Kendirli Tanil, Ekim Mesiiha, Ozçakar Zeynep Birsin, Yüksel Selçuk, Acar Banu, Oztürk-Hiişmi Burcu, Derelli Emel, Kavaz Asli, Yalaki Zahide, Yalçinkaya Fatoş
Department of Pediatric Intensive Care Unit, Ankara University School of Medicine, Ankara, Turkey.
Pediatr Int. 2007 Jun;49(3):345-8. doi: 10.1111/j.1442-200X.2007.02376.x.
Despite constant improvements in caring for critically ill neonates and infants with congenital cardiac disease, sepsis, bone marrow and solid organ transplantation, acute renal failure (ARF) is an important problem in these children. ARF, severe fluid overload and inborn errors of metabolism are some of the indications for acute dialysis in infants and children.
The authors had retrospectively evaluated the medical records of Pediatric Intensive Care Unit, Ankara University School of Medicine, Ankara, Turkey patients who had required acute renal replacement therapy between the dates of January 2002 to February 2005.
Medical records of 332 patients were reviewed. Acute renal replacement therapy was performed in 21 patients (6.3%; mean age, 9.6 +/- 7.4 years). Dialysis modalities were peritoneal dialysis in 15 patients (71.4%; mean age, 3.9 +/- 5.6 years) and hemodialysis in six patients (28.6%; mean age, 12.1 +/- 3.2 years). A total of 90% of patients had severe systemic disease leading to ARF. A total of 95% of patients had multiple organ dysfunction syndrome. The most common cause of ARF was refractory shock. At the beginning of renal replacement therapy, 10 patients were anuric, nine patients had volume overload, seven patients had decompensated metabolic acidosis and nine patients had hypotension. The average dialysis period was 4.7 +/- 6.4 days. Mortality rate was 66.7%. Eight patients recovered from ARF and chronic renal failure had developed in one patient.
In the Pediatric Intensive Care Unit, ARF is frequently seen together with multiple organ dysfunction syndrome and the mortality rate is high. Both peritoneal dialysis and hemodialysis are important renal replacement treatment modalities in patients with ARF. The age and hemodynamic status of the patients are important when choosing treatment modality; generally peritoneal dialysis is preferred in infants and toddler, while hemodialysis is preferred in older children.
尽管在治疗患有先天性心脏病、败血症、骨髓和实体器官移植的危重新生儿和婴儿方面不断取得进展，但急性肾衰竭（ARF）仍是这些儿童面临的一个重要问题。ARF、严重液体过载和先天性代谢缺陷是婴幼儿急性透析的一些指征。
作者回顾性评估了土耳其安卡拉大学医学院儿科重症监护病房2002年1月至2005年2月期间需要急性肾替代治疗的患者的病历。
回顾了332例患者的病历。21例患者（6.3%；平均年龄9.6±7.4岁）接受了急性肾替代治疗。透析方式为15例患者（71.4%；平均年龄3.9±5.6岁）采用腹膜透析，6例患者（28.6%；平均年龄12.1±3.2岁）采用血液透析。共有90%的患者患有导致ARF的严重全身性疾病。共有95%的患者患有多器官功能障碍综合征。ARF最常见的原因是难治性休克。在开始肾替代治疗时，10例患者无尿，9例患者容量过载，7例患者代谢性酸中毒失代偿，9例患者低血压。平均透析期为4.7±6.4天。死亡率为66.7%。8例患者从ARF中康复，1例患者发展为慢性肾衰竭。
在儿科重症监护病房，ARF常与多器官功能障碍综合征同时出现，死亡率较高。腹膜透析和血液透析都是ARF患者重要的肾替代治疗方式。选择治疗方式时患者的年龄和血流动力学状态很重要；一般来说，婴幼儿首选腹膜透析，大龄儿童首选血液透析。
