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目的探讨儿童急性肾损伤(AKI)发病情况、病因、病理改变及病程转归情况。方法回顾性分析2005年9月-2010年9月本院儿肾科收治的所有AKI患儿发病情况、临床诊断、病理诊断、住院天数及预后资料。采用SPSS 13.0软件进行分析。结果共收治AKI患儿121例,每年儿童AKI人数/每年因肾脏疾病住院人数呈递增趋势,其中70例患儿进行了肾活检。121例AKI患儿中,男79例,女42例,发病年龄1～14岁[(7.6±3.8)岁],临床诊断前4位分别为急性感染后肾炎,肾病综合征,溶血尿毒综合征和急性间质性肾炎;病理诊断前4位分别为系膜增生性肾小球肾炎,毛细血管内皮细胞增生性肾小球肾炎,间质性肾炎和狼疮肾炎。所有AKI患儿中61例行血液透析,5例行腹膜透析,其余患儿对症保守治疗后好转。治疗后完全康复95例(78.51%),部分康复24例(19.83%),维持性透析治疗2例(1.66%)。AKI衰竭期患儿住院时间(25.6±6.8)d,明显长于AKI危险期和损伤期患儿,且预后差。结论儿童AKI的病因以感染性疾病为主,尤以感染后肾小球肾炎和间质性肾炎为主,但狼疮肾炎有逐年增多趋势,易并发肾功能不全。肾实质性AKI患儿均应行肾活检以明确病因,进行有效治疗。早期诊断、及时治疗是改善AKI预后的关键。
Objective To investigate the incidence of acute kidney injury (AKI), etiology, pathological changes and course of disease in children. Methods The incidence, clinical diagnosis, pathological diagnosis, hospitalization days and prognosis of all children with AKI admitted to our department from September 2005 to September 2010 were retrospectively analyzed. Using SPSS 13.0 software for analysis. Results A total of 121 children with AKI were enrolled in this study. The annual number of children with AKI / annual number of hospitalizations due to kidney disease showed an increasing trend, and 70 of them had renal biopsy. 121 cases of AKI in children, 79 males and 42 females, the age of onset of 1 to 14 years [(7.6 ± 3.8) years old], the first four clinical diagnosis of acute post-infection nephritis, nephrotic syndrome, hemolytic uremic syndrome And acute interstitial nephritis; the pathological diagnosis of the first four were mesangial proliferative glomerulonephritis, capillary endothelial cell proliferative glomerulonephritis, interstitial nephritis and lupus nephritis. All AKI children with hemodialysis in 61 cases, 5 cases of peritoneal dialysis, the remaining children symptomatic conservative treatment improved. After treatment, 95 cases (78.51%) recovered completely, 24 cases (19.83%) recovered partly, and 2 cases (1.66%) maintained dialysis treatment. The hospital stay of AKI patients was (25.6 ± 6.8) d, which was significantly longer than that of the AKI patients during the critical period and the injury, and the prognosis was poor. Conclusions The causes of AKI in children are predominantly infectious diseases, especially glomerulonephritis and interstitial nephritis after infection. However, there is a trend of increasing year by year for lupus nephritis and renal insufficiency. Renal AKI should be performed in children with renal biopsy to clear the cause, effective treatment. Early diagnosis, timely treatment is the key to improve the prognosis of AKI.