摘要
目的 了解儿童肾脏疾病中是否存在急性肾损伤（AKI）,儿童肾脏疾病基础上AKI的发生率和病因构成,探讨AKI与肾脏疾病患儿住院时间、住院费用和短期预后的关系.方法 对我科住院的部分肾脏疾病患儿进行前瞻性的临床研究.病例入选标准：①确诊（原发性）肾病综合征（NS）、紫癜性肾炎（HSPN）和狼疮性肾炎（LN）的2～18岁住院患儿;②发病或复发≤3个月.AKI的诊断采用成人的AKI诊断标准.结果 共有95例患儿入选本研究,包括原发性NS 65例、HSPN 15例和LN 15例,其中33例（34.7%）符合AKI的诊断标准.LN、HSPN患儿伴发的AKI,100%表现为血肌酐升高;NS伴发的AKI中,65.4%的患儿表现为尿量减少,其中只有19.2%的患儿同时伴有血肌酐升高.AKI的病因：①NS基础上发生的AKI中,只有少数存在明确病因（26.9%）,且多由肾外因素导致（15.4%）,包括环孢素A的副作用、低血容量和肾小管间质损害;②LN和HSPN基础上发生的AKI,均由基础肾小球疾病导致.AKI组的住院时间和住院费用显著高于非AKI组[住院时间分别为28（6～94）、21（7～100）d;Z=-1.971,P=0.049;住院费用分别为12 035.7（1561.7～94 783.1）、8594.3（1390.1～98 876.5）元;Z=-1.993,P=0.046];随访6个月和12个月时,AKI组和非AKI组的血肌酐水平差异无统计学意义[随访6个月时分别为（60.4±91.8）、（42.8±12.2）μmol/L,t=0.937,P=0.358;随访12个月时分别为（48.7±18.1）、（47.7±14.2）μ,mol/L,t=0.197,P=0.845].结论 在儿童肾脏病急性期,34.7%的病例发生AKI;原发性NS中,非肾性因素是导致AKI发生的主要原因,而在LN和HSPN中,AKI的常见病因为基础肾小球疾病.AKI组的住院时间和住院费用高于非AKI组,但6个月和12个月随访时的血肌酐水平与非AKI组的患儿相比无显著差异.
Objective Acute kidney injury （AKI） was recently proposed for early recognition of renal function impairment and prompt interventions. Previous study revealed that AKI was highly associated with the prognosis. However, there was rare report of AKI in renal diseases, especially in children cohorts.Therefore, we performed the prospective clinical research in children with renal diseases in our hospital,aiming to study the prevalence, the clinical characteristics and the short-term prognosis of AKI. Method The study was designed as a prospective, single-center observational study. Inclusion criteria： ① the primary diagnosis was primary nephrotic syndrome （NS）, Henoch-Schoenlein purpura nephritis （HSPN） or lupus nephritis （ LN）, ② the duration from the onset of the renal diseases to the admission was less than 3 months. The serum creatinine and urine output of the subjects would be prospectively monitored. AKI was defined by the adult criteria and stratified by Acute Kidney Injury Network （AKIN） criteria. The patients were followed up at 6 months and 12 months after enrollment. Result Between October 2007 and April 2009, a total of 95 children were included, including 65 cases with NS, 15 HSPN and 15 LN. Mean age was （8. 9 ±3. 9） years （range 2-16 years）. Thirty-three of the 95 patients （34. 7% ） fulfilled the AKI criteria,13 patients （13.7%） were diagnosed as acute renal failure （ARF）. All the AKI in children with LN and HSPN presented with serum creatinine elevation. However, 65.4% of AKI in NS presented with decreasing urine output, only 19. 2% accompanied with increasing creatinine, with higher stages of urine output.Regarding the etiology, only 26.9% of AKI in NS had definite cause, most of which resulted from side-effect of cyclosporine, hypowlemia or tubule-interstitial damage, independent of glomerular diseases. In contrast,the AKI in LN and HSPN were exclusively caused by glomerular diseases. The length and costs of hospitalization of AKI group were significantly higher than non-AKI[length of hospitalization （ d）, 28 （6 to 94） vs. 21 （ 7 to 100 ）, Z = - 1. 971, P = 0. 049; cost of hospitalization （ yuan）, 12 035.7 （ 1561.7 to 94 783.1） vs. 8594.3 （1390.1 to 98 876.5）, Z= - 1.993, P=0.046]. There was no significant difference in the serum creatinine at 6-month and 12-month follow-up between AKI group and non-AKI[6-month, （60.4 ±91.8） μmol/L vs. （42. 8 ± 12. 2） μmol/L, t =0. 937, P =0. 358; 12-month, （48. 7 ±18.1） μmol/L vs. （47.7±14.2） μmoL/L, t=0.197, P=0.845]. Conclusion Theprevalence of AKI （34.7%） was higher than that of ARF （ 13.7% ） in children with renal diseases. Most of the AKI in NS resulted from non-glomerular diseases. In contraat, most AKI in LN and HSPN were caused by underlying glomerular diseases. The length and costs of hospitalization were significantly higher in AKI group.However, there was no significant difference in serum creatinine between AKI and non-AKI group in the follow-up at 6 months and 12 months. Further investigations on criteria for the diagnosis of AKI in children with renal diseases are still needed.
出处
《中华儿科杂志》
CAS
CSCD
北大核心
2011年第1期60-65,共6页
Chinese Journal of Pediatrics
基金
北京大学第一医院科研基金资助
关键词
肾病综合征
狼疮肾炎
紫癜
儿童
急性肾损伤
Nephrotic syndrome
Lupus nephritis
Purpura
Child
Acute kidney injury
