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.     

关注儿童用药后的肾损伤

药物性肾损伤是儿童急性肾损伤的主要原因之一。药物经由肾脏代谢排泄时导致肾小管上皮细胞损伤、肾脏免疫炎症,或导致肾内血流动力学改变,或形成结晶堵塞肾小管。临床主要表现为急性肾损伤、急性肾小管坏死、急慢性间质性肾炎、结晶性肾病、肾病综合征、肾小管功能障碍等。应用生物标志物可以早期监测药物性肾损伤。临床工作中应及时纠正药物性肾损伤的高危因素,及时停用相关药物和监测肾功能,力求早期诊断,早期干预,改善预后。     

小儿急性肾衰竭诊断标准及治疗进展

急性肾衰竭是儿科临床常见的危重症肾脏疾病。早期诊断、早期治疗是改善儿童急性肾衰竭预后、提高患儿生存率的关键。现重点介绍小儿急性肾衰竭诊断标准及治疗方案研究进展，从急性。肾损伤的定义、诊断标准和分期到急性肾衰竭的治疗措施进行阐述。     

急性肾损伤生物标记物的临床研究进展

急性肾损伤是一组以急性肾功能减退为特征的临床综合征,是危重症患者的常见并发症之一,治疗棘手,病死率高.临床上大多数使用血肌酐和尿量作为急性肾损伤的诊断标准,不能及时和准确反映肾功能变化.目前一些新的生物学标记物的出现为急性肾损伤的早期诊断和治疗提供了可能,本文就目前研究较热的几种生物学标记物作一简单综述.     

关注儿童脓毒症急性肾损伤

阐述儿童脓毒症急性肾损伤的临床流行病学特点、主要发病机制、早期诊断指标及治疗要点,提醒儿科临床医师要关注儿童脓毒症急性肾损伤的救治。     

新生儿窒息后急性肾损伤的诊治进展

新生儿窒息后急性肾损伤发生率可达56％,易导致多脏器损伤及新生儿死亡.该文综述了近年来国内外窒息后肾损伤的早期诊断生物学标记物、尿蛋白、尿酶、脉冲多普勒超声肾血流检查及治疗的新进展,对新生儿窒息后急性肾损伤的早期诊断、治疗,提高窒息新生儿的存活率、改善预后具有重要意义.     

中性粒细胞明胶酶相关脂质运载蛋白与急性肾损伤

中性粒细胞明胶酶相关脂质运载蛋白（neutrophil gelatinase-associated lipocalin,NGAL）是脂质蛋白家族成员之一,首先于中性粒细胞中分离得到的一种稳定多肽。作为新型临床早期诊断急性肾损伤的标志物,NGAL不易受机体、药物及。肾外因素影响,血液和尿液中浓度升高都可以预测急性肾损伤。动态监测NGAL可以评估临床治疗手段是否有效,对急性肾损伤的救治有参考意义。     

川崎休克综合征致急性肾损伤1例报告

目的探讨川崎休克综合征并发急性肾损伤的临床特征及治疗。方法回顾分析1例川崎休克综合征合并急性肾损伤患儿的临床资料。结果 12岁女性患儿,因发热、呕吐起病,诊断脓毒性休克,逐渐出现急性肾损伤;患儿于发热10天后热退,5次连续性肾脏替代治疗后尿量恢复,血压稳定,尿素氮和肌酐恢复正常。后期复查心脏彩超提示冠脉扩张,修正诊断为川崎休克综合征,加用阿司匹林口服出院。长期随访心脏彩超示冠脉扩张消失。结论川崎休克综合征早期诊断需与脓毒性休克鉴别,一旦并发急性肾损伤,积极采用血液净化治疗可有效改善预后。     

早期诊断急性肾损伤的生物学标志物研究现状

急性肾损伤(AKI)是一种常见的严重疾病.由于缺乏诊断AKI的早期生物学标志物,往往导致早期有效治疗的延误.目前对于诊断AKI新的生物学标志物的研究已发展到了临床研究阶段,最有希望成为早期诊断AKI的生物学标志物包括中性粒细胞明胶酶相关脂质运载蛋白、IL-18、肾损伤分子-1和L-脂肪酸结合蛋白.本文就近年来关于上述几种生物学标志物的研究作一综述,为应用早期诊断AKI的生物学标志物提供理论依据.     

