Gordillo-Paniagua G, Hernández-Rodríguez O
División de Postgrado, Universidad de la Salle, México, D.F.
Bol Med Hosp Infant Mex. 1991 Sep;48(9):656-62.
Fifty-two clinical charts of children who had been discharged from this hospital, after being treated for acute renal failure, were analyzed to determine the incidence, presentation and results of the treatment used. We found that 0.7% of the total number of children admitted developed this complication and that 4/5 of them were under two years old. The initial illnesses were gastroenteritis, bronchial pneumonia, cyanogenic cardiopathies and sepsis. Some of the patients had hypoxic episodes or went into hypovolemic shock or a combination of both. In half of the patients diagnosis was reached from anamnesis, from of oliguria, acidosis and nitrogen retention. In the rest from whom a urine sample was obtained, the diagnosis was confirmed when the FeNa was higher than 2 and because the U/P osmolarity and urea were under 1.3 and 5 respectively. The oliguric type of acute renal failure was seen in 65% of the cases; the non-oliguric type in 35%. In the first group the mortality rate reached 6.5% even though a third of them were placed under dialysis. Yet, in another 7 cases, dialysis could not be used because the child was in shock. Of the 18 cases of non-oliguric acute renal failure, 12 recovered; only 3 required dialysis. We conclude that the high mortality rate in cases of acute renal failure depends on the severity of the underlying illness, the age of the patient and the delay in the diagnosis of the disease. The use of dopamine and furosemide, as well as the application of hemoperfusion instead place of peritoneal dialysis in neonates with sepsis, could improve results.
对52例因急性肾衰竭接受治疗后已从本院出院的儿童临床病历进行分析，以确定该并发症的发生率、表现及所用治疗的结果。我们发现，入院儿童总数的0.7%发生了这种并发症，其中五分之四为两岁以下儿童。初始疾病为胃肠炎、支气管肺炎、先天性心脏病和败血症。一些患者有缺氧发作或发生低血容量性休克或两者兼有。一半患者通过问诊、少尿、酸中毒和氮潴留做出诊断。其余获取了尿样的患者，当滤过钠排泄分数（FeNa）高于2且尿/血渗透压和尿素分别低于1.3和5时确诊。65%的病例为少尿型急性肾衰竭；35%为非少尿型。在第一组中，尽管三分之一的患者接受了透析，死亡率仍达6.5%。然而，另有7例因患儿处于休克状态而无法进行透析。在18例非少尿型急性肾衰竭病例中，12例康复；仅3例需要透析。我们得出结论，急性肾衰竭病例的高死亡率取决于基础疾病的严重程度、患者年龄及疾病诊断的延迟。使用多巴胺和呋塞米，以及在患有败血症的新生儿中用血液灌流代替腹膜透析，可能会改善治疗结果。
