98 例泌尿道感染患儿肾积水病因分析

目的探讨泌尿道感染患儿肾积水的病因。方法回顾分析2010—2020年间98例因泌尿道感染住院行泌尿系彩超发现肾盂分离患儿的临床资料。结果 98例泌尿道感染肾积水患儿基于泌尿道扩张分级系统进行分级:正常42例、1级17例、2级28例、3级11例。肾积水1、2和3级的患儿共合并泌尿系畸形36例(64.3%),发生率高于正常组(18例,42.9%),差异有统计学意义(χ~2=4.45,P=0.035)。肾积水存在的泌尿系畸形主要包括,肾盂输尿管连接处梗阻16例、膀胱输尿管反流16例及膀胱输尿管连接处狭窄8例等。肾盂输尿管连接处梗阻及膀胱输尿管连接处狭窄均以左侧为主,膀胱输尿管反流以双侧为主,差异有统计学意义(P0.05)。不同肾积水分级组手术率差异有统计学意义(P0.05),以3级组手术率为较高。泌尿道感染存在泌尿系畸形的手术率(29.63%)高于无泌尿系畸形的手术率(11.36%),差异有统计学意义(P0.05)。结论肾积水病因常见为泌尿系畸形,其中以肾盂输尿管连接处梗阻及膀胱输尿管反流最常见,其次为膀胱输尿管连接处狭窄。肾积水分级及泌尿系畸形可考虑作为诊治的依据。     

RENAL FUNCTION DURING HYDROPENIA AND WATER DIURESIS IN CHILDREN WITH RECURRENT URINARY TRACT INFECTIONS

The glomerular filtration rate (GFR), urinary concentrating and diluting capacity and sodium excretion have been determined in 17 children with previous histories of urinary tract infection confirmed by urine cultures. There were no signs or symptoms of infection at the time of the study. Renal function was found to be normal in patients with normal intravenous pyelographies (IVPs). In the patients with renal parenchymal changes a wide variety of functional changes could be found. Reduction of the glomerular filtration rate was the predominant lesion. The GFR could however not be predicted by the IVP-appearance. Most of the patients were able to increase the GFR during water diuresis. The glomerular-tubular balance for sodium was reset in 3 of the patients as manifested by an increased C_Na/C_In. The concentrating capacity was also reduced in those 3 patients, indicating an impairment of the sodium reabsorption in the loop of Henle. All the patients were able to dilute the urine normally during water diuresis, but 5 of the patients were unable to increase their diluting capacity during the transition from hydropenia to water diuresis. It is noteworthy that only those patients were unable to increase the GFR significantly during the transition from hydropenia to water diuresis.     

窒息新生儿尿内皮素、尿微量蛋白的变化观察

目的　 探讨尿内皮素 (ET)、尿微量蛋白 (a1 M、TRF、Alb)在新生儿窒息肾脏损害中的意义。 方法 　窒息组在生后第 3天、第 7天采用放射免疫法测定尿ET ,同时测定其尿微量蛋白水平。对照组健康新生儿同期进行上述检测。 结果 　发现窒息组第 3天尿ET含量明显高于对照组 (P <0 0 1)。且重度窒息组 >轻度窒息组 >对照组。第 7天重度窒息组尿ET平均水平虽高于对照组、轻度窒息组 ,但统计显示无明显差异 (P >0 0 5 )。尿微量蛋白 (a1 M、TRF、Alb)变化与尿ET呈正相关 (P <0 0 1)。 结论 　尿ET与尿微量蛋白含量测定可以作为新生儿肾功能损伤的早期指标。新生儿窒息尿ET的增高与肾损害有密切关系     

定量测定尿促性腺激素判断女童性发育程度应用价值研究

目的 探讨定量测定尿促性腺激素（UGn）,包括尿黄体生成素（ULH）、尿卵泡刺激素（UFSH）在女童性发育中的应用价值。方法 以2013年10月至2015年2月在上海交通大学附属瑞金医院儿内科因乳房发育就诊的109例女童作为研究对象。109例均诊断为性早熟或青春发育提前。收集其就诊第1、2日晨尿,检测UGn浓度。就诊第2日晨采血,行促性腺激素释放激素（GnRH）激发试验,并收集试验后4 h内总尿,测UGn。结果 （1）连续2日晨尿UGn浓度差异无统计学意义,与血Gn基础值显著相关。（2）GnRH激发试验后4 h总尿UGn浓度与血Gn峰值呈显著相关,激发试验后血和尿的LH/FSH比值也呈显著相关。（3）尿、血Gn水平评估Tanner Ⅱ期与Tanner Ⅲ期的价值相似。（4）晨尿ULH、激发后4h总ULH及ULH/UFSH比值有助于临床鉴别乳房早发育（PT）和中枢性性早熟（CPP）。结论 检测UGn对于判断女性儿童性发育程度有一定意义,可作为一种无创而灵敏的诊断方法。     

