371例2-5期慢性肾脏病患儿的单中心回顾性研究

Q4 Medicine

中华实用儿科临床杂志 Pub Date : 2020-03-30 DOI:10.3760/CMA.J.CN101070-20190430-00369

Q. Fu, Xiaorong Liu, Zhi Chen, Jian-feng Fan, Qiang Sun, Chen Ling

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引用次数: 0

摘要

目的探讨儿童慢性肾脏疾病(CKD)的病因、并发症及治疗方法，为综合治疗提供依据。方法收集2012年1月至2018年12月首都医科大学附属北京儿童医院肾内科收治的371例2 ~ 5期CKD患儿的临床资料。回顾性调查分析其病因、并发症及治疗等资料。结果(1)共纳入371例CKD患儿，男女比例为1.44∶1.00。0 ~ 3岁35例，4 ~ 6岁54例，7 ~ 12岁189例，13 ~ 18岁93例。2期11例，3期59例，4期62例，5期239例。(2)所有患者中，先天性肾尿路异常135例(36.39%)，肾小球疾病77例(20.76%)，遗传性肾脏疾病21例(5.66%)，小管间质疾病12例(3.23%)，遗传性代谢性疾病4例(1.08%)。其他疾病5例(1.35%)，病因不明117例(31.64%)。(3)行肾活检57例，肾活检率15.36%。主要病理类型为局灶节段性肾小球硬化(18例，31.58%)、硬化性肾小球肾炎(13例，22.81%)和肾小管间质肾病(10例，17.54%)。(4)贫血和继发性甲状旁腺功能亢进(SHPT)是最常见的并发症，分别占77.90%(289例)和73.05%(271例)，其次是高血压(183例，49.33%)、心血管疾病(CVD)(139例，37.47%)和蛋白能量消耗(PEW)(51例，13.75%)。CKD患儿5期高血压、贫血、SHPT、CVD发生率均显著高于2-4期CKD患儿，差异均有统计学意义(χ2=50.03、122.36、77.07、64.89,P均<0.01)。肾小球疾病患者高血压、CVD发生率高于ckut患者，差异有统计学意义(χ2=65.63、40.89,P均<0.01)。CAKUT患者的PEW发生率高于肾小球疾病患者，差异有统计学意义(χ2=10.58, P<0.01)。(5)患儿接受初始肾脏替代治疗190例，血液透析129例(67.89%)，腹膜透析31例(16.32%)，拒绝治疗30例(15.79%)，初始治疗方式无移植患者。结论本中心儿童CKD 2 ~ 5期发病的主要原因是ckut，但CKD 5期发生ckut和肾小球疾病的比例相似。儿童慢性肾病最常见的并发症是贫血。高血压、贫血、SHPT和CVD随着CKD分期的进展而增加。SHPT通常发生在CKD 4期和5期儿童。不同因素引起的CKD患儿并发症发生率不同。血液透析是该中心初始肾脏替代治疗的主要方法。关键词:慢性肾病;病原学;并发症;治疗;孩子

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A single center retrospective study of 371 children with chronic kidney disease at stage 2 to 5

