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目的探讨儿童肾衰竭的临床特点及治疗转归,以提高本病的诊治水平。方法研究对象为2005年1月-2009年7月在首都儿科研究所附属儿童医院住院并确诊为肾衰竭的患儿51例,对其病因、临床表现、实验室和影像学检查、治疗转归进行回顾性分析。结果 1.急性肾衰竭35例,年龄(5.9±4.5)岁。病因以肾性因素为主,其中肾小球疾病最常见,其次为溶血尿毒综合征。血肌酐平均值295.9μmol.L-1(48.2~911.6μmol.L-1),水肿、少尿,高血压和电解质紊乱明显。肾活检9例,病理表现多样。经积极治疗,24例肾功能有不同程度恢复,死亡8例,3例放弃治疗。2.慢性肾衰竭16例,年龄(6.7±4.1)岁,病因以先天性泌尿系统发育异常为主,其次为获得性肾小球疾病。血肌酐平均值625.8μmol.L-1(76.0~2 336.2μmol.L-1),贫血、生长发育迟缓,肾性骨病和代谢性酸中毒明显。肾活检1例,病理呈慢性增生硬化性肾炎。4例依赖腹膜透析生存,2例外科手术治疗,余均内科保守治疗。结论儿童急性肾衰竭应尽早明确病因,积极治疗,肾活检具有重要意义。慢性肾衰竭临床多呈非特异性表现,易漏诊、误诊,应定期进行肾脏相关检查,防止和延缓肾衰竭的发生。
Objective To investigate the clinical features of children with renal failure and prognosis in order to improve the diagnosis and treatment of the disease. Methods From January 2005 to July 2009, 51 pediatric patients admitted to the Children’s Hospital affiliated to Capital Institute of Pediatrics and diagnosed as renal failure were enrolled in this study. The etiology, clinical manifestations, laboratory and imaging findings, treatment outcome Retrospective analysis. Results 1. Acute renal failure in 35 cases, age (5.9 ± 4.5) years old. The main cause of renal factors, including the most common glomerular disease, followed by hemolytic uremic syndrome. Serum creatinine average 295.9μmol.L-1 (48.2 ~ 911.6μmol.L-1), edema, oliguria, hypertension and electrolyte imbalance. 9 cases of renal biopsy, pathological diversity. After active treatment, 24 cases of renal function have varying degrees of recovery, 8 patients died, 3 patients give up treatment. Chronic renal failure in 16 cases, age (6.7 ± 4.1) years, the cause of congenital urinary system dysplasia, followed by acquired glomerular disease. Serum creatinine average 625.8μmol.L-1 (76.0 ~ 2 336.2μmol.L-1), anemia, growth retardation, renal osteodystrophy and metabolic acidosis significantly. 1 case of renal biopsy, pathology was chronic proliferative sclerosing nephritis. 4 cases rely on peritoneal dialysis survival, 2 cases of surgical treatment, more than conservative treatment of internal medicine. Conclusion Acute renal failure in children should be identified as soon as possible, active treatment, renal biopsy is of great significance. Clinical manifestations of chronic renal failure mostly non-specific performance, easy to missed diagnosis, misdiagnosis, renal-related checks should be regularly to prevent and delay the occurrence of renal failure.