Schwartz公式推算原发性肾病综合征患儿肾小球滤过率

目的 了解原发性肾病综合征(PNS)患儿肾功能变化情况,比较肾小球滤过率(GFR)、血浆尿素氮(BUN)和肌酐清除率(Cr)对肾功能的评价作用.方法 使用酶法测定203例PNS患儿和100例健康儿童BUN和Cr,根据Schwartz公式推算GFR,并以此对肾功能进行分期.结果 肾病组BUN和Cr明显高于对照组,而GFR却显著降低;以GFR为分期标准,在203例PNS患儿中,肾功能1期占72.41%,2期占11.33%,3期占9.85%,4期占4.43%,5期占1.97%;GFR、BUN和Cr对PNS患儿肾功能异常的检出率差异有统计学意义,其中GFR最高.结论 PNS患儿存在不同程度的肾功能损害;Schwartz公式推算GFR可以作为临床评价PNS患儿肾功能改变的敏感指标.     

血清cystatin C对小儿肾功能受损诊断的评价

目的 探讨儿童肾小球肾炎患者血清cystatin C(Cys C)水平与肾功能损害程度之间关系.方法 血清Cys C采用乳微粒子增强比浊法测定,血尿素氮(BUN)采用动力学紫外法测定,血肌酐(sCr)采用酶法测定,内生肌酐清除率(Ccr)采用肌氨氧化酶PAP法计算.结果 肾小球肾炎患者肾功能正常期Cys C明显高于正常对照组(P ＜ 0.01),BUN、sCr与对照组差异无统计学意义(P均＞ 0.05);肾功能不全代偿期,Cys C、sCr与正常对照组差异有统计学意义(P均＜ 0.01),而BUN与正常对照组差异无统计学意义(P ＞ 0.05);肾功能不全失代偿期及肾衰竭期,Cys C、BUN、sCr值与正常对照组差异有统计学意义(P均＜ 0.01).肾小球肾炎各期Cys C与BUN、sCr、Ccr均呈正相关(P ＜ 0.01).结论 血清Cys C可敏感地反映肾小球滤过功能受损程度,可作为早期诊断肾小球肾炎的血清学指标.     

Cystatin C对评价肾小球滤过功能的研究

目的：以往常用于临床检测肾小球滤过功能的方法很多,但其准确性受到一定的限制。该研究用Cystatin C对肾小球滤过功能进行评价。方法：用速率散射法测定35例不同肾功能的病人血清Cystatin C,每例患者均测定99mTc-GFR、血清肌酐(Scr)、24 h肌酐清除率(Ccr),以99mTc-GFR作为检测GFR的标准,比较Cystatin C与99mTc-GFR的相关性,及肾功能不全代偿期18例患者Cystatin C与Ccr、 Scr敏感性比较。结果：血清Cystatin C与99mTc-GFR呈显著性负相关,CC=-0.0326×GFR+4.343(r=-0.868),对于肾功能不全代偿期患者Cystatin C与24 h Ccr异常的符合率无统计学差异。结论：Cystatin C与99mTc-GFR有良好的相关性,与24h Ccr有同样的敏感性,比肌酐更能够早期反映肾小球滤过功能的损害,但其具有无放射性,无需昂贵的技术设备,也无需准确留取24 h尿液等优点,适应患者更广泛,作为临床检测肾小球滤过功能更便捷的方法值得推广。     

99mTc-DTPA肾动态显像在小儿先天性肾积水的应用

目的探讨肾功能临床相关指标对小儿先天性肾积水的诊断价值.方法用99mTc-DTPA核素动态显像测定68只患肾和14只正常肾的肾小球滤过率(GFR),并与年龄及血清尿素氮(BUN)、血清肌酐(SCr)、血红蛋白(Hb)进行相关性分析.结果 GFR与正常儿童年龄呈正相关(r=0.428,P＜0.05);中、重度肾积水患儿GFR与Hb呈正相关(分别为r=0.341、P＜0.05,r=0.635、P＜0.01);GFR与BUN只在重度肾积水呈负相关(r=-0.559,P＜0.05);GFR与SCr呈显著负相关(r=-0.445,P＜0.01);中、重度肾积水肾功能显著性下降(P＜0.05,P＜0.001),轻度积水肾与正常肾肾功能无显著性差异(P＞0.05).结论 GFR与SCr是检测小儿先天性肾积水肾功能的理想指标;BUN不适于肾积水的早期诊断;临床诊断明确的小儿先天性肾积水应早期手术治疗,以防止肾功能下降至失代偿而造成局部和全身性损害.     

