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1.
Blood purification therapy in treatment of acute renal failure in infants with melamine-induced stones 总被引:1,自引:0,他引:1
Background In 2008, infants in some areas of China suffered from stones of the urinary system which were caused by melamine-contaminated milk formula. Most of the infants were asymptomatic, and a few suffered from acute renal failure induced by urinary obstruction by stones. This study aimed to assess the significance of blood purification therapy in treatment of infants with acute obstructive oligo-anuric renal failure. Corrective perception, timely diagnosis, and active treatment of this complex disease are critical factors that guarantee a quick recovery of renal function of infants and help them to prevent multiple organ system failure. Methods Thirteen infants with acute renal failure induced by urinary multiple obstruction caused by melamine-containing stones who had been admitted to Beijing Children's Hospital Affiliated to Capital Medical University in 2008 were investigated for the epidemiological characteristics, image features and indications of dialysis. All these infants were treated with dialysis. The efficacy of dialysis was compared with that of two control groups treated with cystoscopic retrograde catheterization into the ureter and medical treatment for the recovery of renal function. Results The 13 infants with life-threatening complications treated with dialysis showed a blood urea nitrogen (BUN) level of (30.9±7.9) mmol/L and a creatinine (Cr) level of (572±173)umol/L. Of these infants, 8 were treated with peritoneal dialysis (PD), and 5 with hemodialysis (HD). Ten infants recovered to urinate 24-72 hours after dialysis and 3 infants with persistent ureteral obstruction were further treated with cystoscopic retrograde catheterization into the ureter for drainage and urination resumed soon after the operation. The average time of PD and HD were (2.1±0.8) days and (1.2±0.4) days, respectively. The total average time of PD and HD dialysis was (1.77±0.83) days. The recovery time of renal function of infants after dialysis was (3.08±1.20) days, comparable to that of the two control groups treated with catheterization with a cystoscope or by medication. There was no significant difference in the recovery time of renal function among the three groups (P 〉0.05). Conclusions Melamine-contaminated milk formula may cause urinary stones and obstructive acute renal failure in infants. Dialysis is suggested to treat life-threatening complications such as hyperkalemia, oliguria or anuria if surgical intervention fails. If possible, hemodialysis or peritoneal dialysis can be performed early. Blood purification is feasible to help the infants overcome the critical stage of acute renal failure. Surgical measures can be taken to remove the obstruction if necessary. 相似文献
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XU-DONG JIA NING LI ZHU-TIAN WANG YUN-FENG ZHAO YONG-NING WU AND WEI-XING YAN 《Biomedical and environmental sciences : BES》2009,22(2):100-103
Objective To estimate the dietary melamine exposure in Chinese infants and young children from the consumption of melamine adulterated Sanlu infant formula. Methods Four age groups of infants and young children (3, 6, 12, and 24 months) were chosen as the assessed subjects and the maximum amount of infant formula consumption was estimated based on the recommended usage level in the package insert of Sanlu infant formula and other brands. Melamine was analyzed in 111 Sanlu infant fbrmula samples collected from the markets in Beijing and Gansu province using the LC-MS-MS with a limit of quantification of 0.05 mg/kg. Four levels of melamine concentration were chosen to estimate the