Shaffer S E, Norman M E
Department of Pediatrics, Medical Center of Delaware, Newark.
Clin Perinatol. 1989 Mar;16(1):199-218.
Renal function in the newborn infant varies with conceptual age and should be evaluated in this context. Very preterm infants less than 34 weeks' conceptual age have reduced GFR and tubular immaturity in the handling of filtered solutes when compared to term infants. Premature infants between 34 and 37 weeks' conceptual age undergo rapid maturation of renal function similar to term infants, with establishment of glomerulotubular balance early in the postnatal period. ARF in neonates differs from that seen in older children and adults in that ischemic (e.g., hypoxic) insults and congenital malformations constitute the major pathophysiologic mechanisms responsible for clinically observed oliguria and azotemia. Principles of conservative management are similar to those used in older children except for the greatly increased insensible water loss requirements of the very preterm and premature infant. Technical advances have added peritoneal dialysis and CAVH to the therapeutic regimen for persistent ARF or life-threatening complications of reduced renal function.
新生儿的肾功能随孕龄而变化，应在此背景下进行评估。与足月儿相比，孕龄小于34周的极早产儿肾小球滤过率降低，在处理滤过溶质时肾小管不成熟。孕龄在34至37周之间的早产儿肾功能迅速成熟，与足月儿相似，在出生后早期建立肾小球肾小管平衡。新生儿急性肾衰竭与大龄儿童和成人的急性肾衰竭不同，缺血（如缺氧）损伤和先天性畸形是导致临床上观察到的少尿和氮质血症的主要病理生理机制。保守治疗原则与大龄儿童相似，但极早产儿和早产儿的不显性失水量需求大大增加。技术进步使腹膜透析和持续动静脉血液滤过加入到持续性急性肾衰竭或肾功能降低危及生命并发症的治疗方案中。
