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題名 | The Role of Percutaneous Renal Biopsy in the Diagnosis and Management of Renal Diseases in Children=經皮腎臟切片於小兒腎臟疾病診斷與治療的角色 |
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作者 | 黃富源; 蔡淳娟; 蔡政道; Huang, Fu-yuan; Tsai, Tsuen-chiuan; Tsai, Jeng-daw; |
期刊 | 中華民國小兒科醫學會雜誌 |
出版日期 | 19980100、19980200 |
卷期 | 39:1 民87.01-02 |
頁次 | 頁43-47+71 |
分類號 | 417.6252 |
語文 | eng |
關鍵詞 | 腎臟切片; 腎病症候群; 腎衰竭; 血尿; Renal biopsy; Nephrotic syndrome; Renal failure; Hematuria; |
中文摘要 | 本回溯性設計乃研究腎臟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次腎臟切片,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%)人可見腎周圍血腫。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,診斷沒有改變為0分;診斷確認或排除某腎臟疾病為1分;診斷改變或提供 預後為2分。在治療方面,沒有改變為0分;確認臨床診斷,且改變治療為1分;診斷與治 療均改變為2分。在106次的切片中,共有2位(1.9%)病童其診斷獲益分數為0分;78 位(73.6%)為1分;26位(24.5%)為2分。共有62位(58.5%)其治療獲益分數為0分; 24位(22.6%)為1分;20位(18.9%)為2分。改變治療者最多為類固醇抵抗性腎病症候 群(steroid resistant nephritic 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併蛋白尿的病人,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。我們因此認為,小兒腎臟切片是一種安全而有效 的檢查方法,它可明顯的改變臨床診斷與治療,而提供小兒腎臟疾病更合理治療的可能性。 |
英文摘要 | 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 fount the benefit score for diagnosis was 0 in 2 ( 1.9% ) of the 106 biopsied cases; 1 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 nephritic syndrome and systemic diseases with renal involvement, and occasionally occurred in frequent relapsing nephritic syndrome, steroid dependent nephritic syndrome and asymptomatic proteinuria plus hematuria. It never occurred in patients with acute or chronic renal failure and hematuria. 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. |
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