摘要
目的探讨儿童急性肾损伤(AKI)的病因、临床特点及治疗方法,以助于早期诊断及制定合理的治疗方案。方法回顾性分析269例AKI患儿的临床资料。分析儿童AKI的病因分布。并探讨其病史、临床表现、实验室检查、肾损伤分期与预后的相关关系。结果 AKI患儿平均年龄6.06岁。肾前性AKI 34例(占12.6%,依次为腹泻50.0%,新生儿HIE 23.5%,烧伤11.8%),肾实质性AKI 165例(占61.3%,依次为肾病综合征21.8%,非链球菌感染后肾炎14.5%,感染13.9%,SLE 12.1%),肾后性AKI 70例(占26.0%,依次为结石81.4%,膀胱输尿管返流28.6%,肿瘤梗阻7.1%,肾盂输尿管连接处梗阻5.7%,细菌栓塞及后尿道瓣膜各1.4%)。死亡2例(肾实质性AKI),未愈48例,好转142例,治愈77例。不同年龄段患儿的病因分布差异有统计学意义(P=0.000),新生儿AKI主要为肾前性原因(65.4%),婴幼儿期以肾后性AKI(58.3%)为主,学龄前及学龄儿主要为肾性AKI(61.9%,86.2%)。其预后与原发肾脏疾病类型、AKI分期、病史长短及是否伴有少尿、蛋白尿相关(Pa<0.05)。结论新生儿AKI主要为肾前性AKI,婴幼儿期主要为肾后性AKI,学龄前及学龄儿主要为肾性AKI。预后主要取决于原发肾脏疾病类型、病情分级、病史长短及是否伴有少尿、蛋白尿。早期诊断、早期治疗有助于改善预后,提高生存率。
Objective To investigate the etiology,clinical manifestations and therapy of acute kidney injury（AKI）,in order to assist the earlier diagnosis and proper treatment.Methods The clinical data from 269 children with AKI were retrospectively analyzed.The distribution of causes of AKI was analyzed.The relationships between the course of AKI,clinical manifestations,laboratory data,the degree of AKI and prognosis were investigated.Results The mean age of AKI patients was 6.06 years old.Thirty-four children were with prerenal AKI,accounting for 12.6%（50.0% of children were diarrhea,23.5% of children were hypoxic-ischemic encephalopathy,and 11.8% of children were empyrosis）.One hundred and sixty-five children had renal parenchymal AKI,accounting for 61.3%（21.8% cases with nephrotic syndrome,14.5% of children with acute nonpoststreptococcal glomerulonephritis,13.9% of children with infection,12.1% of children with systemic lupus erythematosus）.Seventy children had postrenal AKI,accounting for 26.0%（urolithiasis 81.4%,vesicoureteral reflux 28.6%,tumor 7.1%,ureteropelvic junction obstruction 5.7%,bacterial embolism 1.4% and post-urethral valve 1.4%）.Two patients died（renal parenchymal AKI）,48 cases were not cured,77 cases recovered,142 cases got better.The causes of AKI were different among the distinct age groups（P=0.000）.The main cause of neonates with AKI was prerenal AKI（65.4%）.The main cause of infancy and toddler children with AKI was postrenal AKI（58.3%）.Preschool and school-age children with AKI was renal parenchymal AKI（61.9%,86.2%）.The prognosis of AKI highly depended on the underlying etiology,grade and course of AKI,and it was also due to oliguria and proteinuria（Pa〈0.05）.Conclusions Neonates are prone to prerenal AKI,infants are prone to postrenal AKI,preschool and school-age children are prone to renal parenchymal AKI.The prognosis of AKI is highly depended on the underlying etiology,grade and course of AKI,and it is also due to oliguria and proteinuria.The early diagnosis and treatment play an important role in improving prognosis and survival rate.
出处
《实用儿科临床杂志》
CAS
CSCD
北大核心
2011年第17期1340-1342,共3页
Journal of Applied Clinical Pediatrics
关键词
急性肾损伤
病因
预后
儿童
acute kidney injury
etiology
prognosis
child
