儿童血液净化中心新型冠状病毒感染防控建议

自2019年12月以来,中国持续发生新型冠状病毒(2019-nCoV)感染疫情。流行病学调查提示人群对2019-nCoV普遍易感,儿童及婴幼儿陆续有确诊病例,而慢性透析患儿本身存在基础疾病及免疫力低下,属于易感高危人群。为有效预防慢性透析患儿2019-nCoV感染,避免疾病在儿童血液净化中心发生和传播,中华医学会儿科学分会肾脏病学组根据最新2019-nCoV国家管理方案和国内外相关资料,结合血液净化标准操作规程2020版及临床实际操作,制定了2019-nCoV流行期间在院维持性血液透析和居家腹膜透析儿童感染防控建议。     

中华医学会肾脏病学分会关于血液净化中心(室)新型冠状病毒感染的防控建议

鉴于目前覆盖全国的新型冠状病毒感染疫情,血液净化中心(室)人群相对密集、透析患者及陪同人员流动性大等情况,为有效预防透析患者、陪同人员及工作人员感染新型冠状病毒,保障透析治疗的顺利进行,避免疾病在血液净化中心发生和传播,中华医学会肾脏病学分会根据目前最新新型冠状病毒国家管理方案和国内外相关资料,结合血液净化标准操作规程(SOP)及临床实际操作,制定了关于血液净化中心(室)新型冠状病毒感染的防控建议,为全国血液净化中心在这一特殊时期的工作提供临床实践指导。     

儿童血液净化中心新型冠状病毒感染防控建议

自2019年12月以来,中国持续发生新型冠状病毒(2019-nCoV)感染疫情。流行病学调查提示人群对2019-nCoV普遍易感,儿童及婴幼儿陆续有确诊病例,而慢性透析患儿本身存在基础疾病及免疫力低下,属于易感高危人群。为有效预防慢性透析患儿2019-nCoV感染,避免疾病在儿童血液净化中心发生和传播,中华医学会儿科学分会肾脏病学组根据最新2019-nCoV国家管理方案和国内外相关资料,结合血液净化标准操作规程2020版及临床实际操作,制定了2019-nCoV流行期间在院维持性血液透析和居家腹膜透析儿童感染防控建议。     

慢性肾脏病门诊患者单纯收缩期高血压与肾脏病分期的关系

目的 探讨慢性肾脏病(CKD)患者中单纯收缩期高血压(ISH)与CKD分期的关系.方法 选择CKD患者626例,按血压类型分为:正常血压、单纯舒张期高血压(IDH)、ISH和双期高血压(SDH).观察4种血压亚型在CKD各期的百分比.结果 在CKD 1、2、3、4、5期,IDH患病率分别为9.1％、6.7％、2.9％、3.1％和4.1％;ISH患病率分别为0、9.2％、23.9％、28.6％和37.0％;SDH患病率分别为4.5％、8.4％、8.0％、17.3％和21.9％;血压控制率逐渐下降,分别为86.4％、75.6％、65.3％、51.0％和37.0％(P＜0.05);多因素回归分析结果显示,年龄、糖尿病和CKD分期为发生ISH的独立危险因子.与CKD 1～2期比较,CKD 3、4、5期发生ISH的OR值分别为2.388、2.697和5.980.结论 CKD患者肾功能受损的的程度与ISH进展一致.     

慢性肾脏病合并2019冠状病毒病临床诊治专家共识(2023年版草案)

2019冠状病毒病(coronavirus disease 2019, COVID-19)是指新型冠状病毒(severe acute respiratory syndrome coronavirus 2, SARS-CoV-2)感染导致的包括肺炎在内的全身性疾病。COVID-19除了累及呼吸系统, 亦可累及包括泌尿系统、心血管系统、消化系统、神经系统、血液系统、免疫系统在内的全身多个器官系统。肾脏是COVID-19常见的受累脏器之一, SARS-CoV-2可通过直接和间接作用引起肾脏损伤, 肾脏受累的临床表现包括:急性肾损伤(acute kidney injury, AKI)、蛋白尿、血尿等。慢性肾脏病(chronic kidney disease, CKD)患者常合并不同程度的免疫缺陷, 特别是使用激素/免疫抑制剂的免疫性肾病、肾移植以及接受肾脏替代治疗的终末期肾病(end-stage renal disease, ESRD)患者, 这些患者不但对SARS-CoV-2易感, 且感染后易转为重症或危重症。CKD患者合并COVID-19后治疗与非CKD患者有所不同, 抗病毒药物用于重度肾...     

