Norman L J, Coleman J E, Macdonald I A, Tomsett A M, Watson A R
Department of Nutrition and Dietetics, Nottingham City Hospital, NHS Trust, Hucknall Road, Nottingham, NG5 1PB, UK.
Pediatr Nephrol. 2000 Dec;15(3-4):259-65. doi: 10.1007/s004670000465.
Practical joint medical/dietetic guidelines are required for children with chronic renal insufficiency (CRI). Nutritional status and growth were compared in 95 children (59 male) > 2 years age with CRI, grouped following [51Cr]-labelled EDTA glomerular filtration rate (GFR, ml/min/1.73 m2) estimations into 'normal' kidney function [GFR > 75 (mean 104 (SD 18.9), n = 35], mild (GFR 51-75, n = 23), moderate (GFR 25-50, n = 19) and severe CRI (GFR < 25, n = 18). Anthropometry [weight (wt.), height (ht.), and body mass index (BMI)], laboratory investigations and a 3-day dietary record were obtained. All anthropometric indices deteriorated with worsening renal function, from mean SD scores for wt., ht. and BMI in 'normal' children of 0.32 (SD 1.2), 0.4 (SD 1.0) and 0.1 (SD 1.3), respectively, to values of -1.28 (SD 1.1; P < 0.001), -1.52 (SD 1.1; P < 0.001) and -0.42 (SD 1.1; NS) in severe CRI. Mean total energy intake decreased from 103% (SD 17) estimated average requirement (EAR) in 'normal' children to 85% EAR (SD 27; P = 0.004) in severe CRI. Mean serum PTH concentrations (normal laboratory range 12-72 ng/l) were higher in moderate [67 ng/l (SD 58), P < 0.001] and severe CRI [164 ng/l (SD 164), P < 0.001] and mean serum phosphate concentrations were higher in severe CRI (1.54 mmol/l (SD 0.17), P = 0.009) compared to 'normal'. Disturbances in nutritional intakes, bone biochemistry and growth occur early in CRI and suggest the need for joint medical/dietetic intervention in children with mild and moderate CRI, in addition to those with more severe CRI.
慢性肾功能不全（CRI）患儿需要实用的联合医学/饮食指南。对95名2岁以上的CRI患儿（59名男性）的营养状况和生长情况进行了比较，根据[51Cr]标记的乙二胺四乙酸肾小球滤过率（GFR，ml/min/1.73 m2）估计值将其分为“正常”肾功能组[GFR > 75（平均104（标准差18.9），n = 35]、轻度（GFR 51 - 75，n = 23）、中度（GFR 25 - 50，n = 19）和重度CRI组（GFR < 25，n = 18）。获取了人体测量数据[体重（wt.）、身高（ht.）和体重指数（BMI）]、实验室检查结果以及一份3天的饮食记录。随着肾功能恶化，所有人体测量指标均变差，“正常”儿童的体重、身高和BMI的平均标准差分数分别为0.32（标准差1.2）、0.4（标准差1.0）和0.1（标准差1.3），而在重度CRI组中分别为 - 1.28（标准差1.1；P < 0.001）、 - 1.52（标准差1.1；P < 0.001）和 - 0.42（标准差1.1；无显著性差异）。平均总能量摄入量从“正常”儿童的估计平均需求量（EAR）的103%（标准差17）降至重度CRI组的EAR的85%（标准差27；P = 0.004）。中度[67 ng/l（标准差58），P < 0.001]和重度CRI组[164 ng/l（标准差164），P < 0.001]的平均血清甲状旁腺激素浓度（正常实验室范围12 - 72 ng/l）较高，与“正常”组相比，重度CRI组的平均血清磷酸盐浓度也较高（1.54 mmol/l（标准差0.17），P = 0.009）。CRI患儿早期就会出现营养摄入、骨生物化学和生长方面的紊乱，这表明除了重度CRI患儿外，轻度和中度CRI患儿也需要联合医学/饮食干预。
