中国儿童急性肾损伤的病因和结局：一项前瞻性多中心研究。
Etiology and outcomes of acute kidney injury in Chinese children: a prospective multicentre investigation.
机构信息
Division of Pediatric Nephrology, Children's Medical Center, the Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, P,R, China.
出版信息
BMC Urol. 2013 Aug 21;13:41. doi: 10.1186/1471-2490-13-41.
BACKGROUND
The incidence of AKI appears to have increasing trend. Up to now, prospective, multi-center, large-sample epidemiological study done on pediatric AKI on aspects of epidemiological characteristics, causes and outcomes have not reported. It is necessary to develop prospective, multi-center, large-sample epidemiological study in our country on pediatric AKI. The aim of this study was to determine the clinical features, etiology, and outcomes of acute kidney injury (AKI) in Chinese children.
METHOD
Paediatric patients (≤18 years old) admitted to 27 hospitals (14 children's hospitals and 13 general hospitals) affiliated with the Medical University were investigated. AKI was defined using the 2005 Acute Kidney Injury Network criteria.
RESULTS
During the study period, 388,736 paediatric patients were admitted. From this total, AKI was diagnosed in 1,257 patients, 43 of whom died. The incidence and mortality of AKI was 0.32% and 3.4% respectively. The mean (± SD) age of patients was 48.4 ± 50.4 months. Among the 1,257 AKI paediatric patients, 632 were less than one year old. Among the AKI paediatric patients, 615 (48.9%) were in stage 1, 277 (22.0%) in stage 2, and 365 (29.0%) in stage 3. The most common causes of AKI were renal causes (57.52%), whereas postrenal (25.69%) and prerenal (14.96%) causes were the least common. The three most common causes of AKI according to individual etiological disease were urolithiasis (22.35%), of which exposure to melamine-contaminated milk accounted for the highest incidence (63.7%); acute glomerulonephritis (10.10%); and severe dehydration (7.48%). A total of 43 AKI patients (3.4%) died during their hospital stay; 15 (34.9%) of the 43 died as a result of sepsis.
CONCLUSION
Primary renal diseases are a major risk factor for paediatric AKI in China. In terms of specific etiological disease, urolithiasis (postrenal disease) was the leading cause of paediatric AKI in 2008, when the disease was linked to exposure to melamine-contaminated milk. Sepsis is the leading cause of death in Chinese paediatric AKI patients. Future studies should focus on effective ways of controlling renal disorders and sepsis to improve the clinical management of paediatric AKI in China.
背景
急性肾损伤（AKI）的发病率似乎呈上升趋势。迄今为止，尚未有针对儿科 AKI 的前瞻性、多中心、大样本的流行病学研究从流行病学特征、病因和结局等方面进行报道。有必要在我国开展儿科 AKI 的前瞻性、多中心、大样本的流行病学研究。本研究旨在明确中国儿童急性肾损伤（AKI）的临床特征、病因和结局。
方法
对 27 家医院（14 家儿童医院和 13 家综合医院）收治的≤18 岁的儿科患者进行调查。采用 2005 年急性肾损伤网络（AKIN）标准定义 AKI。
结果
在研究期间，共收治 388736 名儿科患者。其中，1257 例患儿被诊断为 AKI，其中 43 例死亡。AKI 的发生率和死亡率分别为 0.32%和 3.4%。患儿的平均（±SD）年龄为 48.4±50.4 个月。在 1257 例 AKI 患儿中，632 例患儿年龄小于 1 岁。在 AKI 患儿中，615 例（48.9%）处于 AKI 1 期，277 例（22.0%）处于 AKI 2 期，365 例（29.0%）处于 AKI 3 期。AKI 的最常见病因是肾脏原因（57.52%），而后肾（25.69%）和前肾（14.96%）原因则相对较少。按个体病因疾病分类，AKI 的三个最常见病因是尿路结石（22.35%），其中三聚氰胺污染牛奶暴露所致的发病率最高（63.7%）；急性肾小球肾炎（10.10%）；严重脱水（7.48%）。共有 43 例 AKI 患儿（3.4%）在住院期间死亡；43 例死亡患儿中，15 例（34.9%）因败血症死亡。
结论
原发性肾脏疾病是中国儿科 AKI 的主要危险因素。就特定病因疾病而言，尿路结石（后肾疾病）是 2008 年中国儿科 AKI 的主要病因，与三聚氰胺污染牛奶暴露有关。败血症是中国儿科 AKI 患者死亡的主要原因。未来的研究应集中于控制肾脏疾病和败血症的有效方法，以改善中国儿科 AKI 的临床管理。
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