早期诊断急性肾损伤的生物学标志物研究现状

急性肾损伤(AKI)是一种常见的严重疾病.由于缺乏诊断AKI的早期生物学标志物,往往导致早期有效治疗的延误.目前对于诊断AKI新的生物学标志物的研究已发展到了临床研究阶段,最有希望成为早期诊断AKI的生物学标志物包括中性粒细胞明胶酶相关脂质运载蛋白、IL-18、肾损伤分子-1和L-脂肪酸结合蛋白.本文就近年来关于上述几种生物学标志物的研究作一综述,为应用早期诊断AKI的生物学标志物提供理论依据.     

Evaluation of the prevalence and factors associated with acute kidney injury in a pediatric intensive care unit

ObjectiveTo assess the prevalence of acute kidney injury in pediatric intensive care unit according to diagnostic criteria – pediatric risk, injury, failure, loss, end-stage renal disease, Acute Kidney Injury Network and Acute Kidney Injury Work Group, or Kidney Disease: Improving Global Outcomes –, and determining factors associated with acute kidney injury as well as its outcome.MethodologyThis was a cross-sectional monocentric observational study, including patients aged between 29 days and 17 years who were admitted to the pediatric intensive care unit between January 1, 2012 and December 31, 2016. To evaluate the association between the study variables and acute kidney injury, the log-binomial generalized univariate and multivariate linear models were adjusted.ResultsThe study included 1131 patients, with prevalence of acute kidney injury according to the Acute Kidney Injury Network and Kidney Disease: Improving Global Outcomes criteria of 12.6% and of 12.9% according to the pediatric risk, injury, failure, loss, end-stage renal disease. In the multivariate analysis of older children (PR 1.007, 95% CI: 1.005–1.009), sepsis (PR 1.641, 95% CI: 1.128–2.387), demand for ventilatory support (PR 1.547, 95% CI: 1.095–2.186), and use of vasoactive amines (PR 2.298, 95% CI: 1.681–3.142) constituted factors associated with statistical significance to the development of acute kidney injury. The mortality rate among those with acute kidney injury was 28.7%.ConclusionOlder children, diagnosis of sepsis, demand for ventilatory support, and use of vasoactive amines were correlated with a higher risk of developing acute kidney injury. The mortality associated with acute kidney injury was elevated; it is crucial that all measures that ensure adequate renal perfusion are taken for patients with risk factors, to avoid the installation of the disease.     

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??Drug-induced kidney injury is one of the main causes of acute kidney injury in children. Certain drugs can lead to tubular epithelial injury??kidney immune inflammation??or alter the intraglomerular hemodynamics??or cause intrarenal obstruction??which contribute to clinical manifestations including acute kidney injury??acute tubular necrosis??acute or chronic interstitial nephritis??nephrolithiasis/crystal nephropathy??nephrotic syndrome??tubular dysfunction??et al. The setting of several biomarkers are used for prediction and detection of early drug-induced kidney injury. In clinical practice the risk factors of drug-induced kidney injury should be corrected in time and the related drugs be stopped and kidney function be monitored in order to achieve early diagnosis and early intervention??which can improve the prognosis.     

细胞自噬在急性肾损伤中的作用

急性肾损伤(acute kidney injury,AKI)是一种临床预后较差的常见疾病,肾小管上皮细胞的损伤及死亡是其主要的病理特征.近年来,大量的研究已经表明在急性肾损伤过程中,自噬在肾小管上皮细胞中被诱导发生.在多种药理干预或自噬相关基因敲除的急性肾损伤模型中,自噬能通过抑制炎症反应、清除损伤的细胞器等相关机制减少细胞凋亡,保护肾脏损伤.但是也有研究表明自噬在急性肾损伤中起损害作用.阐明自噬在急性肾损伤中的作用及相关调节机制能够为急性肾损伤的治疗及预后提供重要线索.     

Acute kidney injury

The definition and classification of acute kidney injury (AKI) in children has become clearer over the last decade. The paediatric RIFLE criteria stratify AKI in children into five groups (R = risk, I = injury, F = failure, L = loss of kidney function, E = end stage renal disease) enabling earlier recognition and intervention. This article reviews the definition, classification, causes and management of AKI as relevant to the general paediatrician.Common causes of AKI in neonates and children are reviewed including E. Coli associated haemolytic uraemic syndrome, hypoxic ischaemic insults and medication related kidney injury. Initial management of acute kidney injury and its complications is outlined in the context of the role of the general paediatrician and factors which should prompt discussion with a tertiary paediatric nephrologist. The outcome and complications of kidney injury are discussed and future directions in the field considered.     

