小儿慢性肾功能衰竭临床及病理分析

A clinical and pathological analysis of chronic renal failure in children

为探讨小儿慢性肾功能衰竭(CRF)的病因、临床及病理特点,对1987～1995年入住我院的36例CRF患儿临床资料及其中12例的病理类型进行了分析。结果:获得性肾小球疾病24例,起病年龄较大,从发病到诊为CRF平均病程3.6年,多有水肿、高血压及呕吐,尿改变重。其中12例肾活检呈多种病理改变;先天性或遗传性肾脏疾病12例中,肾发育不良9例,起病年龄较小,诊为CRF平均病程9.6年,多以生长发育落后及肾小管损伤症状突出,尿改变轻。36例CRF中,临床隐匿起病者14例。本组3例死亡,20例因病情严重放弃治疗。提示:CRF以获得性肾小球疾病为主要病因,隐匿起病者占38.9%,多种病理类型的肾小球疾患均可能进展为CRF,且预后不佳。

To study the etiology and clinical and pathological characteristics of chronic renal failure (CRF) in children,we reviewed 36 children with CRF, of whoml2 had renal biopsy results. Of the 36 cases ,24 suffered from acquired glomerular dis eases and 12 congenital or hereditary kideney diseases. Those who had acquired glomerular diseases,were at relatively older age of onset and it took 3.6 years from the onset of CRF to its diagnosis. They had edema,hypertension,vomiting and severe changes in urinalysis. Various pathological changes were noted in 12 cases. Nine out of 12 children with congenital kindey diseases had renal dysplasia. Their age of onset was much younger . The average duration from the onset of illness to the diagnosis was 9.6 years . They had no edema, but they had developmental retardation and renal tubules damage. The change in urine was mild . Of the 36 patients with CRF, 14 had an insidious onset. Three patients died and the conditions of 20 patients were deteriorated. The present data showed that the etiology of CRF in the children consisted mainly of acquired glomerular diseases. Cases of insidious onset accounted for 38.9% of all patients. Their prognosis was unfavorable . Thus, knowing the etiology and pathology of CRF has great instructive significance for preventing and delaying the occurrenee of CRF.