血,尿渗透压,纯水清除率,血肌酐在小儿肾脏疾病中的意义

我们对56例原发性肾小球疾病患儿进行了血渗透压(Sosm)、尿渗透压(Uosm)、纯水清除率(CH_2O)和血肌酐(SCr)测定,比较各项检查结果,以求早期发现肾功能损害程度及判断预后,现将结果报道如下。     

应用Schwartz公式和99Tcm-DTPA肾动态显像评估肾小球滤过率的一致性研究

目的 评价应用Schwartz公式评估肾小球滤过率（GFR）的准确性,为儿科临床准确和便捷地评估GFR提供参考。方法 选择2002年 4月至2006 年12月在复旦大学附属儿科医院肾病科诊断为慢性肾脏病（CKD）的患儿为研究对象。患儿于入院后第2日早晨空腹采血,以碱性苦味酸法测定血肌酐（SCr）水平,测量身高,采用Schwartz公式计算GFR（eGFR）。入院后第2或3日行99Tcm-DTPA肾动态显像,获得GFR（mGFR）。采用NKF-K/DOQI推荐的CKD分期标准,依据mGFR分为CKD 1~5期。mGFR与eGFR的相关性采用Pearson相关分析;eGFR估算mGFR的准确性采用相对预测误差（MPE）和绝对预测误差(MAE)表示,eGFR和mGFR的一致性采用Bland-Altman检验。结果 170例CKD患儿进入分析,其中男100例,女70例;年龄2.3～17.8（9.3±3.9）岁。肾病综合征75例,肾小球肾炎28例,泌尿道感染49例,急性肾功能衰竭10例和慢性肾功能衰竭8例。CKD 1期 80例,2期 40例,3期 27例,4期 17例,5期6例。①eGFR和mGFR总体上有显著相关性（r＝0.871）;CKD 1期患儿的eGFR和mGFR呈显著弱相关性,CKD 2~4期患儿eGFR和mGFR无显著相关性。②eGFR预测mGFR的MPE和MAE随肾功能损害程度的加重呈增高趋势,CKD 1期79/80例（98.8%）、CKD 2期32/40例（80.0%）患儿eGFR预测mGFR的MPE均落在±30％内;CKD 3~5期患儿eGFR预测mGFR的准确性较差。③Bland-Altman检验结果提示,eGFR和mGFR的一致性CKD 1和2期患儿较好,CKD 3和4期患儿较差。结论 Schwartz公式对于肾功能损害较轻的CKD 1和2期患儿预测mGFR的准确性较高,CKD 3～5期患儿的准确性较差。对于CKD 3~5期患儿仍应行99Tcm-DTPA肾动态显像以获得准确的GFR。     

血乳酸和乳酸清除率评估脓毒性休克患儿预后的临床分析

目的 评价血乳酸及乳酸清除率与脓毒性休克患儿预后的关系.方法 2009年10月至2011年6月我院PICU收治的脓毒性休克患儿42例,所有患儿均按照脓毒性休克诊疗方案进行早期目标指导治疗,测定每例患儿复苏前及复苏后1h、2h、6h血乳酸值,计算复苏后1h、2h、6h的乳酸清除率.按照预后将患儿分为存活组(n=20)和死亡组(n=22),评价早期乳酸值和乳酸清除率与预后的关系.结果 (1)存活组复苏前及复苏后1h、2h、6h的乳酸值明显低于死亡组[(3.92±2.58) mmol/Lvs (6.91 ±4.16) mmol/L,(2.79±1.89) mmol/L vs (7.93±4.39) mmol/L,(2.20±1.83) mmol/L vs(9.20±4.97) mmol/L,(1.32±0.51) mmol/L vs (9.94±5.02) mmol/L],差异具有统计学意义(P＜0.05).(2)存活组复苏后1h、2h、6h的乳酸清除率明显高于死亡组[(26.31 ±20.82)％ vs(-24.28±53.39)％,(43.46±17.85)％ vs(-34.31±58.98)％,(61.04±16.71)％ vs(-45.33±83.51)％],差异具有统计学意义(P＜0.05).(3)通过受试者工作特征曲线分析,复苏后6h血乳酸值和乳酸清除率的曲线下面积分别为99.4％、96.7％;复苏后6h血乳酸＞2.20 mmol/L及复苏后6h乳酸清除率＜18.65％,患儿病死率高.结论 脓毒性休克患儿动态监测血乳酸具有重要意义,复苏后6h的血乳酸值及乳酸清除率可作为预后判断的指标.     

白细胞介素—6对人肾小球系膜细胞增殖的影响

白细胞介素－６对人肾小球系膜细胞增殖的影响易著文孙林系膜增殖性肾炎（ＭｓＰＧＮ）为我国小儿原发性肾小球疾病的主要病理类型之一，占我国小儿原发性肾小球疾病病理类型的４７．３％。在我院小儿肾穿刺病例中占４０．２％。现已知炎症细胞因子白细胞介素－６（ＩＬ－...     

