三聚氰胺所致婴幼儿肾脏改变：142例分析

目的分析三聚氰胺所致婴幼儿肾结石和肾盂积水的临床表现和处理。方法大同市2253例用过含三聚氰胺奶粉的婴幼儿接受诊治，其中男童1098例，女童1155例，18例〉3岁，其余在3岁以下。均以问题奶粉为主要食物。结果B型超声检查发现肾脏改变142例（6.30％），其中单纯肾结石101例（男孩61例，女孩40例），单纯肾盂积水26例（男孩24例，女孩40例）肾结石并发肾盂积水15例（男孩13例，女孩2例）。17例肾结石直径1〉0.4cm，最大的结石直径1.0cm。男孩发病率为8.92％，显著高于女孩（3.81％，P〈0.05）。主要症状包括排尿时哭闹，尿血和腹痛。尿改变39例，其中尿潜血9例、血尿26例、蛋白尿4例。治疗包括停止食用问题奶粉，多饮水，鼓励排尿以增加结石排出的机会和应用低张碱性液体。住院患儿均治愈。结论三氯氰胺进入以污染奶粉为食的婴幼儿体内可造成肾结石和肾积水。男童发病率高于女童。三聚氰胺所致婴幼儿肾结石和肾盂积水经保守治疗有效。

Clinical manifestations and treatment of melamine-caused nephrolithiasis and renal dysfunction in infants and young children: analysis of 142 cases

Objective To analyze the clinical manifestations and treatment of melamine-caused children nephrolithiasis and renal dysfunction in children. Methods The clinical data of 2253 children, 1098 boys and 1155 girls, 18 being older than 3 years, and the other under that age ,who had been fed with tainted powdered milk and visited the hospital from 17 September to 31 October, were analyzed. Results B-color ultrasonography showed 142 renal changes （6.30%）, including 101 cases of simple nephrolithiasis （61 boys and 40 girls）, 26 cases of simple hydronephrosis （24 boys and 2 girls）, and 15 cases of nephrolithiasis combined with hydronephrosis （13 boys and 2 girls）. Small kidney stones 〈 0.4 cm in diameter were found in 99 cases. The diameter of the biggest stone was 1.0 cm. The detection rate boy was 8.92%, significantly higher than that of the girls （3.81%, P〈 0.05）. The main symptoms included crying on urination, hematuria, and abdominal pain. A few cases showed urine occult blood, hematuria, and urine albumin. Treatment included stopping the use of the original brand of powdered milk, taking copious water and encouraging diuresis to enhance chance of spontaneous passing of stones, and use of hypotonic alkaline liquid. All children were cured. Conclusion Melamine can cause nephrolithiasis and renal dysfunction in infants and young children who mainly lived on tainted powdered milk. Conservative treatment is effective for such disease.