缺血性心力衰竭患者肾功能恶化的相关因素分析

目的]探索缺血性心力衰竭(HF)患者住院期间肾功能变化的特点。 [方法]回顾性纳入2013年10月—2017年12月在中山大学附属第一医院心内科住院的缺血性HF患者,采用描述统计方法描述患者基线临床特点,并通过多因素Logistic回归模型探索缺血性HF患者发生肾功能恶化(WRF)的相关因素。 [结果]本研究共纳入797名缺血性HF患者,平均年龄(70.5±11.1)岁,其中68.9%为男性;其中22.5%为左心室射血分数(LVEF)降低的HF患者,57.6%为LVEF保留的HF患者。WRF的发生率为18.4%。导致WRF发生的相关因素包括高血肌酐(OR＝1.953,P＜0.001)、高血压史(OR＝1.859,P＝0.025)、低血红蛋白(OR＝0.985,P＝0.002)、高纤维蛋白原(OR＝1.241,P＝0.013)、高血氯(OR＝1.042,P＝0.049)、高血尿酸(OR＝1.002,P＝0.039)及使用呋塞米(OR＝1.773,P＝0.033)。 [结论]缺血性HF患者WRF发生率较高,相关因素较多;临床上需要关注患者肾功能变化,及时控制相关因素,尤其是低血红蛋白、高纤维蛋白原、高血氯、高尿酸等。     

Efficacy and outcome of surgical intervention in patients with nephrolithiasis and chronic renal failure

Aim: To prospectively evaluate the efficacy and outcome of surgical intervention in patients with renal stones and chronic renal insufficiency.Methods: The study was carried out from January 1999 till January 2001. Only patients with chronic renal failure without medical renal disease were taken up for study. All patients were subjected to an ultrasound assessment of the kidney, ureter and bladder. In case of obstructed and infected systems a preliminary percutaneous nephrostomy was carried out. After correction of dyselectrolytemia, acid base imbalanceand dialysis (if indicated)patients were subjected to surgical intervention (open surgery or percutaneous nephrolithotomy). ESWL was offered for stones persisting after surgery. The stone burden, composition, therapeutic procedures required to render patients stone free were assessed. The outcome of stone removal on renal function was also evaluated by serial renal dynamic scans and creatinine clearance estimations.Results: Out of 90 patients operated for staghorn or calyceal calculi, complete follow up data was available in 70.Pyelo-nephrolithotomy and percutaneous nephrolithotomy was carried out in 63 and 7 patients respectively. Out of 15 patients with residual stones ESWL was successfully performed in 9 cases. Mixed, calcium oxalate monohydrate, calcium oxalate dihydrate, and struvite stones were encountered in48%, 14%, 17% and 21% respectively. The average pre operative serum creatinine was 4.76 (1.9–16) mg%.The maximum duration of follow up was 9 months. By the 9th post operative month the average fall in serum creatinine values was 1.53 mg/dl (32%)and the average functional improvement by renal dynamic scans stood at 20.665%. 41 patients were saved from further dialysis.Conclusion: Patients with mild to moderate renal failure showed maximal improvement in renal function forestalling or reducing the need for dialysis/renal replacement therapy.     

Evaluation of renal function in leprosy: a study of 59 consecutive patients.

BACKGROUND: Renal abnormalities in leprosy have been largely described in medical literature, but there are few studies evaluating renal function in these patients. METHODS: This is a cross-sectional study in 59 consecutive paucibacillary (PB) and multibacillary (MB) leprosy patients. Glomerular filtration rate (GFR) was estimated by simplified-MDRD formula. Microalbuminuria was determined by 24 h urine collection. Urinary acidification capacity was measured after water deprivation and acid-loading with CaCl(2). Urinary concentration capacity was evaluated after desmopressin acetate administration, using the urinary to plasma osmolality (U/P(osm)) ratio. All parameters except microalbuminuria were measured in a control group of 18 healthy volunteers. RESULTS: Age and gender were similar between leprosy (MB or PB) and control groups. GFR 1.2 mg/dl was observed in 17.9% of MB patients and in none of the controls (P=0.020). A negative correlation was observed between GFR and time of treatment (r= -0.339; P=0.002). Age and time of treatment were independent risk factors for GFR 相似文献   

Simultaneous heart and kidney transplantation in patients with end-stage heart and renal failure.