dietary intakes, including the mean, median, 90th percentile, and maximum. Results The infants of 3 months had the highest intake of melamine, and with the increase of the age (inonth), the intake decreased. Based on the median melamine concentration (1 000 mg/kg) as an example, the melamine intakes fur the infants of 3, 6, 12, and 24 months were 23.4, 21.4, 15.0, and 8.6 mg/kg bw/d, respectively. Conclusion Dietary melamine intakes from tainted Sanln infant formula significantly exceeded the TDI level (0.2 mg/kg bw/d) recommended by the WHO Expert Meeting in 2008. However, the present assessment has some limitations including the poor representative samples, the varied melamine concentrations in the adulterated Sanlu infant formula, and other brand infant formula possibly consumed by these infants. 相似文献
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CHEN Jun-shi 《中华医学杂志(英文版)》2009,122(3):243-244
Since the spring of 2008, an increase of urinary tract 'stones in infants and young children were noticed by pediatricians in Gansu~ Hebei, Beijing, and other cities/provinces. This was followed by an epidemic of urinary tract stones in infants and young children in more than 10 provinces in the mainland of China. In September 2008, the cause of this unusual epidemic was identified, i.e. the illegal use of "protein essence" (melamine, an industrially synthesized chemical) in raw milk (the main ingredient of infant formula) to falsely increase the protein content of raw milk after dilution with water. This was a typical case of raw milk adulteration. When melamine concentration was high enough in the infant formula, because of its very low solubility, 相似文献
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Diagnosis and treatment of melamine-associated urinary calculus complicated with acute renal failure in infants and young children 总被引:2,自引:0,他引:2
SUN Ning SHEN Ying SUN Qiang LI Xu-ran JIA Li-qun ZHANG Gui-ju ZHANG Wei-ping CHEN Zhi FAN Jian-feng JIANG Ye-ping FENG Dong-chuan ZHANG Rui-feng ZHU Xiao-yu XIAO Hong-zhan 《中华医学杂志(英文版)》2009,122(3):245-251
Background Infants in some areas of China developed urinary lithiasis after being fed with powdered milk that was tainted with melamine in 2008 and very small proportion of the infants developed acute renal failure caused by urinary tract calculus obstruction. The aim of this article was to summarize clinical characteristics, diagnosis and treatment of infants with urinary calculus and acute renal failure developed after being fed with melamine tainted formula milk. Methods Data of infant patients with urinary calculus and acute renal failure due to melamine tainted formula milk admitted to the Beijing Children's Hospital Affiliated to the Capital Medical University and the Xuzhou Children's Hospital in 2008 were used to analyze the epidemiological characteristics, clinical manifestations, imaging features as well as effects of 4 types of therapies. Results All the 34 infants with urinary calculus were complicated with acute renal failure, their blood urea nitrogen (BUN) was (24.1±8.2) mmol/L and creatinine (Cr) was (384.2±201.2) umol/L. The chemical analysis on the urinary calculus sampled from 15 of the infants showed that the calculus contained melamine and acidum uricum. The time needed for the four types of therapies for returning Cr to normal was (3.5±1.9) days for cystoscopy group, (2.7±1.1) days for lithotomy group, (3.8±2.3) days for dialysis group, and (2.7±1.6) days for medical treatment group, which had no statistically significant difference (P=-0.508). Renal failure of all the 34 infants was relieved within 1 to 7 days, averaging (3.00±1.78) days. Conclusions Melamine tainted formula milk may cause urinary calculus and obstructive acute renal failure. It is suggested that firstly the patients with urinary calculus complicated with acute renal failure should be treated with dialysis or medication to correct electrolyte disturbance, in particular hyperkalemia, and then relieve the obstruction with available medical and surgical methods as soon as possible. It was observed that the short-term prognosis was satisfactory. 相似文献
