Li Jian-guo, Qu Dong, Li Ying, Wang Fei, Guo Lin-ying, Wang Jing-jing, Cao Li, Ren Xiao-xu
Capital Institute of Pediatrics, Beijing, China.
Zhonghua Er Ke Za Zhi. 2011 Nov;49(11):839-42.
To analyze the clinical characteristics of acute kidney injury (AKI) in critically ill childhood patients with influenza A virus (H1N1) and enterovirus 71 (EV71), and to study the significance of the serum creatinine and urine output in diagnosis of AKI.
The clinical data of AKI in critically ill children admitted to intensive care units (ICUs) with confirmed influenza A (H1N1) or enterovirus 71 infection (EV71 group) from Oct. 2009 to Oct. 2010.
Twenty-eight critically ill children were involved in the study. In H1N1 group, there were 18 cases including 6 males and 12 females, and the average age was 5.4 years. In EV71 group, there were 10 cases including 8 males and 2 females, and the average age was 1.1 years. In H1N1 group: 4 cases developed AKI, whose average number of involved organ was 5.3. Two children were classified as first stage completely recovered after treatment; three children who were classified as third stage died. In 14 children without AKI, the average number of involved organ was 3.0, four of these children died. In EV71 group: 3 cases (first stage) developed AKI and 3 cases' serum creatinine increased to 45.0 to 47.6 percent from baseline. The average number of involved organ was 5.7. All the six children died. The other 4 cases whose serum creatinine was normal, and the average number of involved organ was 3.0, recovered.
In critically ill virus-infected children, more organs were involved in the patients who developed AKI. As to influenza A (H1N1) infected critically ill children, the prognosis was comparatively better if the children were classified as AKI stage 1 and received early effective treatment. On the contrary, the prognosis was comparatively worse for those with AKI stage 3. As to EV71 infected critically ill children, the prognosis was worse once AKI developed. As to diagnosis of AKI, the sensitivity of serum creatinine criteria seemed to be superior to the urine output criteria. However, the significance of the serum creatinine and urine output in diagnosis of AKI still needs to be investigated in the future in large scale clinical studies.
分析甲型H1N1流感病毒和肠道病毒71型（EV71）感染的危重症儿童急性肾损伤（AKI）的临床特征，探讨血清肌酐和尿量在AKI诊断中的意义。
收集2009年10月至2010年10月入住重症监护病房（ICU）确诊为甲型H1N1流感或肠道病毒71型感染（EV71组）的危重症儿童AKI的临床资料。
28例危重症儿童纳入研究。H1N1组18例，男6例，女12例，平均年龄5.4岁。EV71组10例，男8例，女2例，平均年龄1.1岁。H1N1组：4例发生AKI，平均受累器官数为5.3个。2例患儿为1期，治疗后完全康复；3例3期患儿死亡。14例未发生AKI的患儿，平均受累器官数为3.0个，其中4例死亡。EV71组：3例（1期）发生AKI，3例血清肌酐较基线升高45.0%至47.6%。平均受累器官数为5.7个。6例患儿均死亡。另外4例血清肌酐正常，平均受累器官数为3.0个，康复。
在病毒感染的危重症儿童中，发生AKI的患儿受累器官较多。对于甲型H1N1流感感染的危重症儿童，若为AKI 1期并早期接受有效治疗，预后相对较好。相反，AKI 3期患儿预后相对较差。对于EV71感染的危重症儿童，一旦发生AKI，预后较差。对于AKI的诊断，血清肌酐标准的敏感性似乎优于尿量标准。然而，血清肌酐和尿量在AKI诊断中的意义仍需未来大规模临床研究进一步探讨。
