儿童急性肾损伤定义和诊断

<正>近年来,国际肾脏病和急救医学界趋向用急性肾损伤(acute kidney injury,AKI)来取代传统的急性肾衰竭(acuterenal failure,ARF)[1]。ARF是发生在各种临床情况之下(儿童或成人,门诊或住院,ICU或非ICU患者)的一种复杂的     

儿童急性肾损伤生物学标志

<正>国际肾脏病和急救医学界已逐步以急性肾损伤(acute kidney injury,AKI)取代急性肾功能衰竭(ARF)这一概念,旨在更确切地反映该临床综合征的本质和动态病理生理     

儿童急性肾损伤病因及预防

<正>1儿童急性肾损伤(AKI)的病因概述1.1儿童AKI的病因分类AKI的病因一般可分为三大类:肾前性,肾实质性,肾后梗阻性。近10年来,儿童AKI的病因已从原发性肾脏疾病转变为多因素的病因,尤其是     

儿童急性肾损伤临床综合治疗

<正>急性肾衰竭(ARF)是临床常见的急重症,起病急骤,病因和临床表现多种多样,病死率较高,但通过及时正确的治疗,大部分肾功损害是可逆的。近十年来,国际肾脏病     

小儿急性肾损伤的流行病学

近年来国际肾脏病和急救医学界趋向于用急性肾损伤(acute kidney injury,AKI)来取代急性肾功能衰竭的概念.儿童AKI的病因日趋复杂,已由原发性肾脏疾病为主转变为多因素所致,且AKI不仅明显延长了PICU患儿的住院时间,也增加了PICU患儿的病死率.本文将对AKI的病因及流行病学作一简单的介绍,并对RIFLE及AKIN两个诊断标准进行分析.     

儿童急性肾损伤常用血液净化疗法

<正>近年来,以急性肾损伤(AKI)的概念代替急性肾功能衰竭(ARF)[1]。目前对AKI患者进行肾脏替代治疗最佳时机尚无统一标准。国内文献报道在AKI1期或2期即行连续性静脉-静脉血液滤过(CVVH)可明显改善预后,而在     

Epidemiology of traumatic brain injury in children and adolescents in south-western Sweden

Abstract The objectives of this study were to outline the incidence, gender distribution, external causes, severity and early outcome of traumatic brain injury (TBI). The subjects were children and adolescents in the southwestern Swedish health care region, aged 0–17 y in 1987–1991 and fulfilling the criteria for TBI. Identification was made from the discharge registers of the hospitals in the region admitting patients with TBI, and outcome data were obtained from medical records. The mean incidence rate was 12/100 000 for TBI. The dominant external cause was traffic (60%), followed by falls (22%). At discharge, 49% of those surviving were healthy, 48% suffered from one functional impairment and 52% suffered from two or more impairments. In conclusion, although the incidence rate of TBI is low in Sweden, the condition causes permanent functional impairment in 6/100 000 cases every year.     

新生儿急性肾损伤研究进展

新生儿急性肾损伤(AKI)的发生率并不低,在缺氧缺血性损伤、感染、肾毒性药物的使用及泌尿道梗阻等情况下均可发生,其中我国以围生期窒息排在病因的首位.近年来由于食品安全问题形势严峻,泌尿道梗阻的发生率也在上升.对于AKI高危儿,儿童卫生保健系统应更加注重此类疾病的预防及筛查.在新生儿AKI人群中,由于血清肌酐及尿液受较多因素影响,波动较大或难以定量计算,使得明确诊断有一定困难,因此关于新生儿AKI早期标志物的研究有极大的临床意义,目前研究热点包括中性粒细胞明胶酶相关脂质运载蛋白及胱抑素C.新生儿AKI的治疗应该注重解决原发疾病如缺氧缺血等,严重病例可考虑肾脏替代治疗,但病死率仍较高,主要与原发疾病严重度及并发症的出现有关.     

急性肾损伤患儿的营养支持

急性肾损伤是危重患儿常见的多器官功能障碍之一,常发生在危重疾病的严重分解代谢期,代谢紊乱又使肾损伤进一步加重。营养支持对于改善预后至关重要。伴有急性肾损伤的危重患儿存在特殊的营养需求,需要提供肠内或肠外营养支持。应反复评估此类患儿营养需求的变化,以寻求个体化营养支持以及与肾脏替代治疗的精细整合。     

Oral penicillin‐associated acute kidney injury in an infant with acute pyelonephritis

Beta‐lactam‐associated acute tubulointerstitial nephritis (ATIN) is a rare condition in childhood. We report the case of an infant with penicillin‐associated ATIN and concomitant acute pyelonephritis resulting in the development of severe acute kidney injury (AKI). The treatment consisted of penicillin suspension and appropriate AKI management, which required a short period of dialysis. Finally, full recovery and normalization of laboratory parameters occurred. We present here the first case of oral penicillin‐associated ATIN in childhood.     

儿童急性肾损伤的诊断及早期标志物

近年来国际肾脏病和急救医学界应用急性肾损伤取代传统急性肾功能衰竭的概念,旨在早期诊断,以期达到早期干预、早期治疗、降低病死率的目的.单纯根据尿量及血肌酐值的变化不能早期及时诊断急性肾损伤,目前一些新的生物学标志物的出现为急性肾损伤的早期诊断和早期干预提供了可能.     