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A Survey on Occurrence of Melamine and Its Analogues in Tainted Infant Formula in China 总被引:1,自引:0,他引:1
YONG-NING WU YUN-FENG ZHAO JIN-GUANG LI AND MELAMINE ANALYSIS GROUP 《Biomedical and environmental sciences : BES》2009,22(2):95-99
Objective To investigate the occurrence and concentrations of melamine and its analogues in tainted infant formula and to identify the etiologic factors for the urinary stones epidemic in infants and young children in China in 2008. Methods Sanlu infant formula samples were collected from families of the affected children in Gansu province, and markets in Gansu and Hebei provinces and Beijing city. Melamine and its analogues, including cyanuric acid, ammeline, and ammelide were measured by gas chromatography/tandem mass spectrometry. Results High prevalence and concentrations of melamine were found in Sanlu infant formula samples, with low concentrations of cyanuric acid, ammeline and ammelide. Melamine were detected in 87 out of 111 Sanlu infant formula samples with a range of 118 to 4 700 mg/kg, Conclusion The results provide strong evidence for melamine as the etiological factor for the urinary stones epidemic in infants and young children in China in 2008. 相似文献
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1病例介绍
患儿男,9个月。主因少尿12d入院。患儿于12d前无诱因出现纳差、恶心、呕吐、尿量减少,渐出现颜面水肿。经B超检查示双肾结石,双侧输尿管结石,双肾积水,双侧输尿管上段扩张。血生化检查提示肾功能衰竭,电解质及酸碱平衡紊乱。于9d前在某儿童医院给予血液滤过及对症治疗,期间患儿仍少尿,每日约50ml,水肿加重,出现胸腔及腹腔积液。为进一步去病因治疗转我院。入院前一天血液化验检查(血液滤过后): 相似文献
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《北京大学学报(医学版)》2009,41(2)
北京大学第一医院儿科管娜博士和范青锋博士等撰写的题为《三聚氰胺污染配方奶粉和儿童泌尿系结石》的研究论文,在The New England Journal of Medicine(NEJM)网络版发表,并配发了相关述评。该研究证实,早产和高三聚氰胺污染奶粉与泌尿系结石发生有相关性;受影响患儿缺乏典型的泌尿系结石的症状和体征,需要依靠泌尿系超声检查诊断。 相似文献
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刚刚过去的2008年9月11日,新闻媒体报道了三鹿牌婴幼儿配方奶粉受到三聚氰胺污染事件,甘肃等地报告多例婴幼儿泌尿系统结石病例与之有关。国家卫生部已经证实,并快速制定了《与食用受污染三鹿牌婴幼儿配方奶粉相关的婴幼儿泌尿系统结石诊疗方案》,(以下简称《诊疗方案》)。近日,许多家长前来咨询“污染奶粉结石症”。为让读者及时了解相关知识,我们特邀天津市儿童医院主任医师高维新等专家撰写了《三聚氰胺6问》、《污染奶粉结石症诊疗方案6问》和《污染奶粉结石症诊治的6个为什么》三篇短文,以问答形式为读者解惑。 相似文献
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Background Intake of melamine can cause renal and ureteral lithiasis in infants and children. The present study aimed to understand the value of ultrasonography in the diagnosis of renal and ureteral lithiasis in infants and young children caused by melamine, and the characteristics of ultrasonograms of melamine-associated calculi. Methods Ultrasonographic examination on the urinary system was performed for 28 332 children who ingested milk powder that was possibly tainted with melamine; 395 of the children were diagnosed by ultrasonography as having urinary calculus, and 231 cases had lump-like calculi and 164 cases had sand gravel-like calculi. The features of the calculi, the sites of obstruction and the status of hydronephrosis and hydroureterosis were analyzed. Ultrasonographic reexamination was performed for 116 patients and the findings were compared with those of the first ultrasonography, and the short-term expulsion of the calculi was evaluated. Results Most of the 395 patients with urinary lithiasis, except for those who developed renal failure, had no symptoms. The whole profile of the calculi could be seen in most of the cases, because the echogenicity of the calculi with no sharp or absent acoustical shadowing, was