性发现(包括红细胞、白细胞、颗粒，通常有红细胞管型及其他细胞管型)，并存在不同程度的蛋白尿。 (参见“儿童肾小球肾炎发病机制和病因的概述”和“链球菌感染后肾小球肾炎”)
- 肾病型患者的组织学检查无炎症表现，而是出现肾病范围蛋白尿，并且尿沉渣镜检有非活动性发现(仅有少量细胞或管型)。
这两种类型均可表现为急性或隐匿性起病，而且它们的某些表现可同时或相继出现于某些患者中。 (参见“肾小球疾病的鉴别诊断与评估”)
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