儿童慢性肾脏病3~5D期贫血状况的单中心调查研究

目的:探讨慢性肾脏病（chronic kidney disease,CKD）3~5D期患儿肾性贫血的临床特点,为规范化诊治提供参考数据。方法:回顾性分析2016年1月至2018年12月于首都医科大学附属北京儿童医院就诊的CKD患儿的临床资料,按照估算肾小球滤过率分成CKD 3期组、4期组及5期组,比较各组患儿的贫血指标...     

慢性肾脏病患者血管钙化发生机制研究进展

慢性肾脏病（chronic kidney disease,CKD）是世界范围内的严重健康问题,而血管钙化（vascular calcification）对CKD患者的高心血管事件发病率和病死率起着重要促进作用。基于其所带来的巨大的卫生、经济负担,探索其发生机制及防治手段任务迫切且艰巨。我们综述文献发现,多种细胞如平滑肌...     

线粒体靶向治疗在慢性肾脏病中的研究进展

线粒体的结构和功能障碍参与慢性肾脏病（chronic kidney disease,CKD）的发生和发展,线粒体靶向治疗在慢性肾脏疾病治疗中有重要的应用价值。我们总结和综述了线粒体损伤在CKD发生发展中的作用,探讨线粒体靶向治疗CKD的临床价值与未来方向。     

上海市静安区慢性肾脏病高危人群社区筛查结果分析

目的以上海市静安区为试点,依托社区卫生服务中心,筛查慢性肾脏病(CKD)高危人群中的CKD患病率,为CKD的社区筛查分析提供依据。方法采用回顾性分析方法,分析上海市静安区2016年7月至2018年11月参加社区筛查的CKD高危人群的患病情况。对25199例研究对象进行间隔时间大于3个月的两次实验室检查。根据CKD诊断标准对高危人群患病情况进行诊断,并对患有CKD人群进行疾病分期、分层。将筛查人群分别按照性别、年龄、病史分组,比较各组CKD检出率的差异。结果该筛查人群中既往已知的CKD患者有788例,而经区级医院确诊的CKD患者有3713例,检出率为14.73%,筛查前未知的CKD患者是已知患者的4.71倍。女性高危人群CKD检出率高于男性(16.00%比13.00%,χ2=44.213,P<0.001);老年(≥65岁)组CKD检出率高于非老年组(14.94%比13.76%,χ2=4.001,P=0.046)。患有高血压、高尿酸血症、慢性肾炎家族史的高危人群组的CKD检出率均明显高于无上述疾病人群(均P<0.05)。结论CKD高危人群中通过筛查检出的CKD患者人数是既往已知患者人数的4.71倍,因此在社区高危人群中开展CKD筛查十分必要。女性、高龄、高血压、高尿酸血症、慢性肾炎家族史是CKD的独立危险因素。     

疑似或确诊新型冠状病毒肺炎患者相关手术室感染防控建议

根据新型冠状病毒肺炎的流行病学特点,结合国家近期印发的有关该疾病的相关防控方案、指引和感染防控的相关法律、法规,结合手术室工作特点,组织我省手术室护理专家制订首版-该疾病患者手术在手术室过程的感染防控指引,内容包括手术间准备、用物准备、手术人员准备、患者转运、手术中和手术后的管理等各个环节,以预防和控制新型冠状病毒肺炎手术患者在手术过程中造成交叉感染,并供全国各地医院手术室参考。     

Strategies for prevention and control of the 2019 novel coronavirus disease in the department of kidney transplantation

To summarize measures for the prevention and control of the 2019 novel coronavirus disease (COVID-19) in the department of kidney transplantation. We retrospectively analyzed the clinical data of outpatients and inpatients in the department of kidney transplantation from January 20 to March 1, 2020, and followed up the in-home kidney transplant recipients and those waiting for kidney transplantation through the Internet platform. Our department had formulated detailed prevention and control measures, mainly including kidney transplant outpatient management, kidney transplantation ward management, management of kidney transplant surgery, dialysis management of patients waiting for kidney transplantation, personal protection of medical staff, and follow-up management of discharged patients after kidney transplantation. During the epidemic period, there were no COVID-19 cases among 68 outpatient examined kidney transplant recipients, 32 hospitalized kidney transplant recipients, 19 patients waiting for kidney transplantation in hospital, and 30 medical staff. There were no COVID-19 cases among 160 follow-up recipients after kidney transplantation and 60 patients waiting for kidney transplantation. During the epidemic period, we implemented strict prevention and control measures and adjusted working methods and procedures to ensure safe and orderly work of the department.     

