Clinicopathologic study of different variants of focal segmental glomerulosclerosis / 中华病理学杂志

<p><b>OBJECTIVE</b>To study the clinicopathologic features of different variants of primary focal segmental glomerulosclerosis (FSGS).</p><p><b>METHODS</b>One hundred and two cases of FSGS were retrieved from the archival files of Peking University First Hospital during the past 6-year period. The pathologic findings were reviewed and the degrees of active and chronic changes were assessed by morphometric analysis. The histopathologic patterns were then correlated with clinical manifestations.</p><p><b>RESULTS</b>Amongst the 102 cases of primary FSGS studied, 55.9% belonged to the NOS (not other specified) variant, while the perihilar, cellular, tip and collapsing variants accounted for 6.9%, 25.5%, 4.8% and 6.9% respectively. The level of proteinuria in the cellular and tip variants were much higher than that in the NOS variant; and the incidence of nephrotic syndrome in the tip and collapsing variants was higher than that in the other three variants (chi(2) = 12.23, P < 0.05). The activity score of the cellular and collapsing variants was also higher than that of the other three variants (P < 0.05). The interval between disease onset and renal biopsy diagnosis in the perihilar variant was longer than that in the other variants. The chronicity score of this variant was higher than that of the tip and NOS variants (P < 0.05). On the other hand, the total scores of active and chronic changes of the tip variant was lower than that of the cellular and collapsing variants (P < 0.05); and its chronic score was lower than that of the NOS and perihilar variants (P < 0.05).</p><p><b>CONCLUSIONS</b>The NOS variant is the commonest morphologic pattern seen in primary FSGS. The cellular and collapsing variants are the patterns associated with active lesions, while perihilar variant is the pattern associated with chronic lesions. The tip variant shows mild pathological changes compared with the other patterns.</p>

Clinical and pathological features of anti-neutrophil cytoplasm antibody associated systemic vasculitis in children / 中华儿科杂志

<p><b>OBJECTIVE</b>Anti-neutrophil cytoplasmic antibodies (ANCA) are serological diagnostic markers for certain types small vessel vasculitis including Wegener's granulomatosis and microscopic polyangiitis, which are also termed ANCA associated systemic vasculitis (AASV). The majority of patients with primary AASV reported are adults and predominantly elderly. Data on pediatric patients with primary AASV in China are lacking. This study aimed to analyze the clinical and pathological features of primary AASV in children.</p><p><b>METHODS</b>Patients with primary AASV, admitted to the hospital within the past 7 years, were retrospectively studied. The clinical and pathological features were compared between pediatric and adult patients. In pediatric group, there were 20 cases with an average age of (12.1 +/- 4.1) years (aged from 5 to 17 years); in adult group, there were 38 cases with an average age of (55.3 +/- 14.1) years (aged from 20 to 78 years).</p><p><b>RESULTS</b>The data of this study showed that pediatric patients accounted for 7.87% (20/254) of the whole primary AASV patients. Compared with 38 adult hospitalized patients, pediatric patients were predominantly female (80% vs 50%, P = 0.047). Patients from both groups were microscopic polyangiitis predominantly (95% vs 74%, P > 0.05) and the majority of the sera were P-ANCA/anti-MPO antibody positive in both groups (95% vs 74%, P > 0.05). The prevalence of hypertension in pediatric patients was significantly lower than that in adults (20% vs 61%, P = 0.005). There was no significant difference in clinical manifestations and clinical remission rates between the two groups.</p><p><b>CONCLUSION</b>Pediatric patients with AASV were not rare in China. The clinical and pathological features of patients with AASV in childhood were similar to adult patients, but there was a female predominance in children.</p>