Combined simultaneous organ transplantation has become more common as selection criteria for transplantation have broadened. Broadening selection criteria is secondary to improved immunosuppression and surgical techniques. The kidney is the most common extrathoracic organ to be simultaneously transplanted with the heart. A series of 13 patients suffering from both end-stage heart and renal failure underwent 14 simultaneous heart and kidney transplantations at Temple University Hospital between 1990 and 1999. This is the largest series reported from a single center. Three patients died during the initial hospitalization for an in-hospital mortality of 21%. Of 10 patients who left the hospital, 1-year survival was 100% and 2-year survival 75%. One patient required retransplant for rejection within the first year. Overall mortality at 1 and 2 years was 25 and 41%, respectively. Four out of nine (44%) patients greater than 5 years post-transplant were alive. Of the 10 patients who left the hospital, 66% were alive at 5 years. One patient succumbed to primary nonfunction of the cardiac allograft, while the four other deaths were secondary to bacterial or fungal sepsis. The patient's racial backgrounds were equally divided between African-American and white. These results are similar to those reported in a United Network of Organ Sharing Database (UNOS) registry analysis of 84 simultaneous heart and kidney transplants that found 1- and 2-year survival to be 76 and 67%, respectively. Simultaneous heart and kidney transplantation continues to be a viable option for patients suffering from failure of these two organ systems, although the results do not match those of heart transplant alone.     

Significant benefits after renal transplantation in patients with chronic heart failure and chronic kidney disease

Background: Chronic heart failure (CHF) and chronic kidney disease (CKD) are serious medical conditions with significant morbidity and mortality and often coexist. Because of perioperative risks in these patients, they may not be considered a candidate for renal transplantation (RTx).

Material and methods: We compare retrospectively RTx outcomes [graft/patient survival, rejection rates and adverse cardiac events] in study group [low left ventricular ejection fraction (LVEF) ≤45% by echocardiogram, n?=?63] and control group [normal LVEF ≥50%, n?=?537] from a developing country.

Results: The mean EF was 35?±?5.6 and 57?±?3% for the study and control groups, respectively (p?Conclusion: RTx may play a role in reversing LV systolic dysfunction. Once thought by many to be a contraindication for renal transplantation, this appears not to be the case. The outcomes between the 2 groups are comparable and transplant is an option for even low EF patients.     

Poor prognosis of heart transplant patients with end-stage renal failure.

BACKGROUND: Chronic kidney disease (CKD) and end-stage renal failure (ESRF) are major complications after a heart transplant. The aim of this study is to compare survival in heart transplant (HT) vs non-heart transplant (non-HT) patients starting dialysis. METHODS: Survival was studied among the 539 newly dialysed patients between 1 January 1995 and 31 December 2005 in our Department. All patients were prospectively followed from the date of first dialysis up to death or 31 December 2005. Multivariate survival analysis adjusted on baseline characteristics was performed with the Cox model. RESULTS: There were 21 HT patients and they were younger than non-HT patients at first dialysis: 58.6+/-11.6 vs 63.0+/-16.2 years (P=0.09). Calcineurin inhibitor nephrotoxicity was the main cause of ESRF in HT patients (47.6%). Crude 1, 3 and 5-year survival rates in HT and in non-HT patients were as follows: 76.2%, 57.1%, 28.6% and 79.1%, 58.7%, 46.7% (P=0.2). The adjusted hazard ratio of death in HT vs non-HT patients was 2.27 [1.33-3.87], P=0.003. Sudden death was the main cause of death in HT patients, in 33.3% vs 10.4% in non-HT patients (P=0.01). Five HT patients benefited from renal transplant. They were all alive at the end of the study period, while one patient among the 16 remaining on dialysis survived. CONCLUSION: HT patients with CKD who reached ESRF have a poor outcome after starting dialysis in comparison with other ESRF patients. Improvement in renal function management in the case of CKD is needed in these patients and non-nephrotoxic immunosuppressive regimens have to be evaluated. Renal transplant should be the ESRF treatment of choice in HT patients.     