Cardiovascular disease in children with chronic kidney disease

In children with end-stage renal disease (ESRD), cardiovascular disease (CVD) mortality has not changed for the past 3 decades. Cardiac disease remains the second most common cause of death. Recent data demonstrate a high incidence and prevalence of traditional and chronic kidney disease (CKD)-related CVD risk factors in children. Early markers of cardiomyopathy, such as left ventricular hypertrophy (LVH) and left ventricular dysfunction (LV dysfunction), and early markers of atherosclerosis, such as increased carotid artery intima-media thickness (IMT) and carotid arterial wall stiffness, are frequently found in this patient population. Early identification of modifiable risk factors and treatment of asymptomatic CVD might lead to decrease of cardiovascular morbidity and mortality in young adults who developed CKD during childhood.     

Cardiovascular disease in children with chronic kidney disease

More than a decade ago, cardiovascular disease (CVD) was recognized as a major cause of death in children with advanced CKD. This observation has sparked the publication of multiple studies assessing cardiovascular risk, mechanisms of disease, and early markers of CVD in this population. Similar to adults, children with CKD have an extremely high prevalence of traditional and uremia-related CVD risk factors. Early markers of cardiomyopathy, such as left ventricular hypertrophy and dysfunction, and early markers of atherosclerosis, such as increased carotid artery intima-media thickness, carotid arterial wall stiffness, and coronary artery calcification, are frequently present in these children, especially those on maintenance dialysis. As a population without preexisting symptomatic cardiac disease, children with CKD potentially receive significant benefit from aggressive attempts to prevent and treat CVD. Early CKD, before needing dialysis, is the optimal time to both identify modifiable risk factors and intervene in an effort to avert future CVD. Slowing the progression of CKD, avoiding long-term dialysis and, if possible, conducting preemptive transplantation may represent the best strategies to decrease the risk of premature cardiac disease and death in children with CKD.     

Anemia in children with chronic kidney disease

Anemia is a common feature of chronic kidney disease, but the management of anemia in children is complex. Erythropoietin and supplemental iron are used to maintain hemoglobin levels. The National Kidney Foundation-Kidney Disease Outcomes Quality Initiative (NKF-KDOQI) clinical practice guidelines for the management of anemia specifically in children were recently published. Pediatric nephrologists are encouraged to use current clinical practice guidelines and best evidence in conjunction with their clinical experience to optimally manage patients with anemia.     

Immunizations in children with chronic kidney disease

Children with chronic kidney disease (CKD) are at increased risk for vaccine-preventable diseases. These patients may have a reduced response to and/or reduced duration of antibody after immunization and therefore monitoring of antibody levels or titers is indicated for some vaccines. In addition, pediatric CKD patients require immunizations not routinely provided to healthy children. Unfortunately, studies in pediatric CKD patients, including those on dialysis and awaiting kidney transplantation, have demonstrated sub-optimal immunization rates. In order to minimize the risk for vaccine-preventable disease in pediatric CKD patients, it is imperative that all who care for these patients remain abreast of the recommended childhood immunization schedule, as well as alterations to this schedule required for children with CKD, including end-stage kidney disease. This article reviews recent changes to the recommended childhood immunization schedule and alterations and additions to this schedule recommended for children with CKD. Where available, data on antibody response to immunizations in children with CKD are presented.     

Anemia in children with chronic kidney disease

Anemia in children with chronic kidney disease (CKD) is common secondary to inadequate erythropoietin production, iron deficiency, blood loss, inflammation, secondary hyperparathyroidism, uremic toxins, and nutritional deficiencies. Anemia has a variety of deleterious consequences, including associations with increased mortality and left ventricular hypertrophy. Recombinant human erythropoietin is effective in treating anemia in children with CKD, and recent studies show that darbepoetin alpha is an attractive alternative because it requires less frequent injections. Iron deficiency is a major cause of anemia that is resistant to erythropoietin or darbepoetin alpha. Although oral iron is effective in some patients, many children, especially those receiving hemodialysis, require intravenous iron to replenish their iron stores. Both acute dosing and chronic dosing of intravenous iron are effective in pediatric patients.