소아 신생검 환아의 임상 및 병리학적 고찰

Abstract

[한글]

소아 신질환 환아들 중에서 대부분은 임상소견상 신질환을 진단할 수 있지만, 때로는 임상적으로 진단하기 어려운 경우가 적지 않다.

이에 저자는 우리나라 소아에서 발생한 신질환 환자들 중에서 신생검 적응증에 해당되는 환아들을 선별하여 이들의 병리조직학적 소견에 근거를 둔 최종진단과 이중에서도 신증후군 환아들에 비하여 조직학적 분류와 검사소견을 비교관찰하여 병의 경과와 조직학적 분류에 따른 상관성을 알아보고자 하였다.

1978년 7월부터 1980년 6월까지 만 2년간 연세대학교 의과대학 부속 세브란스병원 소아과에 입원하였던 신질환 환아들 중신생검을 실시한 112예를 대상으로 임상 및 병리학적 소견을 분석 검토하여 다음과 같은 결과를 얻었다.

1. 대상환아 112예 중에서 남아가 78예, 여아가 34예로 남여비는 3.3:1이었고, 연령은 생후 3개월부터 10세까지였고, 그 중 7세에서 19예로 가장 많았다.

2. 신생검에 따른 최종진단을 임상적으로 분류한 바 신증후군 51예 (75.5%)로 가장 많았고, 신염군 47예 (42.0%), 급성신부전 6예 (5.4%) 기타가 8예 (7.1%) 였다.

3. 신증후군의 조직학적 소견으로는 미소변화형 (Minimal lesion)이 22예 (42.3%)로 가장 많고, Mesangial proliferative 사구체신염 14예 (26.9%), 자반병성신염 ( Purpura nephritis) 5예 ( 9.6%), 초점성사구체경화 (Foca1 glomerulo sclerosis) 4예 (7.7%), 막증식형사구체신영 (Membranopro1iferative glomerulonephritis) 3예 (5.8%), 막성사구체신염 (Membranous nephropathy) 3예 (5.8%), 그리고 미분류 (Unclaseified)가 1예 (1.9%) 이었다.

4. 혈뇨는 신증후군 대상환아의 21예 (47.7%)에서 관찰되었고, 사구체의 구조적 병변이 있는 막증식형사구체신염, Mesangial proliferative 사구체신염, 막성사구체신염 순으로 혈뇨의 빈도가 높았으며 미소변화형에서는 4예 (18.2%)에서 혈뇨를 보였다.

5. 고혈압은 신증후군 대상환아의 8예 (15.7%)에서 관찰되었고, 자반병성신염에 의한 신증후군에서는 관찰되지 않았으나, 특발성신증후군 중 사구체의 구조적 병변이 있는 신증후군에서 다소 그 빈도가 높았다.

6. 신기능 저하는 미소변화형에 비해 사구체의 구조적 병변이 있는 신증후군에서 다소 그 빈도가 높았다.

7. 혈청 Albumin 농도는 신증후군 대상환아의 40예 (78.4%)에서 2.5g/dl 이 하였으며, Mesangial Proliferative 사구체신염에서 7예, 미소변화형에서 3예, 그리고 막증식형사구체신염 1예에서 2.5g/dl 이상이었다.

8. 24시간 뇨단백양은 신증후군 대상환아의 32예 (63%)에서 2.0gm 이상의 중증 단백뇨를 보였으며, 0.5∼2.0gm의 중등 단백뇨가 13예(25%), 그리고 0.5gm이하의 경도 단백뇨가 6예(12%) 이었다.

9. 혈청 α^^2 -globulin 농도는 신증후군 대상환아의 22예 (43%)에서 증가하였으며 초 점성사구체 경화, 미소변화형, Mesangial proliferative사구체신염 순으로 증가되어 있었다.

Clinicopathological Study on Renal Biopsies in Children.

Choong Kil Chung

Department of Medioal Science, The Graduate School, Yonsei University

(Directed by Professor Duk Jin Yun, M.0.)

A clinical and pathologic study was made on 112 cases of renal biopsies in

children who were admitted to Severance Hospital, Yonsei University College of

Medicine, from June 1, 1978.to July 31, 1980.

The results are as follows :

1. Among 112 cases, 78 cases were male and 34 cases were female. The sex ratio of

male & female was 2.3 : 1. The age distribution was from 3 months to 16 years of

age, and the peak incidence occurred at 7 years of age in 19 cutes.

2. Clinical classfications of renal diseases were nephrotic syndrome 51 cases

(45.5%), niphritic syndrome 47 cases (42.0%), acute renal failure 6 cases (5.4%)

and miscellaneous 8 cases (7.1%).