The evaluation of the effects of renal failure on erectile dysfunction in a rabbit model of chronic renal failure

OBJECTIVE: To determine whether chronic renal failure (CRF) reduces nitrergic relaxant responses in a rabbit model. MATERIALS AND METHODS: Ten rabbits underwent surgery to induce uraemia (CRF rabbits) and a further 10 a sham operation (controls). Corpus cavernosal tissue was prepared and used in organ-chamber experiments, with relaxation assessed against a background of pre-contraction with phenylephrine. At the plateau of contraction, relaxation responses to cumulative concentrations of carbachol or sodium nitroprusside (SNP), to test endothelium-dependent and -independent relaxations, respectively, were assessed. Before electrical-field stimulation (EFS), the tissue was treated with an adrenergic nerve blocker and a muscarinic receptor blocker to eliminate the adrenergic and cholinergic components, and to determine the relaxation responses to the stimulation of nonadrenergic, noncholinergic (NANC) nerves. The relaxation responses in corporal strips obtained from CRF rabbits were compared with those from controls. RESULTS: When tissues were contracted with KCl, tensions were similar in all groups. The impairment in concentration-dependent relaxation with carbachol was significant in CRF rabbits, but SNP- and papaverine-induced concentration-dependent relaxation responses were no different among the groups. EFS-induced frequency-dependent relaxations were significantly lower in CRF rabbits than in controls. CONCLUSION: CRF inhibits the NANC-mediated relaxation of rabbit corpus cavernosum smooth muscle. Changes in NANC-mediated and carbachol-induced (endothelium-dependent) relaxation of corporal smooth muscle in the rabbit are probably caused by uraemia and subsequently, hyperthyroidism, hyperparathyroidism or low testosterone levels in CRF. These results also suggest that if vasoactive agents are to be used for treating erectile dysfunction in uraemic patients, direct-acting vasodilators and phosphodiesterase inhibitors will be useful.     

Gastrointestinal function in chronic renal failure

Feeding problems, anorexia and vomiting are common in infants and children with chronic renal failure (CRF), and play a major role in the growth failure often found in this condition. However, the gastroenterological and nutritional aspects of CRF in children have received little attention, hence therapeutic interventions are usually empirical and often ineffective. Gastritis, duodenitis and peptic ulcer are often found in adults with CRF on regular haemodialysis and following renal transplantation. Despite persistent hypergastrinaemia, gastric acid secretion is decreased rather than increased in most of these patients, and active peptic disease appears to be promoted by the removal of the acid output inhibition (neutralisation of gastric acid by ammonia) that follows active treatment.Helicobacter pylori, on the other hand, does not seem to play a significant role in the pathogenesis of peptic disease in CRF. Gastro-oesophageal reflux has been found in about 70% of infants and children with CRF suffering from vomiting and feeding problems, and thus appears to be a major problem in these patients. In a number of symptomatic patients with CRF, gastric dysrhythmias and delaved gastric emptying have also been found; hence there appears to be a complex disorder of gastrointestinal motility in CRF. Serum levels of several polypeptide hormones involved in the modulation of gastrointestinal motility [e.g. gastrin, cholecystokinin (CCK), neurotensin] and the regulation of hunger and satiety (e.g. glucagon, CCK) are significantly raised as a consequence of renal insufficiency, and can be reverted to normal by renal transplantation. Furthermore, several other humoral abnormalities (e.g. hypercalcaemia, hypokalaemia, acidosis, etc.) are not uncommon in CRF. By directly affecting the smooth muscle of the gut or stimulating particular areas within the central nervous system, all these humoral alterations may well play a major role in the gastrointestinal dysmotility, anorexia, nausea and vomiting in patients with CRF. Specific pharmacological and nutritional interventions should thus be considered for the treatment of vomiting and feeding problems in CRF.     

