A Review of Paediatric Renal Biopsies in Hong Kong

Abstract

To study the role of renal biopsy in the evaluation of childhood glomerular diseases, we undertook a retrospective review of 150 renal biopsies performed for Chinese children below 16 years of age in nine major public hospitals in Hong Kong from January 1, 1991 to December 31, 1993. Among 75 children biopsied for nephrotic syndrome, pathological diagnosis included minimal change disease (MCD) (37), diffuse mesangial proliferation (DMP) (13), hepatitis B virus (HBV)-membranous nephropathy (7), focal segmental glomerulosclerosis (FSGS) (6). Diseases other than MCD-DMP-FSGS spectrum were diagnosed in 19 cases and all except 2 occurred in children presenting with nephritic-nephrotic features, positive serology for HBV, or steroid resistance. In 21 patients biopsied for persistent isolated hematuria, IgA nephropathy, Alport's syndrome, benign hematuria and proliferative endocapillary GN were diagnosed respectively in 10, 4, 6, and 1 patients. In 16 patients biopsied for persistent hematuria and proteinuria with or without other nephritic features, IgAN(5), proliferative endocapillary GN(5) and various other nephropathies(6) were found. Overall, the commonest primary glomerulonephritis were minimal change disease (MCD) (25%), IgA nephropathy (11%), and diffuse mesangial proliferation (DMP) (9%), while the commonest secondary glomerulonephritis were lupus nephritis (16%) and Schonlein-Henoch purpura (9%). The data showed local paediatric nephrologists performed renal biopsies only on selected patients and this was helpful in their diagnosis and treatment.

為研究腎臟活組織檢查在評估兒童腎小球疾病中的作用，本文對1991年1月1日至1993年12月31日間，香港地區九間主要公立醫院所做150例16歲以下中國兒童腎組織活檢進行回顧性研究。在75例腎病綜合症中，微小病變型佔37例，彌漫性膜性增殖型佔13例，乙型肝炎膜性腎病7例，灶性節段性腎小球硬化6例，其他19例。此19例中，除2例外，其它17例皆表現為腎炎型腎病特徵、乙型肝炎病毒血清原陽性或激素依賴。21例持續性孤立性血尿病兒中，IgA腎病10例，Alport's 綜合症4例，良性血尿6例，增殖性毛血管內腎炎1例。16例持續性血尿、蛋白尿病兒中，IgA腎病5例，增殖性毛細血管內腎炎5例，其他腎病6例。總之，最常見的原發性腎小球腎炎為微小病變型(佔25%)，IgA腎病(佔11%)，彌漫性膜性增殖型(佔9%)，其次為狼瘡性腎炎(佔16%)和紫瘕性腎炎(佔9%)，本組資料表明本地兒科腎臟病學者們為幫助診斷和治療而選擇性對病人實施腎活組織檢查