Acute kidney injury in children

Acute kidney injury (AKI) affects 5% of critically ill hospitalized children and is a risk factor for increased morbidity and mortality. The current review focuses on new definitions of acute kidney injury, standardized to reflect the entire spectrum of the disease, as well as on ongoing research to identify early biomarkers of kidney injury. Its also provides an overview of current practice and available therapies, with emphasis on new strategies for the prevention and pharmacological treatment of diarrhea-associated hemolytic uremic syndrome. Furthermore, a decision-making algorithm is presented for the use of renal replacement therapies in critically ill children with AKI.     

肾损伤分子-1在急性缺血缺氧再灌注大鼠肾组织中的表达及意义

目的 观察肾损伤分子-1(kidney injury molecule-1,KIM-1)在急性缺血缺氧再灌注肾损伤(acute ischemia reperfusion kidney injury,AIKI)大鼠肾组织中的表达及分布规律,探讨其在诊断急性肾损伤(acute kidney injury,AKI)中的价值.方法 采用清洁级SD大鼠128只,随机分为对照组和模型组,模型组按国际标准建立大鼠AIKI模型,分别于2h、6h、24h、48h、72h、1周、2周、4周处死(n=8),取肾组织,常规HE染色,参照Sayhan等标准对肾小管间质损伤进行半定量评分;免疫组织化学、Western blot法检测KIM-1蛋白的表达及分布;生化法测定血清肌酐(serum creatinine,Scr)水平.结果 (1)大鼠缺血再灌注后2h即出现明显肾小管间质损伤,随着再灌注时间延长损伤加重,48h达高峰后逐渐减轻,但仍高于对照组(P<0.01);(2)Western blot和免疫组织化学检测发现,缺血再灌注后2h肾组织KIM-1的表达明显升高,KIM-1表达水平与肾小管间质损伤评分呈显著正相关(r=0.887,P=0.003);(3)大鼠缺血再灌注后2h Scr明显升高,48h达到最高值后降至正常,其升高与肾小管间质损伤评分无相关性(r=0.280,P=0.502).结论 AIKI模型中大鼠肾组织KIM-1蛋白表达水平显著增加,其表达水平与肾小管间质损伤评分呈正相关,与Scr相比,KIM-1可能为更准确地反映肾损伤情况的指标.     

PAX2与急慢性肾脏疾病研究进展

配对盒基因2(paired box2,PAX2)是一种核转录因子,表达在发育期肾脏。研究表明PAX2通过与PTIP的相互作用使染色质处于可转录状态,与Grg4的相互作用削弱了其与PTIP结合而抑制转录。 PAX2在急性肾损伤时再表达,参与促进细胞增殖修复。先天PAX2基因突变与先天性肾脏输尿管异常密切相关。在慢性肾脏疾病,PAX2起到促进增殖及囊肿形成的作用。该文就PAX2的功能及其在急性肾损伤和慢性肾脏疾病中作用的相关研究进行综述。     

Acute and chronic kidney injury during therapy for pediatric acute leukemia: A report from the Leukemia Electronic Abstraction of Records Network (LEARN)

Children with acute leukemia are at increased risk of kidney injury. Using electronic health record data from three centers between 2010 and 2018, this study retrospectively described acute kidney injury (AKI) and chronic kidney disease (CKD) prevalence in children with acute lymphoblastic or myeloid leukemia (ALL, AML) using Common Terminology Criteria for Adverse Events (CTCAE) and Kidney Disease Improving Global Outcomes (KDIGO) definitions. AKI during therapy was 25% (ALL) and 32% (AML) using CTCAE, versus 84% (ALL) and 74% (AML) using KDIGO. CKD prevalence was low and Grade 1/Stage 2. Further investigation is needed to optimally define kidney injury in acute leukemia.     

Continuous renal replacement therapy for patients with acute kidney injury caused by melamine-related urolithiasis

Background  

In 2008 there was an epidemic of renal disease affecting infants after consumption of melaminetainted milk products. Most of the infected children were asymptomatic or with mild symptoms, and a few suffered from acute obstructive kidney injury secondary to melamine-contained renal stones (8 of 15 577 children screened at our hospital for urolithiasis). This study was intended to retrospectively review the management of acute kidney injury using continuous renal replacement therapy (CRRT) in the 8 children with acute kidney injury.