Renal biopsy criterion in idiopathic nephrotic syndrome with microscopic hematuria at onset
Renal biopsy criterion in idiopathic nephrotic syndrome with microscopic hematuria at onset
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起病时镜下血尿的特发性肾病综合征肾活检标准
DOI：
10.1007/s00467-014-2946-9
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发表时间：
2015
期刊：
影响因子：
3
通讯作者：
Yoshikawa N
中科院分区：
文献类型：
--
作者：
Hama T;Nakanishi K;Shima Y;Sato M;Mukaiyama H;Togawa H;Hamahira K;Tanaka R;Kaito H;Nozu K;Iijima K;Yoshikawa N
背景对发病时有镜下血尿的特发性肾病综合征（NS）患儿进行肾活检的标准仍有争议。尿沉渣中最大红细胞（RBC）范围的最佳临界值，以分离微小病变疾病（MCD）通过受试者工作特征分析获得与其他肾小球变化的关系。我们研究了29例NS患儿，这些患儿从2001年1月至2011年9月期间接受肾活检的1，320例患者中筛选出血尿。根据临界值将患者分为两组，以验证其validity.ResultsThe最佳的最大RBC范围是30-49/高倍视野（HPF）。第1组（RBC ≤29/HPF，n= 14）中，3例患者出现肾炎，11例患者出现MCD。第2组（RBC ≥30/HPF，n= 15）中，1例表现为局灶节段性肾小球硬化，12例表现为肾炎，2例表现为MCD。结果表明，非MCD/MCD比值在第2组明显高于第1组（P< 0.01）。结论以最大RBC范围（30-49/HPF）作为NS血尿患者肾活检的标准，在临床上是合理的。
BackgroundThe criterion for performing a renal biopsy in children with idiopathic nephrotic syndrome (NS) showing microscopic hematuria at onset remains controversial.MethodsTo determine an adequate renal biopsy criterion in children with NS showing hematuria, the optimal cutoff for the maximum red blood cell (RBC) range in urine sediment to separate minimal change disease (MCD) from other glomerular changes was obtained by receiver operating characteristic analysis. We studied 29 children with NS showing hematuria who were screened from 1,320 patients who underwent renal biopsies between January 2001 and September 2011. Patients were divided into two groups according to the cutoff value to verify its validity.ResultsThe optimal maximum RBC range was 30–49/high-power field (HPF). In group 1 (RBC ≤29/HPF,n= 14), 3 patients showed nephritis and the other 11 patients showed MCD. In group 2 (RBC ≥30/HPF,n= 15), 1 patient showed focal segmental glomerulosclerosis, 12 showed nephritis, and the other 2 showed MCD. These findings indicated that the ratio of non-MCD/MCD was significantly higher in group 2 than in group 1 (P< 0.01).ConclusionsThe use of maximum RBC range (30–49/HPF) for a criterion of renal biopsy in patients with NS showing hematuria may be reasonable for clinical practice.