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目的探讨儿童急性肾损伤(AKI)的病因、临床特点及治疗方法,以助于早期诊断及制定合理的治疗方案。方法回顾性分析269例AKI患儿的临床资料。分析儿童AKI的病因分布。并探讨其病史、临床表现、实验室检查、肾损伤分期与预后的相关关系。结果 AKI患儿平均年龄6.06岁。肾前性AKI 34例(占12.6%,依次为腹泻50.0%,新生儿HIE 23.5%,烧伤11.8%),肾实质性AKI 165例(占61.3%,依次为肾病综合征21.8%,非链球菌感染后肾炎14.5%,感染13.9%,SLE 12.1%),肾后性AKI 70例(占26.0%,依次为结石81.4%,膀胱输尿管返流28.6%,肿瘤梗阻7.1%,肾盂输尿管连接处梗阻5.7%,细菌栓塞及后尿道瓣膜各1.4%)。死亡2例(肾实质性AKI),未愈48例,好转142例,治愈77例。不同年龄段患儿的病因分布差异有统计学意义(P=0.000),新生儿AKI主要为肾前性原因(65.4%),婴幼儿期以肾后性AKI(58.3%)为主,学龄前及学龄儿主要为肾性AKI(61.9%,86.2%)。其预后与原发肾脏疾病类型、AKI分期、病史长短及是否伴有少尿、蛋白尿相关(Pa<0.05)。结论新生儿AKI主要为肾前性AKI,婴幼儿期主要为肾后性AKI,学龄前及学龄儿主要为肾性AKI。预后主要取决于原发肾脏疾病类型、病情分级、病史长短及是否伴有少尿、蛋白尿。早期诊断、早期治疗有助于改善预后,提高生存率。
Objective To explore the etiology, clinical features and treatment of childhood acute kidney injury (AKI) in order to help early diagnosis and to develop a reasonable treatment plan. Methods The clinical data of 269 children with AKI were retrospectively analyzed. Analysis of the etiology of childhood AKI. And to explore its history, clinical manifestations, laboratory tests, renal injury staging and prognosis of the relationship. Results The mean age of children with AKI was 6.06 years. There were 34 cases of prerenal AKI (12.6%, followed by 50.0% of diarrhea, 23.5% of neonates with HIE and 11.8% of burn), 165 cases of renal parenchymal AKI (61.3%, followed by nephrotic syndrome 21.8% 14.5% postinfection nephritis, infection 13.9%, SLE 12.1%), 70 cases of post-renal AKI (26.0%, followed by 81.4% of the stones, vesicoureteral reflux 28.6%, tumor obstruction 7.1%, ureteropelvic junction obstruction 5.7 %, Bacterial embolism and posterior urethral valve 1.4%). 2 died of renal parenchymal AKI, 48 cases failed to heal, 142 cases improved, 77 cases were cured. There were significant differences in the distribution of etiology in children of different ages (P = 0.000), AKI in neonate was predominantly preintrous (65.4%), and infantile remission was in renal AKI (58.3%), And school-age children mainly renal AKI (61.9%, 86.2%). The prognosis and primary kidney disease type, AKI staging, length of history and whether associated with oliguria, proteinuria (Pa <0.05). Conclusion Neonatal AKI is mainly prerenal AKI, infantile age is mainly post-renal AKI, preschool and school-age children are mainly renal AKI. The prognosis mainly depends on the type of primary kidney disease, disease classification, length of history and whether accompanied by oliguria, proteinuria. Early diagnosis and early treatment can help to improve the prognosis and improve the survival rate.