Paediatric Nephrology Service, Department of Paediatrics, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 298090, Singapore.
Pediatr Nephrol. 2012 Jul;27(7):1125-30. doi: 10.1007/s00467-012-2128-6. Epub 2012 Mar 3.
This study aims to predict risk factors for urological anomalies in children with anorectal malformations (ARM) and describes the clinical features of patients who have developed chronic kidney disease.
We retrospectively reviewed infants with ARM who received surgery and were followed at the Sabah Women and Children's Hospital, Malaysia, from 1986 to 2010.
One hundred and twenty-two children with anorectal malformations were studied, after excluding 24 children with incomplete data. Three factors were significant as predictors of the presence of a urological anomaly: high ARM lesion (OR 3.12, 95%CI 1.1-8.9), the presence of genital abnormality (OR 2.95, 95%CI 1.10-7.91) and cloacal anomaly in girls (OR 8.27, 95% CI 1.91-35.6). The most common anomalies were vesicoureteric reflux, single kidney and neurogenic bladder. Chronic kidney disease (CKD) was noted in 5.7%, in children who had recurrent urinary tract infections, neurogenic bladder or complex renal tract pathology; end-stage renal failure was seen in only 0.8% of children with ARM.
Urological anomalies were seen in 23% of patients, but the overall incidence of CKD and end-stage renal disease is low. Early identification of infants with ARM at risk of renal failure may be important for renal survival.
本研究旨在预测患有肛门直肠畸形（ARM）的儿童发生泌尿系统异常的风险因素，并描述发生慢性肾脏病的患者的临床特征。
我们回顾性分析了 1986 年至 2010 年在马来西亚沙巴妇女儿童医院接受手术并接受随访的 ARM 婴儿。
在排除了 24 例资料不完整的患儿后，我们共研究了 122 例 ARM 患儿。3 个因素是泌尿系统异常存在的显著预测因子：高位 ARM 病变（OR 3.12，95%CI 1.1-8.9）、生殖器异常（OR 2.95，95%CI 1.10-7.91）和女性的会阴直肠畸形（OR 8.27，95%CI 1.91-35.6）。最常见的异常是输尿管反流、单肾和神经源性膀胱。5.7%的患儿出现慢性肾脏病（CKD），这些患儿存在复发性尿路感染、神经源性膀胱或复杂的肾通路病变；只有 0.8%的 ARM 患儿出现终末期肾衰竭。
23%的患儿出现泌尿系统异常，但 CKD 和终末期肾病的总体发生率较低。早期识别有发生肾衰竭风险的 ARM 患儿可能对肾脏的存活很重要。
