Zhong Xu-Hui, Ding Jie, Liu Xiao-Yu, Xiao Hui-Jie, Yao Yong, Huang Jian-Ping
Department of Pediatrics, Peking University First Hospital, Beijing 100034, China.
Zhonghua Er Ke Za Zhi. 2011 Jan;49(1):60-5.
Acute kidney injury (AKI) was recently proposed for early recognition of renal function impairment and prompt interventions. Previous study revealed that AKI was highly associated with the prognosis. However, there was rare report of AKI in renal diseases, especially in children cohorts. Therefore, we performed the prospective clinical research in children with renal diseases in our hospital, aiming to study the prevalence, the clinical characteristics and the short-term prognosis of AKI.
The study was designed as a prospective, single-center observational study.
(1) the primary diagnosis was primary nephrotic syndrome (NS), Henoch-Schoenlein purpura nephritis (HSPN) or lupus nephritis (LN), (2) the duration from the onset of the renal diseases to the admission was less than 3 months. The serum creatinine and urine output of the subjects would be prospectively monitored. AKI was defined by the adult criteria and stratified by Acute Kidney Injury Network (AKIN) criteria. The patients were followed up at 6 months and 12 months after enrollment.
Between October 2007 and April 2009, a total of 95 children were included, including 65 cases with NS, 15 HSPN and 15 LN. Mean age was (8.9 ± 3.9) years (range 2 - 16 years). Thirty-three of the 95 patients (34.7%) fulfilled the AKI criteria, 13 patients (13.7%) were diagnosed as acute renal failure (ARF). All the AKI in children with LN and HSPN presented with serum creatinine elevation. However, 65.4% of AKI in NS presented with decreasing urine output, only 19.2% accompanied with increasing creatinine, with higher stages of urine output. Regarding the etiology, only 26.9% of AKI in NS had definite cause, most of which resulted from side-effect of cyclosporine, hypovolemia or tubule-interstitial damage, independent of glomerular diseases. In contrast, the AKI in LN and HSPN were exclusively caused by glomerular diseases. The length and costs of hospitalization of AKI group were significantly higher than non-AKI [length of hospitalization (d), 28(6 to 94) vs. 21(7 to 100), Z = -1.971, P = 0.049; cost of hospitalization (yuan), 12 035.7 (1561.7 to 94 783.1) vs. 8594.3 (1390.1 to 98 876.5), Z = -1.993, P = 0.046]. There was no significant difference in the serum creatinine at 6-month and 12-month follow-up between AKI group and non-AKI [6-month, (60.4 ± 91.8) µmol/L vs. (42.8 ± 12.2) µmol/L, t = 0.937, P = 0.358; 12-month, (48.7 ± 18.1) µmol/L vs. (47.7 ± 14.2) µmol/L, t = 0.197, P = 0.845].
The prevalence of AKI (34.7%) was higher than that of ARF (13.7%) in children with renal diseases. Most of the AKI in NS resulted from non-glomerular diseases. In contrast, most AKI in LN and HSPN were caused by underlying glomerular diseases. The length and costs of hospitalization were significantly higher in AKI group. However, there was no significant difference in serum creatinine between AKI and non-AKI group in the follow-up at 6 months and 12 months. Further investigations on criteria for the diagnosis of AKI in children with renal diseases are still needed.
急性肾损伤（AKI）最近被提出用于早期识别肾功能损害并及时进行干预。先前的研究表明，AKI与预后密切相关。然而，关于肾脏疾病中AKI的报道很少，尤其是在儿童队列中。因此，我们在我院对患有肾脏疾病的儿童进行了前瞻性临床研究，旨在研究AKI的患病率、临床特征和短期预后。
本研究设计为前瞻性、单中心观察性研究。
（1）主要诊断为原发性肾病综合征（NS）、过敏性紫癜性肾炎（HSPN）或狼疮性肾炎（LN），（2）从肾脏疾病发病到入院的时间少于3个月。将对受试者的血清肌酐和尿量进行前瞻性监测。AKI根据成人标准定义，并按急性肾损伤网络（AKIN）标准分层。患者在入组后6个月和12个月进行随访。
2007年10月至2009年4月，共纳入95例儿童，其中NS 65例，HSPN 15例，LN 15例。平均年龄为（8.9±3.9）岁（范围2 - 16岁）。95例患者中有33例（34.7%）符合AKI标准，13例（13.7%）被诊断为急性肾衰竭（ARF）。LN和HSPN患儿的所有AKI均表现为血清肌酐升高。然而，NS中65.4%的AKI表现为尿量减少，仅有19.2%伴有肌酐升高，且尿量减少程度较高。关于病因，NS中仅26.9%的AKI有明确病因，其中大部分是由环孢素副作用、血容量不足或肾小管间质损伤引起，与肾小球疾病无关。相比之下，LN和HSPN中的AKI完全由肾小球疾病引起。AKI组的住院时间和费用显著高于非AKI组[住院时间（天），28（6至94）对21（7至100），Z = -1.971，P = 0.049；住院费用（元），12 035.7（1561.7至94 783.1）对8594.3（1390.1至98 876.5），Z = -1.993，P = 0.046]。AKI组和非AKI组在6个月和12个月随访时的血清肌酐无显著差异[6个月，（60.4±91.8）µmol/L对（42.8±12.2）µmol/L，t = 0.937，P = 0.358；12个月，（48.7±18.1）µmol/L对（47.7±14.2）µmol/L，t = 0.197，P = 0.845]。
肾脏疾病患儿中AKI的患病率（34.7%）高于ARF（13.7%）。NS中的大多数AKI由非肾小球疾病引起。相比之下，LN和HSPN中的大多数AKI由潜在的肾小球疾病引起。AKI组住院时间和费用显著更高。然而，AKI组和非AKI组在6个月和12个月随访时血清肌酐无显著差异。仍需要进一步研究肾脏疾病患儿AKI的诊断标准。