Predictors of worsening renal function in adult patients with congestive heart failure receiving recombinant human B-type brain natriuretic peptide (nesiritide).

BACKGROUND: A recent meta-analysis suggested that the use of nesiritide (NES), a new agent for the treatment of congestive heart failure (CHF), is associated with an increased risk of acute renal failure (ARF). METHODS: We examined this issue among 219 consecutive CHF patients, and determined the risk factors for development of ARF [defined as a rise in serum creatinine (SCr) >0.3 mg/dl]. The sole primary outcome was the development of ARF. RESULTS: Seventy one of 219 patients received NES. There was no difference in ARF between patients receiving vs not receiving NES (29 vs 20%, P = 0.17). Evaluation of the entire cohort employing forward stepwise regression analysis revealed the following independent predictors of ARF: admission blood urea nitrogen (BUN) [P = 0.0004, odds ratio (OR) = 1.026], and admission brain natiuretic peptide (P = 0.04, OR = 1.0003). We repeated the same analysis for the subgroups of patients receiving or not receiving NES. For patients not receiving NES (n = 148), ARF developed in 30 (20%), with lower estimated glomerular filtration rate and older age being independent predictors. For patients receiving NES (n = 71), ARF developed in 21 (29%), with hypertension, elevated BUN/SCr ratio, and lack of use of angiotensin inhibitors being independent predictors. CONCLUSION: Among all patients with CHF, the use of NES was not an independent risk factor for the development of ARF. However, risk factors for developing ARF differed among patients receiving vs not receiving NES. Comparison of these differing factors suggests that administering NES in the setting of diminished renal perfusion and/or altered renal autoregulation may confer an increased risk of ARF.     

经导管肾交感神经消融术治疗慢性心力衰竭的有效性和安全性:Meta分析

目的通过Meta分析方法评价经导管肾交感消融术(RDN)治疗慢性心力衰竭的有效性及安全性。方法在Cochrane Library、PubMed、EMBASE、中国知网及万方数据库中,检索自建库至2018年12月发表的关于RDN治疗慢性心力衰竭的临床研究,经筛选后用于Meta分析。主要结局指标为左心室射血分数(LVEF)、左心室收缩末期内径(LVDD)及脑钠肽(BNP),次要结局指标为心率、收缩压及舒张压、6 min步行试验结果。采用Rev Man 5.3统计分析软件进行数据处理。以加权均数差(WMD)或标准化均数差(SMD)及95%CI表示效应量。随机对照试验(RCT)和队列研究(CS)采用"RDN组"和"药物治疗组"的结局指标变化,自身对照试验采用"治疗前"和"治疗后"的结局指标变化,进行Meta分析。结果共纳入8篇文献(230例患者)。在RCT/CS中,RDN组主要结局指标LVEF较药物治疗组明显升高[WMD=7.17,95%CI(3.77,10.56),P0.01],LVDD[WMD=-4.42,95%CI(-0.59,0.26),P0.01]及BNP[SMD=-1.48,95%CI(2.38,-1.12),P0.01]明显降低;次要结局指标心率明显降低[WMD=-9.96,95%CI(-17.08,-2.12),P=0.01],收缩压明显升高[WMD=12.89,95%CI(1.15,24.17),P=0.27],舒张压及6 min步行试验结果差异均无统计学意义(P均0.05)。自身对照试验中,RDN治疗后BNP较治疗前明显升高[SMD=-0.47,95%CI(-0.83,0.11),P=0.01],心率较治疗前明显降低[WMD=-2.57,95%CI(-4.75,-0.39),P=0.02],其余主要及次要结局指标差异均无统计学意义(P均0.05)。结论经导管RDN治疗可明显改善慢性心力衰竭患者心功能。     

