小儿慢性肾脏病贫血的诊断与治疗

Diagnosis and treatment for anemia of chronic kidney disease in children

小儿慢性肾脏病（CKD）贫血的产生存在多种原因，包括慢性肾功能不全导致的红细胞生成原料缺乏（铁、叶酸、维生素B12缺乏），红细胞寿命缩短和失血，以及尿毒素抑制骨髓红细胞生成等，但最主要的原因为慢性肾功能不全时肾脏促红细胞生成素生成减少。贫血影响组织氧的供应及利用和心排出量的增加，常表现疲倦、呼吸困难，导致心脏扩大、心室肥厚、心力衰竭、脑供血不全、认知功能下降、免疫功能损伤等一系列病理生理现象，影响患者的预后及生存质量。肾性贫血需要积极治疗，其与慢性肾衰竭患者的生存率及生活质量密切相关。现就小儿CKD肾性贫血的诊断，如何评估贫血、铁剂的治疗及红细胞生成刺激剂治疗的策略进行阐述。

There are many reasons for children with anemia of chronic kidney disease （CKD） , such as chronic renal insufficiency due to lack of raw materies erythropoietin（ iron, folic acid, vitamin B12 deficiency） , shortening of the life of red blood cells and blood loss, bone marrow suppression by urine toxins such as erythropoietin. But the main reason is decreased production of renal erythropoietin accompanying chronic renal insufficiency. Anemia affects tissue＇s ox- ygen supply, utilization, and cardiac output, and patients often show a series of pathophysiology of immune dysfunction, such as fatigue, difficulty in breathing, enlargement of the hearts, ventrieular hypertrophy, heart failure, cerebral insufficiency, cognitive decline, affecting the prognosis and quality of life of patients. Renal anemia requires aggressive treatment, which is closely related to the survival and quality of life in patients with chronic renal failure. This paper elaborates on the diagnosis of anemia in children with CKD, the evaluation strategies of anemia,iron therapy and erythropoiesis stimulating agents treatment.