慢性肾脏病2—5期患儿108例临床分析

Clinical analysis of 108 cases with chronic kidney disease at stage 2 to 5 in children

目的探讨儿童慢性肾脏病（CKD）2－5期的病因构成、首诊症状及临床特点。方法总结2007年9月至2016年4月于首都儿科研究所附属儿童医院住院治疗的CKD 2－5期患儿的临床资料。分析患儿的病因、临床表现及辅助检查，并比较先天遗传性泌尿系统疾病组与获得性泌尿系统疾病组患儿的临床特征。结果1.CKD 108例患儿中男66例，女42例；年龄3个月～15岁1个月；按照CKD分期，2期24例，3期26例，4期35例，5期23例。2.CKD的病因涉及28种疾病，其中先天性肾脏和泌尿系统畸形57例（占52.8%），遗传性肾脏病5例（占4.6%），其他原发性、继发性肾脏病41例（占38.0%），原因不明肾脏病5例（占4.6%）。3.有36例（33.3%）患儿以非肾脏表现为首诊症状，43例（39.8%）患儿缺乏典型症状。79例（73.1%）患儿B超提示泌尿系统结构异常，87例（80.6%）患儿尿常规异常，105例（97.2%）患儿存在尿常规或泌尿系B超检查异常。4.先天遗传性泌尿系统疾病组确诊年龄的中位数为5.89岁，明显小于获得性泌尿系统疾病组（9.20岁），差异有统计学意义（Z＝－3.434，P＝0.001）；出现矮小、低体质量的比例[66.1%（41/62例）、64.5%（40/62例）]显著高于获得性泌尿系统疾病组[43.9%（18/41例）、43.9%（18/41例）]，差异均有统计学意义（χ^2＝4.983、4.263，P＝0.026、0.039）。结论儿童CKD患儿的病因复杂，以先天性肾脏和泌尿系统畸形最为常见。CKD患儿首发症状不典型，常以肾外症状起病或缺少阳性表现。先天遗传性泌尿系统疾病患儿更易出现生长发育迟缓。尿常规和泌尿系统B超检查对CKD患儿的早期发现有重要意义。

Objective To analyze the pathogenesis,initially diagnosed symptoms and clinical manifestations of children with chronic kidney disease（CKD） at stage 2 to 5. Methods The data of 108 children who were hospitalized in Children＇s Hospital Affiliated to Capital Institute of Pediatrics from September 2007 to April 2016 with CKD stage 2 to 5 were retrospectively analyzed. The etiologies, clinical manifestations and examinations were summarized, and the clinical manifestations were compared between the congenital hereditary urinary diseases group and the acquired urinary diseases group. Results （ 1 ） In the 108 cases collected ,66 cases were male ,42 cases were female, aged from 3 months to 15 years and 1 month old. Twenty - four cases were diagnosed at stage 2,26 cases at stage 3,35 cases at stage 4 ,and 23 cases at stage 5. （ 2 ） Twenty - eight kinds of illness were involved in the cause of CKD. Among them, 57 cases （ 52. 8% ） had congenital anomalies of the kidney and urinary tract,5 cases（4.6% ） had hereditary kidney diseases,41 cases （38.0%） had other primary or secondary kidney diseases, and in 5 cases （4.6%） the causes of disease were unknown. （3） For the initially diagnosed symptoms ,29 cases （26.9%） were due to complaints associated with kidney disease,36 cases （33.3%） were of other outside kidney symptoms, and 43 cases （39.8%） were of negative symptoms. The results of urinary ultrasound were abnormal in 79 cases（73.1% ） and 87 cases（ 80.6% ） showed abnormality in urinary analysis. There were 105 cases （97.2%） with abnormal manifestations either in urinary tract ultrasound or in urinary analysis. （4）The ages on diagnosis as CKD in children with congenital hereditary urinary diseases （5.89 years old） were younger than that of children with acquired urinary diseases （9.20 years old） , and the difference was significant（ Z = - 3. 434 ,P = 0.001 ）. The frequency of cases with short stature or lower - weight in group of congenital he- reditary urinary diseases [ 66.1% （41/62 cases） ,64.5 % （40/62 cases） ] were significantly higher than those of the ac- quired urinary diseases group [ 43.9% （ 18/41 cases） ,43.9% （ 18/41 cases ） ], and the differences were statistically significant（χ^2= 4. 983,4. 263 ,P = 0. 026 ,0. 039 ） . Conclusions The causes of CKD are complicated, and the congenital anomalies of kidney and urinary tract are the major causes of CKD at stage 2 to 5 in the cases. The initially diagnosed symptoms of CKD are insidious and atypical. The children with congenital hereditary urinary diseases tend to have more serious growth retardation. Urinary analysis and ultrasound may have an important significance for early diagnosis of CKD in children.