Yoshino Atsunori, Honda Masataka, Sasaki Naomi, Hataya Hiroshi, Ishikura Kenji, Sakazume Satoru, Tanaka Yuriko, Nagai Toshiro
Department of Nephrology, Dokkyo Medical University, Koshigaya Hospital, 2-1-50, Minamikoshigaya, Koshigaya, Saitama, 343-8555, Japan,
Clin Exp Nephrol. 2015 Aug;19(4):678-82. doi: 10.1007/s10157-014-1036-4. Epub 2014 Sep 26.
Although congenital anomalies of the kidney and urinary tract (CAKUT) are the most common cause of pediatric end-stage renal disease (ESRD), little is known about the characteristics exhibited in the infantile period by CAKUT patients who develop ESRD. Further, an efficient screening method for CAKUT diagnosis is not available currently. In the present study, we aimed to develop a method to select infants who potentially have CAKUT from a large group of infants.
We retrospectively investigated the clinical characteristics of CAKUT patients in the infantile period. The medical records of 101 patients with CAKUT who had undergone dialysis or renal transplantation were reviewed. The data of gestational age, birth weight, oligohydramnios, poor body weight gain, asphyxia, and jaundice were recorded. We attempted to determine the ideal characteristics that could be used to select infants who potentially have CAKUT.
14 % of patients were born prematurely, 18 % had low birth weight, 79 % had poor body weight gain, 18 % had asphyxia, 8 % had oligohydramnios, and 12 % had jaundice. We found that 82 % of patients had poor body weight gain or oligohydramnios among our patients and regarded these two symptoms as ideal markers for selecting those who potentially have CAKUT (specificity, 95 %; efficacy, 95 %). Further, the age of ≤ 7 months was the most appropriate time for the selection.
For timely diagnosis of CAKUT, we recommend that ultrasound examination and the serum creatinine test be conducted for infants showing poor body weight gain or oligohydramnios at age ≤ 7 months.
尽管先天性肾脏和尿路畸形（CAKUT）是儿童终末期肾病（ESRD）最常见的病因，但对于发展为ESRD的CAKUT患者在婴儿期所表现出的特征知之甚少。此外，目前尚无一种有效的CAKUT诊断筛查方法。在本研究中，我们旨在开发一种从大量婴儿中筛选出可能患有CAKUT的婴儿的方法。
我们回顾性研究了CAKUT患者婴儿期的临床特征。对101例接受透析或肾移植的CAKUT患者的病历进行了审查。记录了胎龄、出生体重、羊水过少、体重增加不佳、窒息和黄疸的数据。我们试图确定可用于筛选可能患有CAKUT的婴儿的理想特征。
14%的患者早产，18%出生体重低，79%体重增加不佳，18%有窒息，8%有羊水过少，12%有黄疸。我们发现，在我们的患者中，82%的患者体重增加不佳或羊水过少，并将这两种症状视为筛选可能患有CAKUT的患者的理想指标（特异性为95%；效能为95%）。此外，≤7个月龄是最合适的筛选时间。
为了及时诊断CAKUT，我们建议对7个月龄及以下出现体重增加不佳或羊水过少的婴儿进行超声检查和血清肌酐检测。