Objective To investigate the etiology, complications and treatment of children with chronic kidney disease(CKD), in order to provide evidence for the comprehensive management. Methods The clinical data of 371 children patients with CKD at stage 2 to 5 admitted to the Department of Nephrology, Beijing Children′s Hospital Affiliated to Capital Medical University from January 2012 to December 2018 were collected.The etiology, complications and treatment and other data were retrospectively investigated and analyzed. Results (1)A total of 371 children with CKD were enrolled, and the male to female ratio was 1.44∶1.00.Thirty-five cases aged from 0 to 3, 54 cases aged from 4 to 6, 189 cases aged from 7 to 12, 93 cases aged from 13 to 18.Eleven cases were diagnosed at stage 2, 59 cases at stage 3, 62 cases at stage 4, and 239 cases at stage 5.(2) In all patients, 135 cases (36.39%) had congenital anomalies of the kidney and urinary tract(CAKUT), 77 cases (20.76%) had glomerular diseases, 21 cases (5.66%) had hereditary kidney diseases, 12 cases (3.23%) had tubulointerstitial diseases, 4 cases (1.08%) had inherited metabolic diseases, 5 cases (1.35%) had other diseases and in 117 cases (31.64%) the causes of disease were unknown.(3) Renal biopsy was performed in 57 cases with the rate of renal biopsy of 15.36%.The main pathologic types included focal segmental glomerulosclerosis(18 cases, 31.58%), sclerosing glomerulonephritis (13 cases, 22.81%) and tubulointerstitial nephropathy (10 cases, 17.54%). (4)Anemia and secondary hyperparathyroidism(SHPT) were the most common complications, accounting for 77.90% (289 cases) and 73.05% (271 cases), respectively, followed by hypertension (183 cases, 49.33%), cardiovascular disease (CVD) (139 cases, 37.47%) and protein-energy wasting (PEW) (51 cases, 13.75%) successively.The incidence of hypertension, anemia, SHPT and CVD in children with CKD at stage 5 were significantly higher than those in CKD at stage 2-4, and the differences were statistically significant(χ2=50.03, 122.36, 77.07, 64.89, all P<0.01). The incidence of hypertension and CVD in patients with glomerular diseases were higher than those in CAKUT patients, and the differences were statistically significant(χ2=65.63, 40.89, all P<0.01). The incidence of PEW in CAKUT was higher than that in patients with glomerular diseases, and the difference was statistically significant(χ2=10.58, P<0.01). (5)Initial renal replacement therapy was performed in 190 children, hemodialysis in 129 cases (67.89%), peritoneal dialysis in 31 cases (16.32%), and 30 cases (15.79%) refused treatment There was no transplant patient in initial treatment modality. Conclusions In the center, the major cause of CKD stage 2 to 5 in children was CAKUT, but the proportion of CAKUT and glomerular diseases was similar in CKD stage 5.The most common complication of CKD in children is anemia.Hypertension, anemia, SHPT and CVD increased with the progression of CKD staging.SHPT usually occurs in children with CKD stage 4 and 5.The incidence of complications in children with CKD caused by different factors is different.Hemodialysis is the main method of initial renal replacement therapy in the center. Key words: Chronic kidney disease; Etiology; Complication; Treatment; Child

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来源期刊

中华实用儿科临床杂志 Medicine-Pediatrics, Perinatology and Child Health

CiteScore

0.60

自引率

0.00%

发文量

14243

期刊介绍： Chinese Journal of Applied Clinical Pediatrics ( semi-monthly ) is a core journal of paediatrics under the supervision of China Association for Science and Technology, sponsored by Chinese Medical Association and undertaken by Xinxiang Medical College. Founded in 1986, it is openly circulated both at home and abroad. The journal has several columns, such as Expert Forum, Experimental Research and Paediatric Surgery, which are mainly for paediatric medical workers and medical researchers in hospitals. Its purpose is to reflect the new theories and technologies in paediatric medicine and scientific research at home and abroad, and to promote academic exchanges. Chinese Journal of Applied Clinical Pediatrics is a source journal of China Science Citation Database (CSCD), a core journal of Peking University, a source journal of Chinese science and technology paper statistics (China Science and Technology Core Journals), a core academic journal of RCCSE, a high-quality scientific and technical journal of China, a high-quality scientific and technical journal of China Association for Science and Technology, and a high-quality scientific and technical journal of China Biomedical Science and Technology Association. We have been published in China Biomedical Literature Database (SinoMed), China Knowledge Network, Wanfang Data Knowledge Service Platform, China Academic Journal Abstracts, Scopus Database, Chemical Abstracts (USA), Japan Science and Technology Agency (JSTA) Database, Copernicus Abstracts (Poland), Abstracts of the Centre for Agricultural and Biological Sciences (CABS) of the United Kingdom, Cambridge Scientific Abstracts ProQuest Database, WHO Medical Journal of the Western Pacific Region (WMPR), and WHO Medical Journal of the Western Pacific Region (WMPR) of the United States. We have been included in dozens of authoritative databases at home and abroad, such as WHO Western Pacific Region Index of Medicine (WPRIM), Ullrich's Guide to Periodicals, and so on.