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肾活检的指征和并发症

Authors
William L Whittier, MD
Stephen M Korbet, MD
Section Editors
Richard J Glassock, MD, MACP
Brad H Rovin, MD
Deputy Editor
John P Forman, MD, MSc
Translators
董德鑫, 副主任医师

引言.

可行经皮肾活检的原因有很多，包括确立准确的诊断、有助于确定推荐的治疗性质、协助做出治疗是否无效的决定、确定活动性(即潜在可逆的)和慢性(即不可逆的)病变的程度[1,2]。活动性或慢性病变程度有助于判断预后和对治疗有反应的可能性。此外，肾活检也可帮助评估遗传病。

单纯依据肾脏病理的预后评估可受到取样大小的影响(特别是局限性病变)，并且在含有少数(即≤5个)肾小球的活检中可能不是很准确，认识到这点很重要。肾活检的结果总是需要结合临床和实验室特征进行解读。例如，慢性病变(间质纤维化及肾小管萎缩)是既往损伤程度和持续时间的一种征象。

本专题概述了与经皮肾活检相关的问题，对非经皮肾活检技术也进行了讨论。

概述

经皮肾活检的常规评估涉及光镜下的组织检查、免疫荧光检查(在一些实验室里也用免疫过氧化物酶技术[3])和电子显微镜技术。评估中每项检查都可以提供重要的诊断信息。(关于具体疾病病理发现的讨论参见相应专题。)活检标本的常规免疫荧光检查应包括(至少包括)评估IgG、IgM、IgA、C3、C1q、白蛋白、纤维蛋白和免疫球蛋白κ和λ轻链。特殊检查包括血清淀粉样蛋白A沉积、IgG亚类(IgG1-4)和胶原蛋白链(α3、4和5)的评价，在某些可用的情况下这些检查会有帮助。 (参见“薄基底膜肾病(良性家族性血尿)”和“遗传性肾炎(Alport综合征)的遗传学、发病机制及病理学”)

关于电子显微镜常规应用的依据主要来自20世纪60年代和70年代的研究，这些研究表明这项技术在接近50%的病例中都提供了大量的通过光学显微镜无法获得的诊断信息。然而，大部分研究是在免疫荧光显微镜没有得到广泛应用的时候开展的。

                     

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Literature review current through: 2017-06 . | This topic last updated: 2016-07-22.
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