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中华肾病研究电子杂志 ›› 2015, Vol. 04 ›› Issue (05) : 223 -226. doi: 10.3877/cma.j.issn.2095-3216.2015.05.001

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加强少见肾脏病的临床与基础研究
章友康1,(), 王素霞2   
  1. 1. 100034 北京大学第一医院肾内科、北京大学肾脏病研究所、卫生部肾脏疾病重点实验室、慢性肾脏病防治敎育部重点实验室
    2. 100034 北京大学第一医院电镜室、超微病理中心
  • 出版日期:2015-10-28
  • 通信作者: 章友康

Strengthening clinical and basic researches on rare kidney diseases

Youkang Zhang1,(), Suxia Wang2   

  1. 1. Renal Division, Department of Medicine, Peking University First Hospital; Peking University Institute of Nephrology; Key Laboratory of Renal Disease, National Health and Family Planning Commission of P. R China; Key Laboratory of Chronic Kidney Disease Prevention and Treatment (Peking University), Ministry of Education, Beijing 100034, China
    2. Electron Microscope Laboratory, Center of Ultrastructure Pathology, Peking University First Hospital, Beijing 100034, China
  • Published:2015-10-28
  • Corresponding author: Youkang Zhang
  • About author:
    Corresponding author: Zhang Youkang, Email:
引用本文:

章友康, 王素霞. 加强少见肾脏病的临床与基础研究[J]. 中华肾病研究电子杂志, 2015, 04(05): 223-226.

Youkang Zhang, Suxia Wang. Strengthening clinical and basic researches on rare kidney diseases[J]. Chinese Journal of Kidney Disease Investigation(Electronic Edition), 2015, 04(05): 223-226.

改革开放30余年来,经几代肾脏病学者的艰苦努力和攀登,我国肾脏病事业取得了飞速发展,对常见的肾脏疾病、特别是肾小球疾病的诊治取得了长足的进步,某些研究领域己逐步与国际接轨。但基于我国肾脏病研究基础薄弱、地广人多,发展很不平衡,因此提升我国少见肾脏病的诊治水平尚有很大空间,加强少见肾脏病的临床和基础研究仍任重而道远。本文就如何提高我国少见肾脏病诊治水平提出几点看法:(1)认真做好肾活检病理检查,重视免疫病理和电镜在病理诊断中的作用。强调制片、染色质量,光镜、免疫荧光和电镜检查不应缺失任何一项,互为补充进行综合判断。提倡临床病理讨论会,病理学家与临床专家互动,是提高少见肾脏病诊断率和正确性的有效方法。(2)重视临床资料收集和分析,结合基因检测,提高少见肾脏病的诊断率,防止误诊、漏诊。重视病史(包括家族史)和临床资料(查体、实验室及相关医学影像检查结果)收集,并加以认真分析;在此基础上应努力开展与疾病相关的特殊检查,对于疑似遗传性肾病患者应做遗传基因检测,避免把少见的继发性肾脏病和遗传性疾病漏诊或误诊为原发性肾脏病。(3)对危害性大的少见肾脏病积极开展流行病学调查和发病机制的研究,以期深入阐明其发病机制。(4)组织好高水平临床治疗研究,以期获得高质量循证医学证据,指导和提高我国整体肾脏病的临床治疗水平。(5)强调依据患者具体病情制定个体化治疗方案和充分发挥中医中药优势,努力提高我国少见肾脏病的疗效。

Since the reform and opening up 3 decades ago, China′s nephrology has made great achivements after hard work of several generations of Chinese nephrologists; in the diagnosis and treatment for common kidney diseases, especially glomerular diseases, striking progress has been made; and China′s nephrology in some research fields has geared to the international conventions. But as the study foundation of kidney diseases in China is weak, with widespread population and very uneven development, there is still much space for improving China′s diagnosis and treatment of rare kidney diseases, and there is still a long way to go to enhance clinical and basic researches on rare kidney diseases. To achieve this goal, we put forward the following opinions: 1. Standardization of renal biopsy pathologic examination, paying attention to the roles of the immune pathology, and electron microscopy in pathological diagnosis. We emphasize on high quality production and dyeing of pathological specimen; and light microscopy, immunofluorescence, and electron microscopy are all indispensable and mutually complementary. We advocate clinical pathological conference to promote interactions between pathologists and clinical experts. 2. Attaching great importance to the collection and analysis of clinical data, combining genetic screening to effectively improve the diagnosis of rare kidney diseases, and prevent misdiagnosis and failure to diagnose. We emphasize on complete collection of illness history (including familial history) and clinical data (including physical, laboratory, and related medical image examinations) for serious analysis; on the basis of the above, disease-relevant special examination and gene detection for patients with suspected inherited kidney diseases should be performed, in order to avoid failure to diagnose rare secondary renal diseases and genetic diseases or misdiagnosing them as primary kidney diseases. 3. We also advocate active epidemiological investigation and the pathogenesis researches on very harmful rare kidney diseases so as to elucidate the pathogenesis. 4. We should organize high quality clinical therapeutic trials to obtain high quality evidence-based medical data for the purpose of providing guidance and improving the treatment of rare kidney diseases in China. 5. We emphasize individualized treatment and giving full play to the advantages of traditional Chinese medicine for improving the efficacy of rare kidney diseases.