weaker as compared with those from calcium-containing calculi. Comet tail sign could be seen behind the echogenicity of single gravel calculus. The rate of diagnostic consistency of ureteral lithiasis between the ultrasound and the results of clinical observation (including stones expelled spontaneously or after cystoscopic intervention) in 51 cases for 76 ureters was 100%. Percutaneous renal biopsy was performed for one case, and histopathological examination showed flocculent, fine strip-like, ellipse and circular deeply stained sand gravel-like material in the renal tubules, and the circular calculi were found to be attached to the walls of the tubules. Chemical analysis of the calculi expelled from 12 cases showed that the main contents of the calculi were uric acid and melamine. Short-term ultrasound reexamination in 116 patients showed that gravel-like calculi disappeared in 80.4% of the cases; in 26 non-hospitalized cases who had lump-like calculi without hydronephrosis or hydroureterosis, none of the lump-like calculi were expelled. Conclusions The ultrasonograpic findings of urinary calculi in children caused by ingestion of melamine-tainted milk powder have a certain features as compared to the calculi containing calcium. Careful ultrasound examination can avoid missed diagnoses of ureteral calculi. Most of the gravel-like calculi can be expelled within a short period of term, while lump-like calculi can hardly be expelled. Ultrasonography is an accurate and reliable method of diagnosis of urinary calculus caused by melamine intake in children and it can be used as diagnostic method of choice although abdominal X-ray plain film can also visualize some of larger calculi. 相似文献
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目的:对湿疹婴儿随机进行不同方式的喂养干预,跟踪观察湿疹发生情况,探讨喂养干预对婴儿湿疹发病的影响。方法:将2012年1月~2013年3月就诊的符合条件的120例湿疹婴儿随机分为蛋白质部分水解配方奶粉组(HA组n=60),婴儿普通配方奶粉组(CMF组n=30)及母乳喂养组30例,三组均观察3个月,观察3组婴儿湿疹发生情况和检测血SIgE水平。结果:与CMF组相比,母乳喂养对婴儿湿疹临床症状有一定改善,但两组差异无统计学意义;HA奶粉可改善婴儿湿疹的临床症状,与母乳喂养组及CMF组对比,HA奶粉喂养前后差异有统计学意义;每组喂养前后SIgE水平差异均无统计学意义。结论:蛋白质部分水解配方奶粉喂养可以治疗婴儿湿疹。 相似文献
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《吉林大学学报(医学版)》1994,(2)
小儿霉菌性尿路感染并尿路梗阻致急性肾功能衰竭(附一例报告)第三临床学院儿科于嫦琴,张维忠,郭君关键词霉菌,尿路感染,尿路梗阻,急性肾功能衰竭,婴儿中图号,R692.5小婴儿由于原发性霉菌性尿路感染引起双侧输尿管梗阻致急性肾后性肾功能衰竭国内、外未见报... 相似文献
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目的探讨急性肾衰患者的病因、转归及影响预后的危险因素。方法对急性肾功能衰竭患者89例,分析患者的病因、治疗效果及并发症等,找出影响其预后的重要因素。结果急性肾衰常见于低血容量、术后因素、肾毒性物质和败血症、感染等。89例急性肾衰患者中,肾功能完全恢复26例,肾功能不完全恢复31例,死亡32例,病死率35.9%。结论急性肾衰并发症多,治疗效果差,病死率高,病因多以低血容量、术后因素、肾毒性及败血症等为主,死亡多以败血症、并发呼吸衰竭为主。只有掌握其发病的相关危险因素,才能更好地治疗和改善ARF预后。 相似文献
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目的探讨海狗丸致急性肾功能衰竭,"御坊堂海狗丸"保健食品,批准文号:卫食健字(2002)第0085号,其核准的功能是抗疲劳。中老年人基础病较多,任何一种药品、保健品服用不当都有可能对其构成危害,因为药物大多经过肝脏肾脏代谢,其中最常见的就是肝肾损害,严重者可导致肾脏中毒性损害而致急性肾功能衰竭而死亡。 相似文献
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目的 探讨深度水解蛋白配方奶粉治疗婴儿湿疹的临床效果及牛奶蛋白过敏与婴儿湿疹的关系.方法 选取2018年1月至2019年1月本院收治的80例湿疹患儿,根据治疗方法的不同分为对照组和观察组,每组40例.观察组采用口服深度水解蛋白配方奶粉及母亲回避牛奶及奶制品方法调理,对照组采用外擦剂治疗,饮食不做调整.比较两组临床疗效、SCORAD分值、湿疹复发率.结果 治疗后,两组治疗总有效率比较差异无统计学意义;观察组复发率、SCORAD分值均低于对照组,差异有统计学意义(P<0.05).结论 使用口服深度水解蛋白配方奶粉及母亲饮食回避牛奶及牛奶制品方法可快速改善患儿湿疹,值得临床推广应用. 相似文献
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血管内皮细胞作为人体最大的器官,覆盖在血管内膜表面,将血管壁和循环血液中的有形成分分隔开来。内皮细胞不但是血管内外物质交换的屏障,还能分泌多种血管活性物质。内皮功能障碍作为始动环节,与多种心血管疾病的发生发展密切相关,包括原发性高血压、冠心病、糖尿病、 相似文献
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目的探讨重症监护病房(intensive care unit,ICU)中急性肾功能衰竭的RIFLE分级、预后及其相关因素。方法收集整理67例急性肾功能衰竭患者的临床资料,统一标准对AHF的RIFLE分级、病因、发病时间(分两组。A组:0~2天,B组:≥3天)与预后的相互关系进行分析。结果ARF67例,死亡44例,死亡率高达65.67%。按RIFIZ分层标准,ICU内急性肾功能衰竭的患者中以急性肾损伤的患者最多,占41.79%(28例)。ICU中导致ARF的常见原因为低血容量性休克、感染性休克、脑卒中、重度颅脑损伤、心源性疾病和肺源性疾病。A组死亡率为53.33%,B组为75.68%。结论ARF是ICU中常见危重症,ARF患者的死亡率随RIFLE分层的增高而升高。入ICU3天以后发生ARF的患者死亡率较高,但ARF发生的早晚不能预测患者的预后。 相似文献