1,559례의 소아 신생검에 대한 고찰:단일기관 연구
Analysis of 1559 Kidney Biopsies:A Single Center Study
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목 적 : 신장 조직검사를 시행한 소아 환자들의 신질환의 유형을 분석하여 신장 생검과 임상분야의 관계에 대해 고찰하였다. 방 법 : 1984년부터 2005년까지 22년간 경희대학교 의과대학 부속병원 소아과에서 신 생검을 시행한 2021례의 신 생검 중에서 열람이 가능하였던 1559명의 의무기록 열람을 통한 후향적 조사를 실시하였다. 결 과 : 남녀 비는 1.3:1이었고 평균 연령은 10세이었다. 신 생검을 하게 된 주증상으로는 단독 혈뇨가 751(48.2%)례, 단독 단백뇨가 125(8.0%), 단백뇨를 동반한 혈뇨가 535(34.3%)례였다. 조직 병리학적으로는 원발성 사구체신염이 75.4%로 각각 IgA 신염이 전체의 29.9%, 메산지움 증식성 사구체신염 27.6% 이었고 전신성 질환에 의한 이차적 사구체 신염은 11.4%로 각각 Henoch- Shönlein 자반증성 신염이 전체의 10.5%, 루프스 신염 0.8% 이었다. Alport 증후군이 1.1%로 유전성 신염에 속하였다. 결 론 : IgA 신염과 메산지움 증식성 사구체신염은 소아에 있어서 많은 비중을 차지하는 사구체 신염이다.
Abstract
Purpose : To analyse the results of the renal biopsies and the clinical diagnoses of patients who had undergone percutaneous kidney biopsies in the department of pediatrics at Kyunghee University Hospital for 22 years from 1984 to 2005. Methods : We retrospectively reviewed the medical records of 1559 patients and analyzed the chief complaints that led to a renal biopsy, age, sex, histopathologic findings and diagnosis. Routine kidney biopsies were performed by automated gun biopsy guided by real time ultrasonography. The diagnoses were made based on the specimen's light microscopy, immunofluorescence microscopy and electron microscopy findings and clinical symptoms and signs. Results : The mean age of the patients was 10 years with the male to female ratio being 1.3:1. The chief complaints that led to a renal biopsy included hematuria only(753 cases, 48.3%), proteinuria only(125 cases, 8.0%) and hematuria combined with proteinuria(537 cases, 34.4%). The most frequent histopathological finding was primary glomerular disease(75.4%) which included IgA nephropathy(30.1%) and mesangial proliferative glomerulonephritis(27.6 %). Systemic disease comprised 11.4% which included Henoch-Shönlein nephritis(10.5%) and lupus nephritis(0.8%). Alport syndrome was found in 1.1% of cases which was attributed to hereditary causes. 628 children(40.3%) visited the clinic due to abnormal school urine screening abnormalities and among these, 237 children had mesangial proliferative glomerulonephritis and 234 children who had IgA nephropathy were managed thereafter. Conclusion : IgA nephropathy and mesangial proliferative glomerulonephritis were the two major forms of primary glomerulonephritis found in Korean children who had kidney biopsies from 1984 to 2005.
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