慢性肾脏病病因与流行病学

慢性肾脏病(chronic kidney disease,CKD)现已成为威胁全世界公共健康的主要疾病之一,被公认为21世纪人类面临的全球性公共健康问题,其危害仅次于肿瘤和心脏病,上升为第三大杀手,人类的生存和社会财富深受其害。相关流行病学研究从慢性肾功能衰竭(CRF)或终末期肾病(ESRD)向早期CKD以及相关危险因素的转变,反映     

儿童慢性肾脏病研究现状

关于儿童慢性肾脏病(CKD)治疗的研究日益增多,但是关于儿童CKD发病率的流行病学调查结果比较有限.原因在于不同地区的研究方法不同,因此研究结果无法比较.在儿童CKD病因学研究中,由于地区不同而明显不同,可能与环境、种族、文化不同相关.     

儿童慢性肾脏病管理

2006年国际肾脏病学会(international society of ne-phrology,ISN)和国际肾脏基金联合会(international federa-tion of kidney foundation,IFKF)联合倡议,将每年3月份的第2个星期四定为世界肾脏日,目的是唤起全球各界人士对慢性肾脏病(chronic kidney disease,CKD)的高度关注。目前,儿童CKD的概念也已经得到较广泛的重视。根     

慢性肾脏病儿童预防接种

1免疫接种的必要性来自成人的研究显示,感染是导致终末期肾病(ESRD)患者的第二位死亡原因,也是导致依赖透析和保守治疗的慢性肾脏病(CKD)患者住院的主要原因[1-2]。CKD患者存在免疫功能受损,成人研究显示,CKD患者T淋巴细胞活化、增殖功能受损,抗体依赖细胞介导的细胞毒作用减低,淋巴因子产生减低,B淋巴细胞数量减低,吞噬细胞功能损     

儿童慢性肾脏病现状与防治

慢性肾脏病(chronic kidney disease,CKD)是指肾功能的不可逆性下降并逐渐进展到终末期肾病(end-stage renaldisease,ESRD)的一类肾脏疾病,已成为严重的公共卫生问题之一。美国国家肾脏病基金会肾脏病预后质量指南(NKF-D/OQI)将CKD定义为:肾脏结构与功能持续异常至少达3个月,     

中医药治疗儿童慢性肾脏病

慢性肾脏病(chronic kidney disease,CKD)是肾脏病于急性期未经控制后的共同转归。近年来全球发病率逐年增高,其持续进展已成为国际国内肾脏病学界及全社会高度关注的问题。儿童CKD可由多种病因所致,包括原发性、继发性和先天/遗传性肾脏疾病以及泌尿系统疾病[1]。我国一项儿童慢性肾功能衰竭(CRF)研究结果显示,CKD     

儿童慢性肾脏病

儿童慢性肾脏病(chronic kidney disease,CKD)是严重影响儿童正常生长发育的慢性进展性疾病,该病起病隐匿,部分最终进展为终末期肾病(end-stage renal disease,ESRD),需肾脏替代治疗维持生命.该文就儿童慢性肾脏病的病因、发病机制、诊断及治疗作一综述,旨在使人们更早、更全面地了解CKD,并采取积极的措施,延缓CKD的进展,防止ESRD的发生.     

儿童慢性肾脏病替代治疗

儿童慢性肾脏病(chronic kidney disease,CKD)的替代治疗包括血液净化和肾脏移植,虽然肾移植是最有效的治疗方法,但由于儿童生理特点及肾源等问题,我国目前仍以透析治疗为主。1儿童慢性肾脏病替代治疗现状腹膜透析(peritoneal dialysis,PD)、血液透析(hemodial-ysis,HD)均属血液净化(blood purification)的范畴,指将患者的血液在体外通过净化装置,除去血液中某些致病物质,达到净化血液目的技术总称。     

儿童慢性肾脏病的营养管理

对慢性肾脏病患儿的营养管理,重点在于定期进行营养状态评估及制定适当的营养配方.现简单介绍美国肾脏病杂志发表的最新肾脏病生存预后指南中的慢性肾脏病儿科营养临床实践指南内容,并结合指南简要介绍儿科肾病综合征、慢性肾小球肾炎、慢性肾衰竭患儿的营养管理.     