重症肺炎对肾功能的影响

重症肺炎对肾功能的影响穆亚平王雪萍孟宪贞吴丽霞史海燕孟辉李晓菊潘永娴张宝珍１９９３年１月～１９９５年２月对重症感染，特别是重症肺炎患儿进行了血和尿β２微球蛋白（β２ｍ）的检测，报告如下。对象和方法：重症肺炎５１例，男２５例，女２６例；轻症８４例，男４...     

儿童肾功能评估方法的比较

儿童慢性肾功能不全的严重后果不仅是进展为终末期肾衰竭需要肾脏替代治疗,而且也明显增加心血管疾病、代谢综合征等并发症的危险性,因此对慢性肾功能不全的早期诊断尤为重要.临床医师常通过血肌酐、尿素氮等传统监测指标评估患儿肾功能,但传统的评估指标具有一定滞后性,目前国际上常用胱抑素C、血尿β2微球蛋白等指标评价儿童肾功能.由于不同性别、不同年龄儿童肾小球滤过率不是恒定值,用化验指标很难准确估计儿童肾功能,因此需要与肾小球滤过率评估公式相结合,才能准确评估肾脏损害程度,并为防止肾功能进展到终末期提供干预治疗最好的时机.该文对几种常用的儿童肾功能评估方法进行概述,以寻求出适用于我国儿童的肾功能评估方法及标准.     

肾小球疾病患儿血浆黏附分子P选择素的表达及意义

目的探讨不同肾小球疾病患儿外周血黏附分子P选择素(CD62P)的水平及其临床意义。方法选择不同肾小球疾病患儿154例为病例组。其中原发性肾病综合征(PNS)54例,IgA肾病(IgAN)32例,紫癜性肾炎(HSPN)26例,狼疮性肾炎(LN)32例,乙肝相关性肾炎(HBV-GN)10例。病例均处于活动期。42例年龄、性别相匹配的健康儿童为健康对照组。采用放射免疫法(RIA)测定各组外周血CD62P水平,并分析其与患儿24h尿蛋白定量、血小板(PLT)、血清清蛋白(ALB)、胆固醇(CHOL)、BUN、Scr和尿N-乙酰-氨基葡萄糖苷酶(NAG)、β2微球蛋白(β2-MG)、溶菌酶(Lys)之间的相关性。结果1.各病例组活动期患儿外周血CD62P水平均明显增高,与健康对照组比较均有显著性差异(Pa<0.01)。2.各病例组中,PNS组患儿CD62P水平增高最为显著,IgAN组患儿CD62P水平显著低于其他各组(Pa<0.05)。3.各病例组患儿外周血CD62P水平均与24h尿蛋白定量呈正相关,与血清ALB呈负相关,与血清PLT、CHOL、BUN和Scr均无相关性。4.各病例组患儿外周血CD62P水平与尿NAG、β2-MG水平均呈正相关,与尿Lys水平无相关性。结论CD62P在肾小球疾病患儿外周血中表达增强,提示其参与了儿童肾小球疾病的发生和发展。     

窒息新生儿血肌酐和血尿素氮水平变化及禁食时间对其影响

目的探讨窒息新生儿Scr和BUN水平变化及禁食时间对其变化的影响。方法根据病史和临床表现将100例新生儿分为窒息组和对照组。检测窒息组和对照组入院6 h内Scr和血BUN水平,并记录每例患儿24 h尿量。同时检测窒息组患儿禁食4 h、24 h、48 h和开奶前1 h及开奶后48 h Scr和BUN水平。窒息组禁食期间和开奶后48 h内基础治疗及给氧时间、给氧体积分数均相同,均未用对肾功能有影响的药物。结果窒息组与对照组、轻度窒息组与重度窒息组、禁食4 h与禁食24 h和48 h、开奶前1 h与开奶后48 h Scr水平比较,差异均有统计学意义(Pa<0.05)。窒息可引起Scr水平增高,窒息程度越重,Scr水平增高越明显。窒息组与对照组、轻度窒息组与重度窒息组BUN水平比较,差异均无统计学意义(Pa>0.05),且24 h尿量均>1 mL.kg-1.h-1。结论窒息禁食时可引起Scr水平增高,如病情许可,禁食时间不宜过长,并适当静脉补充蛋白质和氨基酸。     

The relationship between serum creatinine,serum cystatin C and glomerular filtration rate in pediatric renal transplant recipients: a pilot study

Serum cystatin C more accurately reflects glomerular filtration rate (GFR) in pediatric renal transplant recipients than serum creatinine. Nineteen pediatric renal transplant recipients, 15 male and 4 female, ranging in age from 8.35 yr to 19.06 yr (median 13.52 yr), were enrolled in the study over an 18-month period. Twenty-eight measurements of 99mTc-DTPA GFR were compared with simultaneous measurements of serum cystatin C and Cr. Linear regression analysis, Pearson correlation coefficients and analysis of variance (anova) were used to determine the relationship between creatinine, cystatin C and GFR. The correlation coefficients (R2) for the relationship of 1/Cr to DTPA-GFR and for 1/cystatin C to DTPA-GFR were 0.63 and 0.58, respectively. There was no significant difference between serum cystatin C and serum creatinine as markers of GFR. Serum cystatin C, which costs more to measure than serum creatinine, offers no advantage in monitoring the renal function of pediatric renal transplant recipients.     

