终末期肾病患儿113例的病因构成分析  

The spectrum of causes for end-stage renal disease in 113 pediatric patients

作　　者：汤小山[1] 徐虹[1] 沈茜[1] 孙利[1] 缪千帆 周利军[1] 曹琦[1] 刘海梅[1] 陈径[1] 饶佳[1] 翟亦晖[1] 方晓燕[1] 

机构地区：[1]复旦大学附属儿科医院肾脏风湿科,上海201102

出　　处：《上海医学》2014年第5期382-385,共4页Shanghai Medical Journal

基　　金：国家重大科学研究计划(2011CB944000);卫生部行业科研专项项目(201002006);国家自然科学青年基金项目(81000279;30901622);上海市卫生局科研项目(2008071)资助

摘　　要：目的分析终末期肾病（ESRD）患儿的病因构成。方法通过复旦大学附属儿科医院信息科病史查询系统检索2001年1月-2012年12月（2001--2012年）ESRD住院患儿的性别、首次诊断时的年龄、原发疾病和肾脏替代治疗（RRT）信息。ESRD患儿纳入标准参照2002年美国肾脏基金会制定的慢性肾脏病临床实践指南（NKF-K／DOQI）慢性肾脏病（CKD）5期诊断标准。结果2001--2012年共诊断ESRD患儿113例，明确诊断时的平均年龄为（9．5士4．2）岁，男女比例为1．31：1。导致儿童ESRD的病因依次为先天性肾脏与尿路畸形（CAKUT）和肾脏囊性疾病（26．5％）、肾小球疾病（23．0％）、遗传性肾病（7．1％）、其他诊断（5．3％），另有病因不明患儿占38．1％。CAKUT是引起O～6岁息儿ESRD最主要的病因（36．0％，9／25），学龄期（7～10岁）和青春期（10～18岁）ESRD患儿的原发病因以肾小球疾病为主，分别占34．6％（9／26）和22．6％（14／62）。青春期ESRD患儿中病因不明者的构成比（53．2％，33／62）最高。肾小球疾病的病理类型主要为局灶节段性肾小球硬化（23．1％）。与2001年1月--2006年12月比较，2007年1月--2012年12月ESRD患儿接受RRT的构成比有升高的趋势。结论CAKUT在ESRD患儿的原发病因中占重要地位，是婴幼儿和学龄前患儿的主要病因；而学龄期和青春期起病患儿中肾小球疾病占多数。Objective To analyze the spectrum of causes for end-stage renal disease （ESRD） in pediaric patients. Methods The medical records of ESRD cases were reviewed in our hospital from January 2001 to December 2012. The information including, patients sex, age, primary disease and renal replacement therapy （RRT）, was collected. Chronic kidney disease （CKD） classification system developed by National Kidney Foundation （NKF） was used for ESRD diagnostic criteria. Results A total of 113 cases were diagnosed as ESRD during the survey period in our hospital. The average diagnosis age was （9.5＋_4.2） years with a gender ratio of 1.31 （male to female）. The main primary disease was congenital anomalies of the kidney and urinary tract （CAKUT）/cystic kidney disease （26.7%）, followed by glomerular disease （23.0%）, inherited kidney disease （7.1% ） and other diagnosis （5.3%）. In addition, primary diseases in 43 cases （38.1% ） were not clear, 53.2% of whom were adolescents. CAKUT was the main cause of ESRD in the patients aged 0 to 6 years old （36.0%, 9/25）, while the primary disease of school-age （7 to 10 years old） and adolescent （10 to 18 years old） ESRD children was glomerular disease, accounting for 34. 6% （9/26） and 22. 6% （14/62）, respectively. Focal segmental glomerulosclerosis （FSGS） was the main pathological type of glomerular disease （23.1% ）. More ESRD children underwent renal replacement therapy （RRT） during January 2007 to December 2012 period as compared with January 2001 to December 2006. Conclusion CAKUT is a main cause of pediatric ESRD, especially in infants and preschool children, while the primary disease in school-age and adolescent ESRD children may be mainly due to glomerular disease.

关 键 词：儿童 肾功能衰竭 慢性 病因 

分 类 号：R726.9[医药卫生—儿科]