慢性肾脏病对儿童生长发育的影响

生长和发育是儿童不同于成人的重要特点。生长是指儿童身体各器官、系统的长大,可有相应的测量值来表示其的量的变化,发育是指细胞、组织、器官的分化与功能成熟。生长发育受遗传调节,营养和疾病等环境因素对其影响也十分明显。慢性肾脏病(chronic kidney diseases,CKD)对儿童的生长和发育产生抑制作用,在CKD的3、4、5期,这种抑制作用十分明显,可以导致生长显著落后,甚至是患者     

慢性肾脏疾病患儿维生素D水平研究进展

儿童慢性肾脏疾病(chronic kidney disease,CKD)是威胁儿童正常生长发育的主要疾病之一,在我国主要病因以肾小球疾病为主,常并发心血管疾病、肾性贫血、肾性骨病等,严重影响儿童生活质量.CKD患儿由于肾脏病变25-羟维生素D[25-(OH) Vit D]羟化受到影响、尿毒症导致的皮肤变化使骨化三醇合成减少等因素常引起25-(OH) Vit D水平低下.该文就CKD患儿25-(OH) Vit D基础水平和影响因素作一综述.     

Psychiatric morbidity and different treatment modalities in children with chronic kidney disease

IntroductionChronic kidney disease (CKD) is a potentially life-threatening condition leading to various psychosocial problems associated with different treatment modalities in addition to their medical advantages and disadvantages. The aim of this study was to evaluate the psychiatric morbidity in children with CKD in terms of different treatment modalities in comparison to healthy peers. In addition, parental attitudes and psychiatric symptoms in this group of mothers were examined.Population and methodsA matched cohort study including 66 children with CKD (21 renal transplantation, 27 dialysis, 18 conservative treatment) and 37 healthy age- and sex-matched controls were evaluated. Children filled out the Children's Depression Inventory, the State-Trait Anxiety Inventory, and the Parental Attitude Scale, and the mothers filled out the Symptom Checklist-90-R. The Schedule for Affective Disorders and Schizophrenia for School-Age Children, Present and Lifetime Version was used for psychiatric diagnosis.ResultsThe overall depression scores in children and the mothers’ overall symptom severity index were significantly higher in the CKD group: 40.9% of children in the CKD group were diagnosed with a psychiatric disorder, while the corresponding figure for the control group was 16.2%. The in-group comparison of the CKD group failed to detect any significant difference between the three treatment modalities.ConclusionThe results support the findings of research showing that CKD has high psychiatric morbidity. It is important to include psychosocial and psychiatric assessments in the evaluation processes of different treatment modalities in CKD.     