高胆红素血症新生儿血清半胱氨酸蛋白酶抑制剂C变化的意义

目的观察血清半胱氨酸蛋白酶抑制剂C(Cys C)在新生儿高胆红素血症中的变化,评价其对肾滤过功能的影响。方法应用酶联免疫吸附法(ELISA)对68例新生儿高胆红素血症患儿(高胆红素血症组,包括轻度20例,中度26例,重度22例)及28例无黄疸足月新生儿(对照组)血清Cys C、胆红素及Cr、BUN水平进行测定。结果高胆红素血症组血清Cr、BUN水平与对照组比较差异无统计学意义。高胆红素血症组Cys C水平显著高于对照组(P<0.01),且血清胆红素水平与Cys C水平呈正相关(r=0.6751 P<0.05);经治疗黄疸消退后高胆红素血症组血清Cys C水平较治疗前显著下降(P<0.01),与对照组比较无显著性差异(P>0.05)。结论血清Cys C水平是评价新生儿高胆红素血症患儿肾功能的敏感检测指标之一。     

血清γ-痕迹蛋白在儿童肾脏疾病中的应用价值

目的探讨血清γ蛳痕迹蛋白(CysC)在儿童肾小球滤过率(GFR)损伤中的诊断价值。方法检测417例各种肾脏疾病患儿的血清CysC、β2MG、Cr及Ccr,分别比较三者之间的相关性及血清CysC诊断肾小球滤过率下降的准确性。结果在Ccr>80ml/(min·1.73m2)的肾脏疾病组,血清CysC和β2MG异常检出率均高于Cr;当Ccr<80ml/(min·1.73m2)时,血清CysC水平的倒数与Ccr显著相关(r=0.710,P<0.01),β2MG的倒数与Ccr显著相关(r=0.702,P<0.01),血清CysC与β2MG显著相关(r=0.897,P<0.01);血清CysC、β2MG和Cr在诊断GFR降低时的ROC曲线下面积(Area±S.E)分别为0.910±0.022、0.894±0.025和0.683±0.034,两者的面积差异有统计学意义(P<0.05)。结论血清CysC能较早地反映儿童肾小球滤过功能受损,在儿童肾脏疾病实验室诊断方面有较好的应用前景。     

血清胱蛋白抑制剂C测定作为判断肾小球滤过率的临床意义

目的　验证一种新的肾小球滤过功能测定方法———血清胱蛋白抑制剂 (CC)测定在儿科作为判断肾小球滤过功能(GFR)的临床意义。方法　对 62例 (男 3 2例 ,女 2 8例 ) 2～ 16岁不同肾功能的患儿同时测定血CC、血清肌酐 (Scr)、内生肌酐清除率 (Ccr) ,分别比较血CC、Scr及Ccr(4h留尿法 )间相关性。相关性统计采用一元线性相关分析。结果　血CC与血清Scr有显著正线性相关 (P <0 .0 0 1) ;回归方程为 :Scr =95 .78CC -6.987(r=0 .90 6)。与Ccr的对数值呈显著负性相关 :LogCC =-0 .61LogCcr 1.2 1(r=-0 .86)。Ccr>80mL/min组 2 4%血CC异常 ,说明血CC较Ccr更能敏感反映GFR变化。结论　血CC较Ccr、Scr更能反映临床的损害。CC比Ccr和Scr的测定对肾小球滤过功能的变化有更高的敏感性和特异性 ,能替代Ccr和Scr作为GFR变化的指标。用CC代替 4h留尿法Ccr作为儿科患儿GFR指标值得临床应用。     

滤过钠排泄分数对儿童肾功能不全诊断价值的初步评价

为研究滤过钠排泄分数(FENa)在儿童肾功能不全诊断中的意义,我们测定了61例肾脏病患儿(其中合并急、慢性肾功能不全38例)的FENa、BUN、Scr及Ccr。结果:FENa与BUN和Scr呈显著正相关;与Ccr呈负相关,但差别无显著性。表明FENa既反映肾小球功能又反映肾小管功能,其异常先于BUN和Scr的变化,可做为早期急性肾功能衰竭诊断指标。     

