The Role of Percutaneous Renal Biopsy in the Diagnosis and Management of Renal Diseases in Children

經皮腎臓切片於小兒腎臓疾病診斷與治療的角色

黃富源(Fu-Yuan Huang) ； 蔡淳娟(Tsuen-Chiuan Tsai) ； 蔡政道(Jeng-Daw Tsai)

《Acta Paediatrica Sinica》 39卷1期 (1998/02) Pp. 43-47

https://doi.org/10.7097/APS.199802.0043

摘要

本回溯性設計乃研究腎臓切片後導致病人診斷與治療之改變的比例。自1992年四月至1997年六月，於本院共有109位病童共接受111次腎臓切片，其年齡在11月到18歲之間。共106(95.3%)次的切片得到適當的檢體。12(10.8%)次的切片造成巨視性血尿，超音波下8(7.2%)人可見腎週圍血腫。依診斷與治療之改變與否設計一分數分級系統。在診斷獲益方面，診斷沒有改變爲0分；診斷確認或拔除某腎臓疾病爲1分；診斷改變或提供預後爲2分。在治療方面，沒有改變爲0分；確認臨床診斷，且改變治療爲1分；診斷與治療均改變爲2。在106次的切片中，共有2位(1.9%)病童其診斷獲益分數爲0分；78位(73.6%)爲1分；26位(24.5%)爲2分。共有62位(58.5%)其治療獲益分數爲0分；24位(22.6%)爲1分;20位(18.9%)爲2分。改變治療者最多爲類固醇抵抗性腎病候群(steroid resistant nephrotic syndrome)與系統性疾病引發腎病的病人；於經常再發或類固醇依賴腎病症候群與無症狀血尿合蛋白尿的病人，則偶爾會有改變治療的情況；於急慢性腎衰竭與血尿的病患，則未有改變治療者。我們因此認爲，小兒腎臓切片是一種案例而有效的檢查方法，它可明顯的改變臨床診斷與治療，而提供小兒腎臓疾病更鴿合理的治療的可能性。

關鍵字

腎臓切片 ； 腎病症侯群 ； 腎衰竭 ； 血尿

並列摘要

We undertook a retrospective study to determine the proportion of patients in whom diagnostic and therapeutic changes were made as a result of renal biopsy. From April 1992 to March 1997, 111 renal biopsies were performed on 109 children aged 11 months to 18 years at our hospital. Adequate renal tissue was obtained in 106 cases (95.3%). Gross hematuria was observed in 12 cases (10.8%). Perirenal hematoma was found in 8 cases (7.2%) by ultrasound. A scoring system was designed to assess if diagnosis and therapy are affected as a result of renal biopsy. For diagnosis, the score was 0 when no additional information was obtained; 1 when the diagnosis was confirmed or ruled out; and 2 when the diagnosis was changed after biopsy or the pathologic findings provided a definite prognosis. For therapy, the score was 0 when the management was not changed after biopsy; 1 when the clinical diagnosis was confirmed and yielded a change in management; and 2 when the diagnosis and management were changed after biopsy. We found the benefit score for diagnosis was 0 in 2 (1.9%) of the 106 biopsied cases; I in 78 (73.6%), and 2 in 26 (24.5%). The benefit score for therapy was 0 in 62 (58.5%); 1 in 24 (22.6%); and 2 in 20 (18.9%). Therapeutic change always occurred in the biopsied patients with steroid resistant nephrotic syndrome and systemic diseases with renal involvement, and occasionally occurred in frequent relapsing nephrotic syndrome, steroid dependent nephrotic syndrome and asymptomatic proteinuria plus hematuria. It never occurred in patients with acute or chronic renal failure and hematuna. We conclude that renal biopsy is a safe and efficient procedure in pediatric patients. It can markedly change diagnosis and therapy, and can increase the likelihood for a more rational management of children with renal disease.

並列關鍵字

renal biopsy ； nephrotic syndrome ； renal failure ； hematuria