单中心371例儿童慢性肾脏病2~5期回顾性研究

目的探讨儿童慢性肾脏病(CKD)的病因构成、并发症及治疗情况,为儿童CKD的综合管理提供依据。方法收集2012年1月至2018年12月在首都医科大学附属北京儿童医院肾脏科住院的CKD患儿临床资料,对其病因构成、并发症、初始治疗情况等信息进行回顾性调查及分析。结果1.本组371例CKD患儿中,男女比例为1.44∶1.00。年龄分期0~3岁35例,4~6岁54例,7~12岁189例,13~18岁93例。CKD 2期11例,CKD 3期59例,CKD 4期62例,CKD 5期239例。2.先天性肾脏和尿道畸形(CAKUT)135例,占36.39%;肾小球疾病77例,占20.76%;遗传性肾脏疾病21例,占5.66%;肾小管间质疾病12例,占3.23%;遗传代谢病4例,占1.08%;其他病因5例,占1.35%;病因不详117例,占31.64%。3.其中57例进行了肾活检,肾活检率为15.36%。病理类型以局灶节段性肾小球硬化(18例,31.58%)、硬化性肾小球肾炎(13例,22.81%)和肾小管间质肾病(10例,17.54%)为主。4.贫血和继发性甲状旁腺功能亢进(SHPT)是最常见的并发症,分别为289例(77.90%)和271例(73.05%),其次为高血压[183例(49.33%)]、心血管疾病[139例(37.47%)]和蛋白质能量消耗[51例(13.75%)]。CKD 5期患儿高血压、贫血、SHPT和心血管疾病均明显高于CKD 2~4期,差异均有统计学意义(χ^2=50.03、122.36、77.07、64.89,均P<0.01)。肾小球疾病的高血压和心血管疾病发生率高于CAKUT,差异均有统计学意义(χ^2=65.63、40.89,均P<0.01)。CAKUT的蛋白质能量消耗发生率高于肾小球疾病,差异有统计学意义(χ^2=10.58,P<0.01)。5.共190例患儿需进行初始肾脏替代治疗,血液透析129例(67.89%),腹膜透析31例(16.32%),拒绝治疗30例(15.79%),初始移植0例。结论CKD患儿CAKUT为首位病因。本中心CKD 5期CAKUT和肾小球疾病所占比例相近。儿童CKD最常见并发症为贫血。高血压、贫血、SHPT和心血管疾病等随着CKD分期进展呈增多趋势。SHPT多发生于CKD 4期以上患儿。不同病因CKD患儿并发症发生率不同。本中心初始肾脏替代治疗以血液透析为主。     

福辛普利治疗慢性肾脏病患儿安全性的对照试验

目的 评估福辛普利治疗慢性肾脏病患儿的安全性,为临床应用提供依据。方法 以确诊为激素耐药型肾病综合征（SRNS）及IgA肾病的患儿为研究对象。分为福辛普利低剂量组、福辛普利中剂量组和对照组。3组均予甲泼尼龙或泼尼松的基础治疗,福辛普利低剂量组和中剂量组分别在基础治疗上加用福辛普利0.3和0.1 mg·kg-1·d-1,对照组不予福辛普利治疗,3组均治疗24周。以开始治疗后2、4、8、12、16、20和24周为随访时点,测量患儿血压,行血常规、尿常规、SCr、肌酐清除率（CCr）、血K+和ALT检测;记录眩晕、干咳和水肿等不良事件的发生情况。结果 2008年2月至2009年8月广州市妇女儿童医疗中心肾内科住院诊断为SRNS患儿45例、IgA肾病患儿10例进入结果分析。福辛普利中剂量组22例、福辛普利低剂量组19例,对照组14例。①至观察终点,3组患儿无一例出现低血压。福辛普利中剂量组平均动脉压在治疗第8周时显著下降;福辛普利低剂量组在治疗第12周时平均动脉压明显下降;对照组在治疗期间平均动脉压无显著变化。②将福辛普利中、低剂量组患儿合并按治疗前基础血压分成正常血压组及高血压组,至观察终点正常血压组福辛普利治疗前后收缩压、舒张压和平均动脉压变化不明显;高血压组患儿治疗后收缩压、舒张压及平均动脉压较治疗前均显著降低。③至观察终点,福辛普利中、低剂量组、对照组治疗后24 h尿蛋白均较治疗前显著降低,其中福辛普利中剂量组较治疗前下降更显著;3组患儿的SCr、CCr、血K+、WBC、HGB、PLT及ALT均在正常范围。④治疗过程中,福辛普利中剂量组有1例患儿出现轻微干咳。结论 福辛普利0.3 mg·kg-1·d-1在24周治疗期间未见明显不良反应,对慢性肾脏病患儿的安全性较好。     

