Mannix Rebekah, Tan Mei Lin, Wright Robert, Baskin Marc
Division of Emergency Medicine, Children's Hospital, 300 Longwood Ave, Boston, MA 02115, USA.
Pediatrics. 2006 Nov;118(5):2119-25. doi: 10.1542/peds.2006-1352.
The goals were to (1) compare the causes, clinical presentation, and prevalence of acute renal failure in pediatric rhabdomyolysis with the published data for adults; (2) determine predictors of acute renal failure in pediatric patients with rhabdomyolysis; and (3) explore the relationship of acute renal failure with treatment modalities such as fluid and bicarbonate administration.
We performed a retrospective chart review to identify patients with creatinine kinase levels of > 1000 IU/L who were treated in the emergency department of a tertiary pediatric hospital between 1993 and 2003, and we constructed regression models.
Two hundred ten patients were studied. One hundred ninety-one patients met study eligibility (128 male and 63 female), with a median age of 11 years. The most common documented symptoms were muscle pain (45%), fever (40%), and symptoms of viral infection (39%). The most common causes of pediatric rhabdomyolysis were viral myositis (38%), trauma (26%), and connective tissue disease (5%). Six of 37 patients with creatinine kinase levels of > or = 6000 IU/L had previously undiagnosed dermatomyositis or hereditary metabolic disease, compared with 10 of 154 patients with creatinine kinase levels of 1000 to 5999 IU/L. Nine of 191 patients developed acute renal failure. None of 99 patients with initial urinary heme dipstick results of < 2+ developed acute renal failure, compared with 9 of 44 patients with urinary heme dipstick results of > or = 2+. Higher initial creatinine kinase levels and higher fluid administration rates were associated with higher maximal creatinine levels.
The cause of acute pediatric rhabdomyolysis is different from that of adult rhabdomyolysis. The risk of acute renal failure in children is much less than the risk reported for adults.
目标是（1）将小儿横纹肌溶解症急性肾衰竭的病因、临床表现及患病率与已发表的成人数据进行比较；（2）确定小儿横纹肌溶解症患者急性肾衰竭的预测因素；（3）探讨急性肾衰竭与诸如补液和给予碳酸氢盐等治疗方式之间的关系。
我们进行了一项回顾性病历审查，以识别1993年至2003年间在一家三级儿科医院急诊科接受治疗、肌酸激酶水平>1000 IU/L的患者，并构建回归模型。
共研究了210例患者。191例患者符合研究条件（128例男性和63例女性），中位年龄为11岁。记录到的最常见症状为肌肉疼痛（45%）、发热（40%）和病毒感染症状（39%）。小儿横纹肌溶解症最常见的病因是病毒性肌炎（38%）、创伤（26%）和结缔组织病（5%）。在37例肌酸激酶水平≥6000 IU/L的患者中，有6例先前未被诊断出皮肌炎或遗传性代谢疾病，而在154例肌酸激酶水平为1000至5999 IU/L的患者中有10例。191例患者中有9例发生急性肾衰竭。初始尿潜血试纸检测结果<2+的99例患者中无一例发生急性肾衰竭，而尿潜血试纸检测结果≥2+的44例患者中有9例发生急性肾衰竭。初始肌酸激酶水平较高和补液率较高与最高肌酐水平较高相关。
小儿急性横纹肌溶解症的病因与成人横纹肌溶解症不同。儿童急性肾衰竭的风险远低于成人报告的风险。