血清胱蛋白酶C对评估儿童早期肾功能损害的临床意义

由于检测血清肌酐 (Scr)来反映肾小球滤过功能 (GFR)可受到多种因素的影响 ,故其敏感性和准确性较差。自Bokenkamp 等报道血清胱蛋白酶C(CysC)作为检测儿科肾功能的指标 ,近来已越来越受到重视[1]。为此 ,我院测定了236例肾脏疾病患儿血清CysC浓度并与Scr进行对照 ,其中17例患儿虽然Scr正常但血清CysC已有明显增高。因此本研究旨在探讨血清CysC对评估小儿早期肾功能损害的临床意义。资料与方法一、对象2000年10月～2002年4月肾脏疾病住院患儿236例 ,有24例患儿血清CysC增高 ,其中早期肾功能损害17例 ,肾功能不全7例。肾功能衰竭诊断…     

新生儿肾功能损害早期指标分析

目的 探讨血清胱蛋白酶抑制剂C(Cystain C)、尿微量蛋白系列在窒息后新生儿中的变化及意义.评价新生儿肾功能的检测指标.方法 检测2004年9月--2005年9月68例足月窒息新生儿(Apgar评分7分)和40例足月非窒息新生儿的血清Cr、BUN、血β2-微球蛋白(β2-MG)、C、血Cystatin C、尿微量蛋白系列,按不同日龄分3次检测.结果 ①非窒息新生儿血清Cystatin C的平均值为(1.89±0.41)mg/L,血清Cys-tatin C在生后3周内不同日龄间差异无统计学意义,与身高、体重、胆红素之间无相关关系.②窒息组肾小球功能指标中血BUN、Cr、Ccr、Cystatin C、B2-MG明显高于非窒息组;窒息组肾小管功能指标中尿N.乙酰B.D.葡萄糖苷酶(NAG)、α1微球蛋白(α1-MG)明显高于非窒息组.③重度窒息组血BUN、Cr、Ccr、Cystatin C明显高于轻度窒息组;而肾小管功能指标差异无统计学意义.④肾小球功能指标中,尿Alb、IgG与血Cystatin C、血13rMG呈正相关,尿转铁蛋白(TRF)、NAG与Ccr呈正相关;肾小管功能指标中尿NAG、α1-MG与血β2-MG呈正相关.⑤随访发现,血BUN、Cr恢复正常快,尿微量蛋白系列和血β2-MG、血Cystatin C恢复较慢.结论 窒息可引起新生儿肾小球、肾小管功能改变,重度窒息对肾小球功能影响大于轻度窒息,血Cystatin C可作为评价肾小球滤过功能的敏感指标.临床可通过随访尿微量蛋白系列指标来评估肾小管、肾小球损害情况.     

Renal clearance of fluoride in children and adolescents

Renal function and fluoride excretion have been studied in 38 children. The children were divided into three groups according to their glomerular filtration rate: normal (92 to 136 mL/min/1.73 m2 of body surface area [BSA]), low (less than 92 mL/min/1.73 m2 BSA, and super-normal (greater than 136 mL/min/1.73 m2 BSA). Standard clearance technique with infusion of inulin and p-aminohippuric acid during water diuresis was used. Mean renal fluoride clearance was 45.0 +/- 9.8 (SD) mL/min in the group of children with normal glomerular filtration rates and 31.4 +/- 8.8 mL/min in the group with low glomerular filtration rates. This difference was statistically significant. There was a close linear relationship between renal fluoride clearance and glomerular filtration rate, urinary flow, and free water clearance. The fractional fluoride excretion did not differ between the groups. About 60% of the filtered fluoride was reabsorbed. No evidence for tubular secretion exceeding the reabsorption could be found. The results suggest that children have lower renal fluoride clearance rates than adults and indicate that a moderate impairment of the renal function could lead to increased retention of fluoride.     

Renal toxicity of cisplatin in children

We measured renal function in 22 children receiving cisplatin as initial treatment for neuroblastoma or malignant germ cell tumors. Glomerular filtration rates were estimated from the plasma clearance of 51Cr-EDTA and were compared with measurements of plasma creatinine concentration and creatinine clearance. The degree of cisplatin-induced renal damage varied widely, and plasma creatinine measurements and creatinine clearances were not reliable guides to glomerular filtration rate. Renal function in children receiving cisplatin should be monitored by measurement of glomerular filtration rate with an isotope clearance technique.     

