新生儿非少尿型急性肾功能衰竭临床研究

Clinical study of newborns with non oliguria acute renal failure

目的 探讨新生儿非少尿型急性肾功能衰竭的临床特点、病因、发病机制及预后。方法 前瞻性研究新生儿非少尿型急性肾功能衰竭 (ARF) 2 2例。冰点渗透压仪测定血浆、尿液渗透压 ,放射免疫法检测血清抗利尿激素 (ADH)、血清及尿液 β2 微球蛋白 (β2 M) ;同时检测血钠、尿钠、血肌酐、尿肌酐、血尿素氮 ;计算钠排泄分数 (FENa)、肌酐清除率 (Ccr)、肾衰指数 (REI)。对照组为同期肾功能正常的轻型病例。结果 本组原发疾病为新生儿窒息 12例 ,占 5 4%。非少尿型急性肾功能衰竭组尿 /血渗透压 0 .95± 0 .34 ,血 β2 M 4.5 1± 1.97(mg/L) ,ADH 14.71± 5 .0 4(ng/L)明显增高 ,Ccr 10 .5± 7.3ml/(min·1.73m2 ) ,明显降低 ,尿 β2 M改变不明显。结论 新生儿窒息是导致非少尿型ARF的最主要病因。非少尿型ARF主要为肾前因素所致 ,肾小管损害较轻 ,对ADH有效应 ,且预后较好。

Objective To study the clinical features, causes, pathogenesis and prognosis of newborns with non oliguria acute renal failure.Methods Osmotic pressure of plasma and urine were measured with osmotic pressure cryoscope for acute renal failure in 22 newborns with non oliguria; ADH and β 2 microglobulin ( β 2 M) in serum and urine were detected by radioimmunoassay. Blood and urine sodium, blood and urine creatine, blood BUN, FENa, Ccr, REI were also detected. Patients with normal renal function as controls.Results Among the 22 patients, 54 percent (12 patients) were newborn asphyxia. In the patients of non oliguria acute renal failure, the ratio of osmotic pressure for urine and blood was 0.95± 0.34;β 2 M was 4.51±1.97(mg/L) and ADH was 14.7 ±5.04(ng/L), which increased significantly compared with that of the controls. Ccr was 10.5±7.3(ml/min.1.73m 2), which decreased remarkably. No obvious change for urine β 2 M.Conclusion Newborn asphxia is the most important factor to cause neonatal acute renal failure without oliguria. The non oliguria acute renal failure is mainly caused by prerenal factors. The damage of renaltubular is mild. And the patients are reactive to ADH. The prognosis of newborns with non oliguria acute renal failure is good.