Comparative evaluation of iohexol and inulin clearance for glomerular filtration rate determinations

We evaluated iohexol as a filtration marker in 150 children. The clearance of iohexol was compared with that of inulin or with a formula clearance. The single-sample clearance of iohexol showed a good correlation with the clearance of inulin ( r = 0.834). The clearance of iohexol correlated well ( r = 0.672) with the formula clearance. The optimal blood sampling time for iohexol clearance determinations appears to be between 120 and 180 min after injection, at least in patients with relatively normal filtration rates. We conclude that iohexol clearance is an accurate method of determining the glomerular filtration rate in clinical practice.     

Serum creatinine and creatinine clearance in healthy neonates and prematures during the first 10 days of life

Normal serum creatinine (Scr) and creatinine clearance (Ccr) values during the first 10 days of life were obtained in 63 very premature (28–32 weeks of gestation), premature (33–37 weeks) and term infants (38–42 weeks). Scr fell, and Ccr rose less markedly in the very premature infants. Scr was 80 mol/l on the 1st day of life both in very premature and premature infants, and 77 mol/l in full-term neonates. After 10 days, Scr was 73, 53 and 35 mol/l respectively. There was an exponential correlation between Ccr and gestational age, indicating rapid maturation of glomerular function.Abbreviations Scr serum creatinine - Ccr creatinine clearance - GA gestational age - GFR glomerular filtration rate     

Serum creatinine concentration,urinary creatinine excretion and creatinine clearance during the first 9 weeks in preterm infants with a birth weight below 1500 g

Abstract Little is known about serum creatinine concentration, urinary creatinine excretion and creatinine clearance in preterm infants. The aim of the present study was to establish age related reference values for the first weeks of life in preterm infants with a birth weight<1500 g. In addition, the possible influence of therapy with dexamethasone, spironolactone and catecholamines was investigated. In 34 patients, serum creatinine, urinary creatinine excretion and creatinine clearance were measured at weeks 1, 2, 3–4, 5–6 and 7–9 of life. Median birth weight was 1225 g (range 730–1495), mean gestational age 29 (range 26–34) weeks. Concentration of creatinine in serum and urine, urinary creatinine excretion per kilogram body weight and creatinine clearance showed a significant correlation with postnatal age. Thus age related reference values as proposed given in the present study are desirable. Median serum creatinine concentration decreased continuously within the first weeks of life: 97 (10–90th percentile: 69–141) in the 1st week, 70 (45–99) in the 2nd week, 57 (39–71) at week 3–4, 51 (42–62) at week 5–6 and 44 (39–48) mol/l at week 7–9. Median creatinine output in mol/kg body weight was 100 (10–90th percentile: 62–160) in the 1st week, 92 (65–120) in the 2nd week, 79 (52–122) at week 3–4, 89 (68–106) at week 5–6 and 86 (54–109) mol/kg/d at week 7–9. Creatinine clearance increased significantly within the first weeks of life. Values were 12.5 (10–90 the percentile: 7–22) in the 1st week, 16 (10–28) in the 2nd week, 20 (11–34) at weeks 3–4, 23 (15–36) at weeks 5–6 and 29 (17–36) ml/min per 1.73 m² at weeks 7–9. Therapy with dexamethasone, spironolactone or catecholamines showed no influence on creatinine excretion. Creatinine clearance did not only depend on postnatal age but also on gestational age and on the necessity of mechanical ventilation. These findings indicate a reduced glomerular filtration rate in very immature and severely ill preterm infants.Conclusion It might be necessary to lower dosage of renal excreted drugs in very immature and mechanically ventilated infants according to the creatinine clearance.     

Estimation of glomerular filtration rate from plasma creatinine concentration in children

The relation between the true plasma creatinine concentration (Pc) and the glomerular filtration rate corrected for body surface area (GFR/SA) was investigated in 108 individuals, and the following formula was derived: GFR/SA (ml/min per 1-73m2SA) = 0-43 Ht (cm)/Pc (mg/100 ml). This formula was tested in a second group of 83 children, and its accuracy and precision was compared to the 24-hour creatinine clearance. It was found to be superior to the creatinine clearance overall, and was as good, even if all results involving suspect 24-hour-urine collections were eliminated from analysis. The formula in SI usage is: GFR/SA (ml/min per 1-73 m2SA) = 38 Ht (cm)1Pc (mumol/l).