婴幼儿三聚氰胺相关泌尿系结石并发急性肾衰竭诊疗分析

目的 探讨食用受三聚氰胺污染的婴幼儿配方奶粉致泌尿系结石并发急性肾衰竭患儿的临床特点、诊断和治疗措施.方法 回顾性分析首都医科大学附属北京儿童医院和徐州市儿童医院2008年收治的34例因食用三聚氰胺污染的婴幼儿配方奶粉致泌尿系结石、梗阻发生急性肾衰竭的患儿.分析其流行病学、临床表现及影像学特点,总结4种不同的治疗方法 及疗效.结果 34名患儿均存在急性肾衰竭,血尿素氮(24.1±8.2)mmol/L,血肌酐(384.2±201.2)μmol/L.对留取的14例结石标本分析证实,结石是三聚氰胺和尿酸的合成体.膀胱镜治疗组血肌酐降至正常的平均时间为(3.5±1.9)d;切开取石组(2.7±1.1)d;透析组(3.8±2.3)d;内科保守治疗组(2.7±1.6)d.四组肾功能恢复时间差异无统计学意义(P=0.508),组问差异无统计学意义(P=0.803～1).经治疗34例患儿急性肾衰竭全部治愈,泌尿系结石完全或部分排出.肾功能恢复时间为(3.0±1.8)d.结论 三聚氰胺污染婴幼儿配方奶粉可以导致婴幼儿泌尿系结石引发的梗阻性急性肾衰竭,治疗首选药物或透析方法 纠正电解质紊乱,特别是高钾血症,尽快通过内、外科方法 解除梗阻引流尿液.患儿近期预后良好.

Melamine related urinary calculus and acute renal failure in infants

Objective To summarize clinical characteristics, diagnosis and treatment of infants withurinary calculus and acute renal failure developed after being fed with melamine tainted formulamilk. Methods Data of infant patients with urinary calculus and acute renal failure due to melamine taintedformula milk admitted to the Beijing Children's Hospital affiliated to the Capital Medical University and theXuzhou Children's Hospital in 2008 were used to analyze the epidemiological characteristics, clinicalmanifestations, image features as well as effects of 4 types of therapies. Results All the 34 infants withurinary 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)μnol/L. The chemical analysis on the urinarycalculus sampled from 14 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) d for cystoscopygroup, (2. 7±1.1 )d for lithotomy group, (3. 8±2. 3)d for dialysis group, and (2. 7±1.6)d for medicaltreatment group, which had no statistically significant difference ( P = 0. 508 ). Renal failure of all the 34infants was rerelieved within 1 to 7 days, averaging (3.0±1.8) d. Conclusion Melamine tainted formulamilk may cause urinary calculus and obstructive acute renal failure. It is suggested that firstly the patientswith urinary calculus complicated with acute renal failure should be treated with dialysis or medication tocorrect electrolyte disturbances, in particular hyperkalemia, and then relieve the obstruction with availablemedical and surgical methods as soon as possible. It is observed that the short term prognosis is satisfactory.