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??Objective To investigate the value of quantitative assay of urinary gonadotropins ??UGn????including ULH and UFSH??in sexual development in girls. Methods A total of 109 girls with sexual development underwent both GnRH stimulation and UGn assay admitted from October 2013 to February 2015 in Rui Jin Hospital Shanghai Jiao Tong University School of Medicine were analyzed. Two successive morning urine was collected for detection of UGn. On the second day girls underwent conventional GnRH stimulation test while serial blood samples and the total 4-hour urinary sample after GnRH administration was collected for detection of UGn. Results ??There were no significant differences in UGn concentrations between two consecutive days but UGn was significantly correlated with basic serum Gn. ??Total 4 h UGn concentrations were significantly correlated with peak value of serum Gn. The ratio of ULH/UFSH was also correlated with ratio of serum LH/FSH. ??The value of assessment for breast development in Tanner stage ?? and ?? was similar by quantitative assays of UGn or serum Gn. ??Determination of basic morning ULH level and total 4 h ULH and the ratio of ULH/UFSH after GnRH stimulation were all helpful for clinical discrimination of PT and CPP. Conclusion UGn detection is considered as a significant criteria for assessment of activity of HPG axis in children with sexual development??and can be used as a non-invasive and sensitive diagnostic method.     

Neurofibromatosis involving the lower urinary tract in children A report of three cases and a review of the literature

Three children with neurofibromatosis involving the lower urinary tract are reported and their clinical, radiological and pathological findings are described. Lower urinary tract involvement in neurofibromatosis has previously been reported in 17 children, 12 of whom had other stigmata of von Recklinghausens disease. Lower urinary tract involvement may be asymptomatic and can be found incidentally. Every case with neurofibromatosis presenting with what may appear to be even only insignificant urinary symptoms should be thoroughly investigated urologically. Symptoms are usually related to urinary tract obstruction or neurogenic bladder dysfunction due to the involvement of the nerves supplying the bladder. Urinary diversion is the treatment of choice as surgical removal of the extensive tumour is seldom feasible. Following treatment the prognosis for survival appears to be good.     

Late effects on the urinary bladder in patients treated for cancer in childhood: a report from the Children's Oncology Group

Childhood cancer survivors who have had pelvic or central nervous system surgery or have received alkylator-containing chemotherapy or pelvic radiotherapy as part of their cancer therapy may experience urinary bladder late effects. This article reviews the medical literature on long-term bladder complications in survivors of childhood cancer and outlines the Children's Oncology Group Long-Term Follow-up (COG LTFU) Guidelines related to bladder function. An overview of the treatment of bladder late effects and recommended counseling for survivors with these complications are presented.     

A 20-year study of persistence of lower urinary tract symptoms and urinary incontinence in young women treated in childhood

ObjectiveTo determine whether urinary incontinence (UI) and lower urinary tract symptoms (LUTS) persist over years, patients treated for UI and LUTS in childhood were re-evaluated in adulthood.Materials and methodsForty-seven women (cases) treated in childhood for daytime UI/LUTS (group A) and nocturnal enuresis (group B) self-completed (average age: 24.89 ± 3.5 years) the International Consultation on Incontinence Questionnaire for Female with LUTS (ICIQ-FLUTS). ICIQ-FLUTS was self-administered to 111 healthy women (average age: 23 ± 5.1 years) from a nursing school as a control group. Data obtained from ICIQ-FLUTS and quality of life (QoL) score (0–10) were compared (Fisher's exact test) between patients and controls, and between group A (n = 28) and group B (n = 19).ResultsPrevalence of LUTS was higher in patients than in controls. The difference between patients and controls was statistically significant (p = 0.0001) for UI (34% vs. 7%) and feeling of incomplete bladder emptying (49% vs. 28%). QoL score was >5 in 59% of patients and 1% of controls (p = 0.0001). No significant differences were found between groups A and B.ConclusionsUI and LUTS are confirmed in young women who suffered for the same condition in childhood. Longitudinal studies are needed to assess if these symptoms persist or are newly onset.     

