目的 回顾性分析儿童肾脏疾病患儿的肾脏穿刺病理类型分布，为临床诊治提供依据。方法 收集并分析2009年至2022年期间接受肾活检的患儿病理资料，评估其病理类型及特点。结果 在3 496例肾活检患儿中，男性多见。婴幼儿以原发性肾小球疾病和遗传性肾脏病为主，学龄期后继发性肾小球疾病比例显著增加。原发性肾小球疾病总共占63.8%，其中以肾小球微小病变最常见(42.7%)，其次为IgA肾病(26.3%)、系膜增生性肾小球肾炎(13.5%)和局灶节段性肾小球硬化(7.3%)。继发性肾小球疾病总计占33.4%，以紫癜性肾炎最为多见(86.5%)，系统性红斑狼疮性肾炎占12.9%。60例遗传性肾脏病中，以Alport综合征占比最高，占71.7%。结论 浙江地区儿童肾脏疾病以原发性肾小球疾病为主，微小病变是最常见的病理类型；继发性肾小球疾病中，紫癜性肾炎最为多见。婴幼儿期患儿肾脏疾病需警惕先天性和遗传性因素。

Objective To investigate the pathological distribution of pediatric renal diseases through renal biopsy analysis, thereby informing clinical diagnosis and treatment strategies. Methods The pathological data of children who underwent renal biopsy during the period from 2009 to 2022 were collected and analyzed to assess the pathological types and their characteristics. Results A total of 3 496 patients were included, with a male predominance. In infants and young children, primary glomerular diseases and hereditary kidney disorders were predominant, while secondary glomerular diseases increased significantly after school age. Primary glomerular diseases comprised 63.8% in total, with minimal change disease being the most common (42.7%), followed by IgA nephropathy (26.3%), mesangial proliferative glomerulonephritis (13.5%), and focal segmental glomerulosclerosis (7.3%). Secondary glomerular diseases accounted for 33.4%, with Henoch-Schönlein purpura nephritis (HSPN) representing 86.4% of these cases, and lupus nephritis accounting for 12.9%. Among the 60 cases of hereditary kidney diseases, Alport syndrome was the most common, accounting for 71.7%. Conclusion In the Zhejiang area, primary glomerular diseases predominate among children's kidney disorders, with minimal change disease being the most prevalent pathological type. Among secondary glomerular diseases, Henoch-Schönlein purpura nephritis is the most common. Congenital and hereditary factors should be closely monitored for infants and young children with kidney diseases.