The Clinical And Pathological Analysis Of The93Cases Of Nephrotic Syndrome In Yan’an

【Objectives】The first objective of this study is to present the epidemiologicalcharacteristics and the relationship between constrction of pathological type and theclinical manifestations; second, to reveal the significance of renal biopsy in the diagnosisof nephrotic syndrome by analyzing the93cases of nephrotic syndrome in Yan’an.【Methods】The subjects coming from the nephrology department of affiliated hospitalof Yan’an University, who were diagonosed as the nephrotic syndrome. The period lastedfrom January2011to January2013. At the same time, they were required to do the renalbiopsy by the leading of B ultrasonic or ultrasonography with the help of AmericanBart automatic biopsy gun. Theses samples were sent to the pathology department ofChinese Medicine Hospital of Shaanxi Province to do the examnination of lightmicroscopy and electron microscopy. In addition, by the classification of the all thepathology, it suggests that all the patients of membranous nephropathy be HBVspecialized coloured.【Results】During the2years, there were93patients diagnosed as the nephroticsyndrome with the renal biopsy. The number of femeale and male patients is38and55respectively, accounting40.90%and59.10%. The ratio of male and female is1.45:1. Thescale of the age is from16to79with the average age38.7±15.2. The young occupy46cases (with the age≤35), the middle age,39cases (with the age between36-59) and theold8cases(with the age≥60). Among all the cases, there are72cases of primarynephrotic syndrome, accounting77.42%of the93cases. The distribution of thepathological type is membranous nephropathy (28cases,30.10%), mesangialproliferative glomerulonephritis (26cases,28.45%), minimal change disease (6cases,6.45%), focal segmental glomerulosclerosis(5cases,5.37%), immunoglobulin Anephropathy (4cases,4.30%), endocapillary proliferative glomeru-lonephriti (2cases, 2.15%), and mesangial proliferative glomerulonephritis (1cases,1.07%). The secondarynephrotic syndromen has21cases,22.58%. The pathological types are HBV associatedglomerulonephritis (9cases,9.68%), lupus nephritis and diabetic nephropathy (both4cases,4.30%), gestational nephropathy (2cases,2.14%), allergic purpura nephropathyand amyloid degeneration of nephropathy (both1cases,1.07%). Of all the subjects inthis study (the number is93), there are39cases belonging to the primary type in theyoung group (the number is48). By the sort descending of the distribution ofpathological type, they are mesangial proliferative glomerulonephritis (16cases,34.8%),membranous nephropathy (13cases,28.2%), immunoglobulin A nephropathy (3cases,6.52%), minimal change disease (3cases,6.52%), focal segmental glomerulosclerosis(3cases,6.52%), endocapillary proliferative glomeru-lonephriti (1cases,2.17%). Thesecondary have7cases, namely, HBV associated glomerulonephritis (3cases,6.52%),gestational nephropathy (2cases,4.34%), lupus nephritis (1cases,2.17%), and diabeticnephropathy (1cases,2.17%). There are28cases of primary in the39cases of middleage patients. By the sort descending of the distribution of pathological type, they aremembranous nephropathy (12cases,30.7%), mesangial proliferative glomerulonephritis(9cases,23.1%), focal segmental glomerulosclerosis (2cases,5.1%), minimal changedisease (2cases,5.1%), immunoglobulin A nephropathy (1cases,2.56%), andendocapillary proliferative glomeru-lonephriti (1cases,2.56%). The secondary have11cases, by the sort descending of the distribution of pathological type, they are HBVassociated glomerulonephritis (5cases,12.8%), lupus nephritis (3cases,7.6%), diabeticnephropathy (2cases,5.1%), and allergic purpura glomeru-lonephriti (1cases,2.56%).The number of old patients is8. The distribution is membranous nephropathy (3cases,37.5%), amyloid degeneration of nephropothy (1cases,12.5%), diabetic nephropathy (1cases,12.5%), HBV associated glomerulonephritis (1cases,12.5%), minimal changedisease (1cases,12.5%), and mesangial proliferative glomerulonephritis (1cases,12.5%).The level2of immunoglobulin A nephropathy has2cases, with level3and level4bothhaving1cases. The IV, V and V+III type of lupus nephritis has2case,1case, and1caserespectively (ISN/RPS,2003). The result of4cases of HBV markers of negativemembranous nephropathy which were specialized coloured by HBV is negative. Amongthe4cases, there are one case which has biopsy by hepatic tissue presents the particles of HBV in the hepatic tissues.【Conclusions】1. Most of the nephrotic syndrome in Yan’an is the primary, which is similar to thedomestic cover; the pathological types mainly come from membranous nephropathy,mesangial proliferative glomerulonephritis, and minimal change disease; the secondarymainly covers HBV associated glomerulonephritis which are all the secondarymembranous nephropathy and the second type is diabetic nephropathy; it is ofsignificance (to some extent) to specially colour the HBV anyigen for the patients whohas negative response with the HBV serum makers in the process of pathology. If thecondition allows, it is necessary to do the hepatic tissue biopsy in order to diagnosedexplicitly.2. Among all the patients in this study, the male cover more than female; in addition,the young cover more than the middle age and the old. The distribution of thepathological type of the young is membrane proliferative glomerulonephritis,membranous nephropathy which occupy more than other types. For the middle age, thetypes are membranous nephropathy, membrane proliferative glomerulonephritis, andHBV associated glomerulonephritis; for the old, the types are membranous nephropathy,amyloid degeneration, diabetic nephropathy.3. The examination of the biopsy of kidney can supply the diagnosis of morphologyof tissue with the pathology and observation of ultramicro tissues for patients withnephrotic syndromen, which is beneficial to clarify the clinical-pathological type of thepatients. The diagnosis of kidney diseases should cover3diagnostic levels: clinical,pathological, and functional.