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??Proteinuria measurement is used to identify and monitor kidney damage. Accurate assessment of proteinuria is essential to clinical practice. This review focuses on the current status and question of proteinuria measurement. We also addressed standardization of preanalytical??analytical??and postanalytical issues including urine sample collection??urine protein and albumin measurement??and reporting of test results.     

表现为失盐危象的婴幼儿暂时性假性醛固酮减少症1例临床分析

目的探讨暂时性假性醛固酮减少症的诊断和治疗。方法回顾分析1例暂时性假性醛固酮减少症患儿的临床资料,并复习相关文献。结果女性患儿,3月龄初次出现电解质紊乱(低钠血症、高钾血症)和代谢性酸中毒,考虑为先天性肾上腺皮质增生症可能,予以激素治疗后未再随访。6月龄时再次出现电解质紊乱、代谢性酸中毒。实验室检查均提示17-羟孕酮无异常,血醛固酮、肾素水平升高。多项影像学检查提示泌尿道畸形(左侧重复肾畸形、左侧输尿管囊肿、左侧膀胱输尿管反流(III-IV级)。经积极控制感染、纠正水电解质紊乱症状很快缓解,血醛固酮、肾素水平迅速恢复正常。考虑为泌尿道畸形和/或泌尿道感染引起的暂时性假性醛固酮减少症故停用激素,积极抗感染治疗后外科手术治疗泌尿道畸形,随访中未再发生电解质紊乱及代谢性酸中毒。结论新生儿期后的婴幼儿失盐危象,须排查是否存在泌尿道感染和泌尿道畸形,并观察抗生素治疗后48小时内是否能迅速纠正水电解质紊乱,以避免过度检查和治疗。     

Iodine nutritional status among school children in selected areas of Howrah District in West Bengal, India

This article is a study on iodine nutritional status among 1627 school children aged 6-12 years, along with biochemical analysis of iodine of 200 urine samples, 50 drinking water samples and 175 salt samples carried out in certain randomly selected areas of the district Howrah in Gangetic West Bengal. Results indicate that the entire region is clinically goitre endemic having goitre prevalence 38%; however the median urinary iodine level was 25 microg/dl indicating no biochemical iodine deficiency, 70% salt samples had a recommended level of iodine and the region was found to be environmentally iodine sufficient. Consumption of dietary goitrogen and hard drinking water may have the possible role for the persistence of endemic goitre in the region.     

肾脏病患儿随机尿蛋白/尿肌酐比值的临床应用

目的观察肾脏病患儿24h尿蛋白（24hUp）与随机尿蛋白／尿肌酐比值（Up／Ucr）的相关性，探讨采用随机尿Up／Ucr代替24hUp的可行性。方法162例肾脏病患儿分别留取24h尿和随机尿及血标本测定血、尿肌酐和尿蛋白，并分析随机尿Up／Ucr与24hUp的相关性。结果按肌酐清除率（Ccr）将肾脏病患儿分为4组，Ccr80-147mL／min、50～80mL／min、10～50mL／min、3～10mL／min。各组随机尿Up／Ucr与24hUp的相关系数分别为0．86、0．93、0．74、0．19。结论当Ccr〉10mL／min时，随机尿Up／Ucr与24hUp有良好的相关性，可代替24hUp用于临床尿蛋白程度的监测。     

Age-dependent normal values of urinary histamine- and 1-methylhistamine in children

In order to establish normal values for urinary histamine and 1-methyI-histaniine exeretion in ehildhood, we investigated 57 healthy nonatopic ehiidren aged 2-16 years. Morning urine samples of HI and MH were determined by two different radioimmunoassays. Mean histamine excre-tion for all age groups was 24, 7 mieromol/mol ereatinine and 177 miero-mol/mol creatinine for 1-methylhistamine. Comparing three different age groups (1-4 years, 5-9 years and 10-16 years) we found an age-de-pendent deerease for both mediators. Our findings may be useful for further clinical trials, e. g. for monitoring allergie reaetions.     