Cardiac function and structure in patients with chronic renal failure

The long-term consequences of cardiac alterations in children with chronic renal failure (CRF) and after renal transplantation (TX) are largely unknown. Studies in adults with end-stage renal disease (ESRD) assume that the fate of many pediatric patients is determined by a high cardiovascular morbidity and mortality. This review describes clinical manifestations, pathophysiology, cardiac function and structure, and management of heart disease in children with CRF and post transplant. Echocardiography and Doppler ultrasonography allow differentiation of three functional disturbances: hypercirculation, systolic left ventricular (LV) dysfunction, and diastolic LV dysfunction, in addition to analysis of LV size and myocardial mass. From adult studies LV hypertrophy is recognized as an early prognostic marker of cardiovascular disease. It is present in about half of children with ESRD and after TX. It may regress, at least in part, by control of hypertension, hypervolemia, and anemia. Experimental studies have shown that, independent of these hemodynamic complications, uremia is associated with structural abnormalities of the heart, which were also described in adult patients with ESRD. These lesions consist mainly of hypertrophy of cardiomyocytes, interstitial fibrosis, and vascular changes (rarefied capillaries, thickened arteriolar walls). Cardiac complications in children with CRF and after TX deserve regular clinical and echocardiographic monitoring in order to minimize later cardiovascular morbidity by appropriate treatment. Received: 3 December 1998 / Revised: 16 April 1999 / Accepted: 19 April 1999     

The impact of anaemia and kidney function in congestive heart failure and preserved systolic function.

BACKGROUND: The importance of anaemia in chronic heart failure was highlighted recently by different cohort studies. The aim of this study was to assess the prevalence of anaemia and its relationship to renal function, left ventricular function and symptoms of heart failure. METHODS: We surveyed cases of patients admitted to the Department of Cardiology during 22 consecutive months. Laboratory measurements, blood pressure and echocardiographic parameters were obtained with standardized methods. RESULTS: Out of a total number of 2941 patients, 238 patients (8.1%) had haemoglobin values <11 g/dl. There was a positive association of anaemia with the symptoms of heart failure with a lowering of the median haemoglobin from 14.2 g/dl [New York Heart Association (NYHA) I] to 12.9 g/dl (NYHA IV, P<0.001). Interestingly, anaemia was not associated with left ventricular function or any left ventricular parameters. Symptoms of heart failure, however, were associated with kidney function. The estimated glomerular filtration rate (GFR) was 82 ml/min at NYHA I and 59 ml/min at NYHA IV, P<0.05. There was an association between impaired renal function and haemoglobin values. Haemoglobin was 14.2 g/dl in the group with normal renal function and 11.1 g/dl in the group with a GFR <25 ml/min (P<0.001). Even in patients with normal renal function (878 patients, GFR >85 ml/min), we still found an association of anaemia with the symptoms of heart failure. Haemoglobin was 14.5 g/dl at NYHA I and 13.4 g/dl at NYHA IV, P<0.0001. CONCLUSION: Anaemia is found in 8.1% of patients admitted to cardiology service. Anaemia was clearly associated with symptoms of congestive heart failure even in patients with normal renal function. Anaemia was not associated with left ventricular function.     

Association between renal function and cognition in childhood chronic renal failure

Forty-five children with renal failure who were either being medically managed, receiving dialysis (hemodialysis or continuous ambulatory peritoneal dialysis) therapy or who had received successful kidney transplants were longitudinally examined on multiple neuropsychological measures. A variety of medical parameters was also obtained at each time of testing. The neuropsychological variables were correlated with the medical variables using the repeated measures regression analysis method. There were associations between levels of renal function, short-term memory and list learning. Other neuropsychological variables did not in general correlate with the medical parameters consistently for all ages at the time of initial testing. Verbal performance decreased with increasing duration of renal failure in 6- to 11-year-olds and immediate recall decreased with increasing percentile rank of systolic blood pressure in 16- to 18-year-olds.     

