A 10-year Retrospective Analysis Of Urinary System Disease In Hospitalized Children

Objective:1.To investigate the epidemiological features and observe the change of the spectrum of pediatric urinary system disease in recent 10 years and provide the emphasis of the prevention and cure for the clinical work in future. 2.To investigate the epidemiological and clinical features of nephrotic syndrome. 3.To analyze the clinicopathologic features of 170 cases of percutaneous renal biopsy-proven glomerular disease particularly IgA nephropathy and provide the information for the clinical work to scienctifically diagnosing and curing the disease.Methods:1.The data of case history, which was the main pediatric urinary system disease over a period of 10-year between 1999 and 2008, was statistically analyzed and described. The decade of 1999～2008 was divided into two periods of 1999～2003 and 2004～2008. 2.The retrospective analysis of 170 cases of renal biopsy with glomerular disease and the clinical classification, pathological grading, immunoflu- orescence typing of IgA nephropathy was performed.Results:1.Nephrotic syndrome(56.8%) was the most common type of the main pediatric urinary system disease in recent 10 years, followed by Henoch-Schonlein purpura nephritis (26.8%). 2.In a comparison between two 5-year intervals of 1999～2003 and 2004～2008, the constituent ratio of the main urinary system disease had changed with the acute glomerulonephritis dramatically decreased from the third to the sixth position and nephrotic syndrome, Henoch-Schonlein purpura nephritis and IgA nephropathy increased. 3.Pre-school and school age children with nephrotic syndrome were both common and the prevalence of patients from village were much higher than in the city. The most common causes of nephrotic syndrome were upper respiratory infection and tonsillitis and the mean hospitalized time decreased from 31.1±12.4 days in 1999 to 14.5±10.0 days in 2008. 4.Primary glomerular disease was the most common type of the 170 renal biopsies and IgA nephropathy(49.2%), minor lesion and minimal change disease(each account 10.9%) were the main pathologic forms. Nephrotic syndrome was the most common form of the clinical manifestation of primary glomerular disease and IgA nephropathy(49.3%), minimal change disease(20.9%), focal segmental glomerulosclerosis(7.5%) were on the first three position of the pathologic forms. 5. The most common clinical manifestation among 63 children with IgA nephropathy was nephrotic syndrome and the most common pathologic grade was gradeⅢwith the nephrotic syndrome gradeⅢandⅣ, the isolated hematuria gradeⅡandⅢ. The type of IgA+IgG+IgM was the main immunofluorescence type. Conclusions:1. Nephrotic syndrome was the most common type of the pediatric urinary system disease in recent 10 years, followed by Henoch-Schonlein purpura nephritis. The two kind of disease are the emphasis of the prevention and cure in future. The spectrum had changed with the incidence of acute glomerulonephritis dramatically decreased. 2.In nephrotic syndrome, the hospitallized days obviously decreased and most cases were sensitive to adrenal cortical hormone. The key steps of controlling recrudescence are positively preventing and treating infection and elevating the immunity. 3. Primary glomerular disease was the most common type of the renal biopsies. The most common form of the clinical manifestation was nephrotic syndrome and of the pathologic forms was IgA nephropathy. 4. The detection rate of IgA nephropathy had gradually increased along with the development of renal biopsy. In IgA nephropathy, clinical manifestation was multiple, gradeⅢand the deposition of IgA+IgG+IgM were the most common in pathologic change and the serious extent of proteinuria was correlated with the renal pathologic change.