儿童泌尿系结核1例报告

儿童泌尿系结核并不多见,临床症状多不典型,病情早期发生、发展隐匿,诊断较为困难,容易误诊、漏诊。现将中国医科大学附属盛京医院儿肾脏内科病房收治的1例泌尿系结核病例报告如下。1病例资料患儿女,12岁,以间断低热1个月,发现尿常规异常1d于2010-05-04入院。患儿近1个月间断午后低热,体温波动于37.2～37.8℃。夜尿增多,排尿终末疼痛,无尿频尿急,无肉眼血尿,无腰部疼痛,无咳嗽咳痰,无盗汗,无疲倦乏力,饮食睡眠良好,于外院静滴头孢呋辛钠、头孢哌酮舒巴坦钠等抗炎治疗1个月无效,故就诊于我院门诊,查     

Suprapubic voiding cystourethrography in the evaluation of lower urinary tract

Suprapubic micturating cystourethrography is a technique of great value in evaluating lower urinary tract in infants and children. It has been employed in 28 patients of age group ranging from newborn to 12 years, without any serious complication. The minor complication of extravasation of contrast media into the perivesical and peritoneum was observed in three patients. The method is easy, safe, reliable and time saving.     

The Urinary C-Peptide Excretion in Normal Healthy Children

ABSTRACT. The 24 h urinary C-peptide excretion was determined in 137 normal healthy children, 52 girls and 85 boys, 3–15 years of age. No significant difference was found between boys and girls. Median value of urinary C-peptide for boys and girls was 0.24 nmol/kg/24 h with a range of 0.07-0.61 nmol/kg/24 h. Urinary C-peptide correlated positively and significantly with age, weight, height, body surface area and the 24 h urinary creatinine excretion. Since the values of C-peptide excretion were not normally distributed they were log transformed and plotted against body weight. The linear regression and the 95% confidence limits were then calculated. Girls at puberty, 11–15 years of age, had significantly higher C-peptide excretion per kg body weight and per body surface area than younger girls, 3–10 years of age. Boys 13–15 years of age had significantly higher C-peptide excretion per body surface area than younger boys, 5–12 years of age. This indicates that children during the maximal growth spurt have an increased insulin secretion as measured by urinary C-peptide per body surface area.     

Prophylactic cefdinir for pediatric cases of complicated urinary tract infection

Background: This study evaluated the effect of prophylactic cefdinir (3 mg/kg given once daily) for the prevention of recurrent and complicated urinary tract infections (UTI) in pediatric patients. Methods: The study included 14 infants who were observed for at least 6 months following the first signs of infection (eight boys, six girls; mean age at admission [±SD]: 6.2 [±7.4] months). Twelve patients had vesico‐ureteric reflux (grade I, two; grade II, three; grade III, six; grade IV, one), and two patients had ureteropelvic junction stenosis. Results: No patients discontinued medication due to diarrhea or other adverse drug reactions. The patients had a 6‐month recurrence‐free rate of 93% (13/14); only one patient had recurrent UTI. The mean urinary cefdinir concentration was 16.3 [±11.7]µg/mL; there was considerable variability among individual measurements, even though the samples were collected at similar intervals after drug intake (mean 18.00 [±2.63] h after dose). However, the lowest measured urinary cefdinir concentration (1.16 µg/mL) was sufficient to eradicate Escherichia coli, one of the most significant causes of UTI. Fecal cultures, obtained at monthly clinic visits during the observation period, indicated that the patients' E. coli strains were very sensitive to cefdinir. No patients were infected with Pseudomonas aeruginosa or other non‐fermenting Gram‐negative bacilli or fungi. Conclusions: These results show that cefdinir given 3 mg/kg once daily is very effective and safe for preventing recurrent complicated UTI in infants.     

ABNORMAL TYROSINE METABOLISM IN HEREDITARY FRUCTOSE INTOLERANCE

Elevated plasma tyrosine and methionine levels, together with excessive urinary excretion of p-hydroxypheny-acetic and -lactic acids were found in an infant with hereditary fructose intolerance (HFI). Such findings may be common in HFI and this diagnosis must be considered in any infant with biochemical abnormalities of tyrosine metabolism.