Acute tubulointerstitial nephritis in children and chronic kidney disease

BackgroundAcute tubulointerstitial nephritis (ATIN) is a rare condition in children. The etiology, treatment, and outcome of childhood ATIN remain poorly understood. The long-term prognosis seems to be favorable; however, chronic kidney disease has been reported. This article describes clinical outcomes in a series of children with biopsy-proven ATIN.MethodsAll medical records with biopsy-proven ATIN between January 2006 and 2016 were retrospectively analyzed. The incidence, clinical features, etiology, treatment, and outcome were recorded for each patient.ResultsOver 10 years, ATIN was diagnosed in 25 cases (8%) based on 306 renal needle biopsies. The most frequent clinical signs were abdominal pain, asthenia/weight loss, and fever. A median glomerular filtration rate estimated at 30.1 mL/min/1.73 m² (16.5; 45.5). Drug-induced toxicity was the main etiology (eight patients). Other causes were TINU syndrome (tubulointerstitial nephritis and uveitis) (seven patients), infection (two patients), and toxic agents other than medication (one patient). No etiology was found in seven patients (idiopathic cases). Eighteen patients (72%) were treated with steroids. At the end of follow-up, eight patients presented chronic kidney disease, three hypertension, and three tubular dysfunction. Overall, renal function was highest in the idiopathic ATIN group and in children treated without delay.ConclusionsIn a single-center 10-year series of biopsy-confirmed ATIN in children, drugs and TINU syndrome were the main etiologies of ATIN. This study suggests that children with idiopathic ATIN and prompt treatment have a better prognosis. In this series, occurrence of chronic kidney disease justified long-term follow-up.     

儿童肾囊性疾病的诊治

Potter分型将儿童肾囊性疾病分为4型:常染色体隐性遗传性多囊性肾病、多囊性肾发育不良、常染色体显性遗传性多囊性肾病、梗阻性囊性发育不良肾.此外,单纯性肾囊肿、发生在肾肿瘤及其他伴囊性肾病的综合征也可引起肾脏呈囊性改变.这类病由于其发病机制和病理基础不同,临床诊断及治疗方案选择亦不同,要正确诊断这类疾病,需要仔细分类并查明病因.该文就儿童常见的肾囊性疾病进行综述.     

Growth hormone treatment in short children with chronic kidney disease

Growth hormone (GH) has been used for treatment of impaired growth in children with chronic kidney disease (CKD) for nearly 17 years. Controlled and open-label studies have shown that GH is highly effective in improving growth velocity and adult height. The growth response is negatively correlated with age and height at start and time spent on dialysis treatment; it is positively correlated with dose and duration of treatment and the primary renal disease (renal hypodysplasia). In children with renal transplants, corticosteroid treatment is an additional factor negatively influencing spontaneous growth rates. However, GH treatment is able to compensate corticosteroid-induced growth failure. GH treatment improved final height by 0.5-1.7 standard deviation score (SDS) in various studies, whereas the control group lost about 0.5 SDS in comparable time intervals. These variable results are explained in part by the factors mentioned above. The adverse events are comparable to those in non-CKD children treated with GH. CONCLUSION: GH treatment is safe and highly effective in improving growth and final height of short children with all stages of CKD. The highest treatment success is obtained if treatment is started at an early age and with relatively well-preserved residual renal function and continued until final height.     

新生儿急性肾损伤与慢性肾脏病

由于新生儿处于从宫内环境向宫外环境的过渡期,内环境变化大,且肾脏的结构、功能发育不成熟,与成人相比,肾脏储备能力低下。在正常情况下,新生儿肾脏的成熟能与生长发育相适应,维持内环境于一个相对平衡状态,但在各病理因素影响下,却极易出现急性肾损伤,不仅会造成水电解质紊乱和酸碱失衡,增加短期的不良预后,还会影响生后肾脏结构功能的进一步成熟,甚而增加远期慢性肾脏病的风险。