3. Histopathological classifications of nephrotic syndrome were minimal lesion 22

cases (42.3%), mesangial proliferative glomerulonephritis 14 cases (26.9%), purpura

nepliritis 5 cases (9.6%), focal glomerulosclerosis 4 cases (7.7%),

membranoproliferative glomerulonephritis 3 cases (5.8%), membranous nephropathy 3

cases (5.8%) and unclassified 1 case (1.9%).

4. Hematuria was observed in 21 cases (44.7%) with neprhotic syndrome and in 4

cases (18.2%) with minimal lesion; it occurred in a higher proportion of patients

with structural glomerular abnormalities which were membranoproliferative

glomerulonephritis, mesangial profiterative glomerulonephritis and membranous

nephropathy than in those with minimal lesions.

5. Hypertension was observed in 8 cases (15.7%) with nephrotic syndrome; it

occurred in a slightly higher proportion of patients with structural glomerular

abnormalities than in those with minimal lesions and it was not observed in purpura

nephritis.

6. Renal insufficiency was observed in a slightly higher proportion of patients

with structural glomerular abnormalities than in those with minimal lesions.

7. Serum albumin concentration below 2.5g/dl was observed in 40 cases (78.4%)

with nephrotic syndrome and above 2.5g/dl in mesahgial proliferative

glomerulonephritis 7 cases, minimal lesion 3 cases, and membraous nephropathy 1

case.

8. Masssive proteinuria over 2.0gm per day was observed in 32 cutes(63%) with

nephrotic syndrome and moderate proteinuria from 0.5 to 2.0 gm per day in 13 cutes

(25%) and mild proteinuria below 0.5 gm per day in 6 cases (12%).

9. Increased serum Alpha 2-globulin concentration was observed in 22 cases (43%)

with nephrotic syndrome which were focal glomerulosclerosis, minimal lesions and

mesangial proliferative glomerulonephritis in orders.

[영문]

A clinical and pathologic study was made on 112 cases of renal biopsies in children who were admitted to Severance Hospital, Yonsei University College of Medicine, from June 1, 1978.to July 31, 1980.

The results are as follows :

1. Among 112 cases, 78 cases were male and 34 cases were female. The sex ratio of male & female was 2.3 : 1. The age distribution was from 3 months to 16 years of age, and the peak incidence occurred at 7 years of age in 19 cutes.

2. Clinical classfications of renal diseases were nephrotic syndrome 51 cases (45.5%), niphritic syndrome 47 cases (42.0%), acute renal failure 6 cases (5.4%) and miscellaneous 8 cases (7.1%).

3. Histopathological classifications of nephrotic syndrome were minimal lesion 22 cases (42.3%), mesangial proliferative glomerulonephritis 14 cases (26.9%), purpura nepliritis 5 cases (9.6%), focal glomerulosclerosis 4 cases (7.7%), membranoproliferative glomerulonephritis 3 cases (5.8%), membranous nephropathy 3 cases (5.8%) and unclassified 1 case (1.9%).

4. Hematuria was observed in 21 cases (44.7%) with neprhotic syndrome and in 4 cases (18.2%) with minimal lesion; it occurred in a higher proportion of patients with structural glomerular abnormalities which were membranoproliferative glomerulonephritis, mesangial profiterative glomerulonephritis and membranous nephropathy than in those with minimal lesions.

5. Hypertension was observed in 8 cases (15.7%) with nephrotic syndrome; it occurred in a slightly higher proportion of patients with structural glomerular abnormalities than in those with minimal lesions and it was not observed in purpura nephritis.

6. Renal insufficiency was observed in a slightly higher proportion of patients with structural glomerular abnormalities than in those with minimal lesions.

7. Serum albumin concentration below 2.5g/dl was observed in 40 cases (78.4%) with nephrotic syndrome and above 2.5g/dl in mesahgial proliferative glomerulonephritis 7 cases, minimal lesion 3 cases, and membraous nephropathy 1 case.

8. Masssive proteinuria over 2.0gm per day was observed in 32 cutes(63%) with nephrotic syndrome and moderate proteinuria from 0.5 to 2.0 gm per day in 13 cutes (25%) and mild proteinuria below 0.5 gm per day in 6 cases (12%).

9. Increased serum Alpha 2-globulin concentration was observed in 22 cases (43%) with nephrotic syndrome which were focal glomerulosclerosis, minimal lesions and mesangial proliferative glomerulonephritis in orders.