Protein restriction in chronic renal failure

The aim of the study was to investigate the effect of a protein restricted diet on renal function and growth of children with chronic renal failure. In a multicentre prospective study 56 children (aged 2-18 years) with chronic renal failure were randomly assigned to the protein restricted (0.8-1.1 g/kg/day) or the control group. All children were followed up by the same paediatrician and dietitian. After a follow up period of three years there was no significant difference in glomerular filtration rate between children on a protein restricted diet and children of the control group. There was no significant difference in weight with respect to height and height SD score between the protein restricted and the control group. Compliance with the protein restricted diet, as indicated by the prospective diet diaries and the serum urea:creatinine ratio, was good. This study shows that children with chronic renal failure do not benefit from a protein restricted diet.     

肾功能亢进对耐甲氧西林金黄色葡萄球菌感染患儿万古霉素血药浓度及治疗效果的影响分析

目的 研究肾功能亢进（ARC）对万古霉素治疗儿童耐甲氧西林金黄色葡萄球菌（MRSA）感染时的血药浓度、细菌学疗效及临床疗效的影响。方法 回顾性研究2013年1月至2017年7月期间因明确MRSA感染使用万古霉素,并进行血药浓度监测的60例危重患儿的病例资料,根据肾小球滤过率（eGFR）分为ARC组（n=19）和肾功能正常组（n=41）,对两组患儿在万古霉素使用、血药浓度及治疗效果等方面进行统计学比较分析。结果 ARC组的年龄主要分布在1~12岁,其体重和体表面积明显大于肾功能正常组（P < 0.05）。ARC组初始万古霉素血药谷浓度明显低于肾功能正常组,且ARC组达有效血药谷浓度（10~20 mg/L）比例低于肾功能正常组（P < 0.05）。两组在细菌学疗效评价和临床疗效评价方面比较差异均无统计学意义（P > 0.05）,但ARC组的儿童重症监护室（PICU）住院时间及总住院时间明显长于肾功能正常组（P < 0.05）。结论 ARC明显降低MRSA感染患儿的万古霉素血药谷浓度,延长PICU住院时间及总住院时间。临床上应注意对ARC患儿施行个体化给药治疗。     

Renal function abnormalities after ifosfamide treatment in children

Renal function was evaluated in 12 children (aged 2.5–17.5 years) who received ifosfamide as part of their chemotherapy for different malignancies. A blood and urine analysis evaluating renal glomerular and tubular function and an isotopic determination of glomerular filtration were carried out four months or later after treatment had been stopped. Three patients had several biochemical abnormalities suggesting a significant degree of proximal renal dysfunction (increased urinary excretion of calcium, glucose, beta ₂-microglobulin, amino acids (three patients) and decreased tubular reabsorption of phosphate (one patient)). The tubular dysfunction in these patients was associated with a diminished glomerular filtration. These patients could be characterized by their younger age at treatment and a higher dose of ifosfamide received if calculated per kg body weight.     

儿童IgM肾病与IgA肾病临床和病理的对比研究

目的比较IgM肾病(IgMN)与IgA肾病(IgAN)患儿在临床及病理方面的异同。方法对经肾活检确诊的38例IgMN及40例IgAN患儿的临床表现、实验室检查及肾脏病理进行对比分析。结果 IgMN患儿的平均发病年龄小于IgAN患儿,平均肾活检前病程长于IgAN患儿,肉眼血尿发生率、尿IgG及尿白蛋白水平均低于IgAN患儿,同时严重肾小球损伤发生率也低于IgAN患儿,差异均有统计学意义(P0.05)。IgMN患儿中,有严重肾小球损伤患儿的血清白蛋白水平更低而尿白蛋白水平更高,与无严重肾小球损伤的同组患儿比较,差异有统计学意义(P0.05);有严重肾小管损伤患儿以男性多见,肉眼血尿发生率、尿白蛋白和N-乙酰-β-D氨基葡萄苷酶(NAG)水平以及出现基底膜厚薄异常的比例高于无严重肾小管损伤的患儿,差异均有统计学意义(P0.05),但发生严重肾小球损伤的差异无统计学意义(P0.05)。在IgAN患儿中,有严重肾小球损伤患儿的蛋白尿、肾小管见RBC管型、C3及Fibrinogen显著沉积和足突融合的发生率均高于无严重肾小球损伤的同组患儿,差异有统计学意义(P0.05);有严重肾小管损伤的患儿的肾功能受损程度、出现重度系膜细胞增生及肾小球纤维硬化情况比无严重肾小管损伤的同组患儿更严重,差异均有统计学意义(P0.05)。结论儿童IgMN与IgAN在临床和病理方面存在差异,IgMN肾脏损伤程度较IgAN轻。与IgAN不同,IgMN患儿的肾小管损伤与肾小球损伤无平行关系。     

