儿童肾衰竭51例

Renal Failure in 51 Children

目的探讨儿童肾衰竭的临床特点及治疗转归,以提高本病的诊治水平。方法研究对象为2005年1月-2009年7月在首都儿科研究所附属儿童医院住院并确诊为肾衰竭的患儿51例,对其病因、临床表现、实验室和影像学检查、治疗转归进行回顾性分析。结果 1.急性肾衰竭35例,年龄（5.9±4.5）岁。病因以肾性因素为主,其中肾小球疾病最常见,其次为溶血尿毒综合征。血肌酐平均值295.9μmol.L-1（48.2~911.6μmol.L-1）,水肿、少尿,高血压和电解质紊乱明显。肾活检9例,病理表现多样。经积极治疗,24例肾功能有不同程度恢复,死亡8例,3例放弃治疗。2.慢性肾衰竭16例,年龄（6.7±4.1）岁,病因以先天性泌尿系统发育异常为主,其次为获得性肾小球疾病。血肌酐平均值625.8μmol.L-1（76.0~2 336.2μmol.L-1）,贫血、生长发育迟缓,肾性骨病和代谢性酸中毒明显。肾活检1例,病理呈慢性增生硬化性肾炎。4例依赖腹膜透析生存,2例外科手术治疗,余均内科保守治疗。结论儿童急性肾衰竭应尽早明确病因,积极治疗,肾活检具有重要意义。慢性肾衰竭临床多呈非特异性表现,易漏诊、误诊,应定期进行肾脏相关检查,防止和延缓肾衰竭的发生。

Objective To investigate the clinical features and therapeutic effect and prognosis in children with renal failure in order to improve the level of diagnosis and treatment of this disease.Methods The study was performed in 51 children with renal failure admitted to Children′s Hospital Affiliated to Capital Institute of Pediatrics from Jan.2005 to Jul.2009.The etiology,clinical features,laboratory tests,imaging modalities,treatment response and prognosis were analyzed retrospectively.Results 1.There were 35 cases of acute renal failure,with average age of（5.9±4.5） years old.Glomerular disease was the most frequent cause and hemolytic uremic syndrome ranked second.The average serum creatinine was 295.9 μmol·L-1（48.2-911.6 μmol·L-1）.Edema,oliguria,hypertension and electrolyte disturbances were obviously observed.Kidney biopsy was done in 9 cases and showed different changes.After active therapy,renal function was recovered in di-fferent degree in 24 cases.Eight cases died and 3 cases were withdrawed.2.There were 16 cases of chronic renal failure,with average age of（6.7±4.1） years old.The main cause was congenital deformities of urinary system,and glomerular disease took the second place.The avera-ge serum creatinine was 625.8 μmol·L-1（76.0-2 336.2 μmol·L-1）.Most cases had anemia,growth retardation,renal osteodystrophy and metabolic acidosis.Only 1 case accepted kidney biopsy with the report of proliferative sclerotic nephritis.Four cases lived relying on peritoneal dialysis and 2 cases underwent surgery treatment.Others received conservative treatment.Conclusions Early diagnosis and prompt management should be taken as soon as possible and kidney biopsy is much important in acute renal failure.And chronic renal failure is easy to be misdiagnosed and missed diagnosis for lack of specific changes.Regular examination should be helpful to the prevention in chronic renal failure.