1
陈香美.中国肾脏病进展. 中华医学会肾脏病学分会2011年学术年会专题汇编,北京,2011:1-2.
2
Devuyst O, Knoers Nine VAM, Remuzzi G, et al. Rare inherited kidney diseases: challenges, opportunities, and perspectives [J]. Lancet, 2014, 383(9931): 1844-1859.
3
Schieppati A, Henter JI, Daina E, et al. Why rare diseases are an important medical and social issue [J]. Lancet, 2008, 371(9629): 2039-2041.
4
Machuca E, Benoit G, Antignac C. Genetics of nephritic syndrome: connecting molecular genetics to podocyte physiology [J]. Hum Mol Genet, 2009, 18(R2): R185-R194.
5
Stechman MJ, Loh NY, Thakker RV. Genetic causes of hypercalciuria nephrolithiasis [J]. Pediatr Nephrol, 2009, 24(12): 2321-2332.
6
Herrera GA, Turbat-Herrera EA. Renal diseases with organized deposits [J]. Arch Pathol Lab Med, 2010, 134(4): 512-531.
7
Harada M, Kamijo Y, Ehara T, et al. A case of podocytic infolding glomerulopathy with multiple myeloma [J]. BMC Nephrol, 2014, 15: 32-35.
8
Larsen CP, Bell JM, Harris AA, et al. The morphologic spectrum and clinical significance of light chain proximal tubulopathy with and without crystal formation [J]. Modern Pathol, 2011, 24(11): 1462-1469.
9
Klimtchuk ES, Gursky O, Patel RS, et al. The critical role of the constant region in thermal stability and aggregation of amyloidogenic immuglobin light chain [J]. Biochemistry, 2010, 49(45): 9848-9850.
10
Bekheirnia MR, Reed B, Gregoey MC, et al. Genotype-phenotype correlation in X-linked Alport syndrome [J]. J Am Soc Nephtol, 2010, 21(5): 876-883.
11
Stratikos E, Chroni A. A possible structural basis behind the pathogenic role of apolipoprotein E hereditary mutations associated with lipoprotein glomerulopathy [J]. Clin Exp Nephrol, 2014, 18(2): 225-229.
12
倪兆慧,金海姣,徐维佳.C1q肾病的诊断与治疗[J].中华肾病研究电子杂志,2015,4(5): 232-235.
13
汪年松,桂定坤. C3肾小球肾炎的诊断与治疗[J].中华肾病研究电子杂志,2015,4(5): 241-245.
14
林珊,贾俊亚. 轻链沉积病的诊断与治疗[J].中华肾病研究电子杂志,2015,4(5): 236-240.
15
何亚妮,林利蓉.脂蛋白肾病的诊断与治疗[J].中华肾病研究电子杂志,2015,4(5): 227-231.
16
Sethi S, Nester CM, Smith RJ. Membranoproliferative glomerulonephritis and C3 glomerulopathy: resolving the confusion [J]. Kidney Int, 2012, 81(5): 434-441.
17
Barbour TD, Pickering MC, Cook HT. Recent insights into glomerulopathy [J]. Nephrol Dial Transpant, 2013, 28(7): 1685-1693.
18
Saito T, Matsunaga A, Ito K. Topics in lipoprotein glomerulopathy: an overview [J]. Clin Exp Nephrol, 2014, 18(2): 214-217.
19
Jimenez-Zepeda VH. Light chain deposition disease: novel biological insights and treatment advances [J]. Int J Lab Hematol, 2012, 34(4): 347-355.
20
章友康,王素霞.超微病理在肾脏疾病诊断中的作用及其评价[J].诊断学理论与实践,2007, 6(6): 505-506.
21
Fogo AB, Bostad L, Svarstad E, et al. Scoring system for renal pathology in Fabry disease: report of the International Study Group of Fabry Nephropathy (ISGFN) [J]. Nephrol Dial Transplant, 2010, 25(7): 2168-2177.
22
Yadav P, Leung N, Sanders PW, et al. The use of immunoglobulin light chain assays in the diagnosis of paraprotein-related kidney disease [J]. Kidney Int, 2015, 87(4): 692-697.
23
王海燕.肾脏病临床概览[M].北京: 北京大学医学出版社,2009:359-370.
24
Coffman TM, Falk RJ, Molitoris RA, et al. Schrier's Disease of the Kidney [M]. Ninth edition. Philadelphia: Wolter Kluwer and Lippicott Williams & Wilkins, 2013: 1710-1754.
25
Iorember FM, Vehaskari VM. Uromodulin: old friend with new roles in health and disease [J]. Pediatr Nephrol, 2014, 29(7): 1151-1158.
26
Kinomura M, Sugiyama H, Saito T, et al. A novel variant apolipoprotein E Okayama in a patient with lipoprotein glomerulopathy [J]. Nephrol Dial Transplant, 2008, 23(2): 751-756.
27
Moriniere V, Dahan K, Hilbert P, et al. Improving mutation screening in familial hematuric nephropathies through next generation sequencing [J]. J Am Soc Nephrol, 2014, 25(12): 2740-2751.
28
Fujun Lin, Fan Bian, Jun Zou, et al. Whole exome sequencing reveals novel COL4A3 and COL4A4 mutations and resolves diagnosis in Chinese families with kidney disease [J]. BMC Nephrology, 2014, 15: 175.
29
陈香美.中国肾脏病防治面临的挑战[J/CD].中华肾病研究电子杂志,2012,1(1,创刊号).
30
Lv JC, Zhang H, Cui Z, et al. Delayed severe pneumonia in mycophenolate mofetil-treated patients with IgA nephropathy [J]. Nephrol Dial Transplant, 2008, 23(9): 2868-2872.
31
Su T, Li HC, Chen M, et al. Invasive pulmonary aspergillosis in patients with antineutrophil cytoplasmic antibody associated vasculitis [J]. J Clin Rheumatol, 2009, 15(8): 380-382.
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