儿童异基因造血干细胞移植后急性肾损伤临床分析

目的分析儿童异基因造血干细胞移植(allo-HSCT)后急性肾损伤(AKI)的临床特征及危险因素。方法回顾性分析2016年8月至2020年3月于武汉儿童医院血液肿瘤科接受allo-HSCT患儿的临床资料,对比移植预处理开始前及移植后100天血肌酐(Cr)、肌酐清除率(Ccr),以及移植后1年的生存情况;采用logistic回归分析影响AKI发生的危险因素。结果共147例allo-HSCT患儿纳入研究,其中男85例、女62例,接受移植时中位年龄5.5岁(0.7个月～16岁)。其中101例(68.7%)患儿发生AKI,中位时间为移植后24.0(-5.0～91.0)d。二元logistic回归分析显示,移植后急性移植物抗宿主病(aGVHD)、肝窦间隙阻塞综合征(SOS)是AKI发生的独立危险因素(P<0.05)。按pRIFLE诊断标准将发生AKI的101例患儿分为风险期组54例、肾损伤期组31例以及肾衰竭期组16例。不同分期之间患儿Cr以及Ccr差异均有统计学意义(P<0.05),肾衰竭期组Cr较高,Ccr较低。allo-HSCT后随访1年,18例患儿死亡,其中AKI患儿死亡16...     

尿IGFBP-7对危重症患儿急性肾损伤的早期预测价值

目的探讨尿胰岛素样生长因子结合蛋白7(IGFBP-7)对危重症患儿急性肾损伤(AKI)的早期预测价值。方法选择2012年5月至8月儿童重症监护病房(PICU)收治的患儿为研究对象。分为轻度AKI(AKI 1期)、严重AKI(AKI2和3期)和非AKI组。检测入PICU第一个24小时尿IGFBP-7水平,并于入PICU 24小时内行儿童死亡风险Ⅲ(PRISMⅢ)评分。以多因素logistic回归分析评估在校正混杂因素后尿IGFBP-7与AKI的关系,用受试者工作特征曲线(ROC)及曲线下面积(AUC)评价尿IGFBP-7对危重症患儿AKI的早期预测价值。结果共纳入危重症患儿144例,21例(14.6%)在样本采集120小时内发生AKI,其中严重AKI 11例。严重AKI组入PICU第一个24小时的尿IGFBP-7水平、PRISMⅢ评分均高于轻度AKI及无AKI组,差异均有统计学意义(P0.05)。Logistic回归分析显示,在校正年龄、体质量、PRISMⅢ评分后,尿IGFBP-7是严重AKI的独立危险因素(OR=2.93,95%CI:1.07～8.03,P=0.037),预测危重症患儿严重AKI的AUC值为0. 79(95%CI:0. 66～0. 92,P=0. 001)。结论尿IGFBP-7是危重症患儿严重AKI的独立预测指标,具有早期预测价值。     

Hematopoietic stem cell transplantation and acute kidney injury in children: A comprehensive review

AKI in the setting of HSCT is commonly investigated among adult patients. In the same way, malignancies requiring treatment with HSCT are not limited to the adult patient population, AKI following HSCT is frequently encountered within pediatric patient populations. However, inadequate information regarding epidemiology and pathophysiology specific to pediatric patients prevents development of appropriate and successful therapeutic strategies for those afflicted. Addressing AKI in the context of sinusoidal obstruction syndrome, chemotherapy, thrombotic microangiopathy and hypertension post chemotherapy, glomerulonephritis, and graft versus host disease provides greater insight into renal impairment associated with these HSCT‐related ailments. To obtain a better understanding of AKI among pediatric patients receiving HSCT, we investigated the current literature specifically addressing these areas of concern.     

Epidemiology of childhood acute myeloid leukemia

Although leukemia is the most common childhood cancer diagnosis, the subtype, acute myeloid leukemia (AML), is less common and fewer etiologic studies exist. This review summarizes the major risk factors for AML. We searched the literature using PubMed for articles on childhood AML and reviewed 180 articles. While few risk factors are definitive, we identified several with consistent evidence of a possible effect. Thorough analysis of genetic and epigenetic factors is missing from this literature and methodological issues are unresolved. Future studies should more closely examine causal mechanisms, improve exposure measurement, and include analysis using genetic and epigenetic factors. Pediatr Blood Cancer 2013; 60: 728–733. © 2013 Wiley Periodicals, Inc.     

Severe intrinsic acute kidney injury associated with therapeutic doses of acetaminophen

Acetaminophen is a commonly used medication to manage fever and pain in children and the drug is generally considered to be safe when used at appropriate therapeutic dosages. Recently, we encountered the case of a 3‐year‐old Japanese girl who suffered from severe intrinsic acute kidney injury (AKI) after therapeutic doses of acetaminophen for a fever due to viral infection. Renal biopsy indicated severe acute tubular necrosis with a significant striped interstitial fibrosis and mild interstitial inflammation. Unfortunately, she developed chronic kidney disease thereafter. This is the youngest case of biopsy‐proven severe intrinsic AKI associated with therapeutic doses of acetaminophen. Acetaminophen, even if administered at therapeutic dosages, may be dangerous in selected children, especially with possible pre‐existing volume depletion.     

急性肾损伤的定义、诊断及治疗

近年来凼际肾脏病和急救医学界趋向于用急性肾损伤(AKI)来取代急性肾衰竭(ARF)的概念,这对于早期诊断、早期治疗和降低病死率具有更积极的意义.新的AKI诊断标准为48 h内血肌酐上升26.5 μmol/L(0.3 mg/dl)或较原先水平增高50%;和(或)尿量减少<0.5 ml/(kg·h),持续6 h以上.AKI诊断的新生物学标志物正处于研究中.AKI的治疗仍以肾脏替代治疗为主,但目前关于肾脏替代治疗的时机、模式、剂量尚存在争议.