Prevalence of biliary lithiasis in a Sicilian population of chronic renal failure patients.

BACKGROUND: The aim of this study was to evaluate the prevalence of biliary lithiasis (BL) and associated risk factors in a population of undialysed patients with chronic renal failure (CRF), and to compare these with findings we had obtained previously in chronic haemodialysis (HD) patients and in subjects from the general population located in the same geographic region. METHODS: A total of 118 CRF patients on conservative treatment were included in the study. In all subjects, we measured several clinical and humoral parameters potentially correlated with BL. Liver and biliary tract ultrasonography was performed with a 3.5 MHz linear probe after at least 12 h of fasting. RESULTS: The prevalence of BL in CRF patients was 22%, which was higher than in the general population (chi(2) = 9.4, P < 0.002) but lower than in HD patients (chi(2) = 25.9, P < 0.0001). Age was similar in the three groups. Body mass index (BMI) was significantly higher in the CRF group than in both HD patients (P < 0.0001) and the general population (P < 0.0001). When the CRF group was divided into subjects with or without BL, the only difference was lower serum calcium levels in the subgroup with BL (P < 0.04). CONCLUSIONS: The prevalence of BL in a Sicilian population of CRF patients was higher than in the general population, but lower than in patients with CRF on chronic HD. Apart from BMI, none of the risk factors traditionally associated with BL in the general population were related to BL in the CRF patients. These data suggest that other factors inherent to kidney pathology contribute to the high prevalence of BL in CRF patients.     

Atrial natriuretic peptide as a preload depressor in acute renal failure secondary to congestive heart failure

The present study was undertaken to verdy the hypothesis that infusion of atrial natriuretic peptide (ANP) might lower preload and be beneficial in the treatment of pulmonary congestion even without a diuresis in patients with acute renal failure (ARF) secondary to severe congestive heart failure (CHF). We studied 22 patients with ARF secondary to CHF. The mean age of the patients (14 men and 8 women) was 72 years (range 36 to 85 years). Seven of the patients had dilated cardiomyopathy, ten had ischemic heart disease, and five had valvular heart disease. ANP was infused intravenously and the following data before and 1 hour after the start of ANP infusion were recorded; urinary output, systemic blood pressure (SBP), pulmonary blood pressure (PBP), right atrial pressure (RAP), cardiac index (CI), heart rate (HR), and arterial blood oxygen pressure. Diastolic PBP were employed as plumonary capillary wedge pressure. Urinary output did not change. Mean SBP decreased from 92 to 85 mmHg (p < 0.05), and mean PBP decreased from 34 to 28 mmHg (p < 0.01). Mean RAP decreased from 11 to 9 mmHg (p < 0.01) and diastolic PBP decreased from 25 to 19 mmHg (p < 0.01). HR did not change significantly and CI increased 2.4 to 2.5 mi/min/m² (p < 0.05). Arterial blood oxygen partial pressure increased significantly from 71 to 82 mmHg (p < 0.05). In conclusion, ANP decreased and improved arterial blood oxygen partial prissure, though diuretic response to ANP is attenuated in ARF secondary to CHE. Infusion of ANP will be very beneficial in cases in which dyspnea and pulmonary edema due to elevation of preload are the principal clinical problems.     

Colchicine myoneuropathy in chronic renal failure patients with gout

Colchicine myoneuropathy is a rare and often underdiagnosed disease. It often presents as painless subacute muscle weakness. We present a case of painful colchicine myoneuropathy in a 76-year-old man with chronic renal failure and gout. Published work about clinical presentations of colchicine myoneuropathy in gouty arthritis patients are reviewed. During the previous year, the patient had a drug regimen of colchicine 0.5 mg three times per day for a 3 day course each month. He developed bilateral lower leg weakness and severe myalgia. His serum creatinine level was 680.7 micromol/L and creatinine kinase was 959 IU/L on admission. Laboratory findings included decreasing amplitude of motor and sensory nerve conduction velocity and an electromyogram showed small amplitude, short duration polyphasic waves over the right biceps. A muscle biopsy disclosed vacuolar changes in the cytoplasm. These results all supported a diagnosis of colchicine myoneuropathy. After cessation of colchicine, the creatinine kinase level decreased approximately 50% in 6 days, myalgia subsided and his muscle weakness improved gradually over the next 2 weeks.     