Acute renal failure in children: prognostic features after treatment with acute dialysis

A 12-year review (1972–1983) is presented of 76 children who were dialysed because of acute renal failure. The causes of acute renal failure were mainly the haemolyticuraemic syndrome (53%), trauma (16%) and operation (13%).Fifty-eight children (76%) survived, 18 children (24%) died. Fifty-two children, the majority suffering from haemolytic-uraemic syndrome, regained complete or partial renal function after a period of dialysis lasting between 1 and 57 days. One to 7.7 years after dialysis, clearance studies with inulin (C_In), p-aminohippuric acid (C_PAH) and phosphate (T_p/C_In) for staging renal function were carried out. The results of this investigation show a significant inverse correlation between the glomerular function regained and the duration of intermittent dialysis.Abbreviations C_In clearance of inulin - C_PAH clearance of p-aminohippuric acid - FF filtration fraction - T_p/C_In fractional phosphate reabsorption - HUS haemolytic-uraemic syndrome - ARF acute renal failure - SCR serum creatinine - GFR glomerular filtration rate - CRF chronic renal failure - a.t. antihypertensive treatment     

Beta 2 microglobulin. Index of glomerular filtration in children

121 assays for plasma Beta 2 microglobulin (B2M) levels were carried out with an immuno-enzymatic technique in 94 children whose ages ranged from 13 months to 18 years and whose renal functions showed various levels of renal impairment. In the 37 children with normal glomerular filtration rate, plasma B2M level was 1.58 +/- 0.48 mg/l (mean +/- 1 SD) and no significant differences were found according to sex, ages or heights. In the 29 children with glomerular filtration rate (GFR) ranging from 20 to 100 ml/min/1.73 m2, there was a significant correlation between B2M and the inulin clearance, plasma creatinine level and creatinine clearance (p less than 0.001). In 28 patients presenting with terminal renal failure, plasma B2M levels were significantly higher in children undergoing hemodialysis than in those under chronic peritoneal dialysis. These results indicate that B2M levels are as good an index of glomerular filtration rate as serum creatinine whereas its assay uses a long and difficult technique.     

手足口病合并病毒性脑炎患儿血清铁蛋白及神经元特异性烯醇化酶水平的变化及意义

目的：探讨手足口病（HFMD）合并病毒性脑炎患儿血清铁蛋白和神经元特异性烯醇化酶（NSE）水平的变化及意义。方法：采用酶联免疫吸附（ELISA）与电化学发光法对20 例HFMD合并病毒性脑炎（脑炎组）和20 例单纯HFMD患儿(单纯HFMD组)进行血清铁蛋白和NSE水平测定,并与20 例正常健康儿(对照组)进行比较。结果：脑炎组血清铁蛋白含量为 212±71 μg /L,明显高于单纯HFMD组（85±18 μg /L）及对照组（70±15 μg/L）（均P＜0.01）;脑炎组血清NSE含量（8.6±2.6 μg/L）亦明显高于单纯HFMD组（6.0±1.3 μg/L）及对照组（5.6±1.8 μg/L）,（均P＜0.01）。治疗后脑炎组血清铁蛋白及NSE分别下降至126±37 μg /L、6.8±1.9 μg/L,较治疗前差异有统计学意义（P<0.01）。结论：HFMD合并病毒性脑炎患儿血清铁蛋白和NSE含量显著升高,对血清铁蛋白和NSE含量的检测有利于HFMD合并病毒性脑炎的早期诊断。