Effects of chronic renal failure on the expression of connexin 43 in the rat＇s corpus cavernosum

Aim： To explore the mechanism of chronic renal failure （CRF）-related erectile dysfunction （ED）. Methods： CRF experimental models were established by 5/6 nephrectomy from male Sprague-Dawley rats. Both the rats from the control group （NCRF group, n = 6） and the experimental group （CRF group, n = 30） were injected with a low dose （80 μg/g） of apomorphine in the 12th week after resection surgery to measure corresponding penile erections. Western blot method was thereafter conducted to measure the expression of connexin 43 （CX43） in the rat corpus cavernosum in the 12th week after the resection surgery. Results： There was one death in the NCRF group and five in the CRF group. The penile erection ratio of the CRF group was 28% （7/25）, whereas that of the NCRF group was 100% （5/5）, which presents a significant difference between the two groups （P 〈 0.05）. In terms of penile erection frequency, the average of the CRF group was 1.0 ± 0.0, which was significantly different from that of the NCRF group （2.2 ± 0.8） （P 〈 0.05）. As for the expression of CX43 in the rat corpus cavernosum, a notable difference existed between the CRF group （0.21 ± 0.07） and the NCRF group （0.53 ± 0.27） （P 〈 0.01）. Conclusion： CRF significantly reduces the erectile function of rats. A close correlation exists between the expression of CX43 in rats＇ corpus cavernosum and CRF-related ED. （Asian J Andro12008 Mar; 10： 286-289）     

慢性肾功能衰竭患者结核感染预防治疗的指征探讨

观察了８３０例慢性肾功能衰竭患者长期随访过程中结核感染的发生情况，以探讨这类患者预防性抗结核治疗的指征。由此提示，具有前三项中一项或一项以上因素的慢性肾衰患者应视为结核感染的高危人群而给予预防性抗结核治疗。     

Aetiology and outcome of acute and chronic renal failure in infants.

BACKGROUND: The aetiology and outcome of acute (ARF) and chronic renal failure (CRF) in infants were analysed in a retrospective study. METHODS: Between January 1997 and April 2004 all children <1 year of age with a serum creatinine >100 mumol/l at Hannover Medical School were followed up for up to 6 years. One hundred and nineteen children with a serum creatinine >100 mumol/l were identified, 70 infants suffering from ARF and 49 from chronic kidney disease (CKD), stages 3-5. RESULTS: Renal failure was caused in 49/119 (41%) by congenital and in 70/119 (59%) by acquired diseases. The aetiology of ARF (n = 70) included cardiac (27%), prematurity (27%), septic (10%), hepatic (9%), renal (9%) and other (18%) causes. Twelve infants needed transient dialysis treatment. Renal function recovered in all surviving children. The mortality rate was 37%. Causes of death were unrelated to kidney function. Twenty-one of 49 infants with CKD were dialyzed with a median age of 65 days at the start of dialysis, and 23/49 children received a kidney transplant (RTx). The 5-year patient and graft survival for RTx-children of 95.5% was not different from older children. The 5-year patient survival rate of 26 children with CKD without RTx was 63%. The causes of death were parental refusal of therapy in neonates (n = 4) and life-threatening extra-renal comorbidity (n = 3). CONCLUSION: Renal replacement therapy offers good chances of survival in infants without life-threatening comorbidity. Patient survival of infants treated for CKD in the first year of life was comparable to that of older children.