Hattori Motoshi, Iwano Masayuki, Sako Mayumi, Honda Masataka, Okada Hirokazu, Akioka Yuko, Ashida Akira, Kawasaki Yukihiko, Kiyomoto Hideyasu, Terada Yoshio, Hirano Daishi, Fujieda Mikiya, Fujimoto Shouichi, Masaki Takao, Maruyama Shoichi, Mastuo Seiich
Department of Pediatric Nephrology, Tokyo Women's Medical University, School of Medicine, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan.
Division of Nephrology, Department of Medicine, School of Medicine, Faculty of Medical Sciences, University of Fukui, Fukui, Japan.
Clin Exp Nephrol. 2016 Dec;20(6):918-925. doi: 10.1007/s10157-016-1231-6. Epub 2016 Jan 19.
Transition of adolescent and young adult (AYA) patients with childhood-onset chronic kidney diseases (C-CKD) from pediatric to adult renal services has received increasing attention. However, information on transition of Japanese patients with C-CKD is limited.
The Transition Medicine Working Group, in collaboration with the Japanese Society for Nephrology, the Japanese Society for Pediatric Nephrology and the Japanese Society of Pediatric Urology, conducted a retrospective cross-sectional study in 2014 on issues concerning the transition of Japanese patients with C-CKD.
Few institutions in Japan had transition programs and/or transition coordinators for patients with C-CKD. Refusal to transfer by patients or their families, lack of concern about transition and inability to decide on transfer were common reasons for non-transfer of patients still followed by pediatric renal services. Around 25 % of patients who had ended or interrupted follow-up by pediatric renal services presented to adult renal services because of symptoms associated with C-CKD. Patients with various types of childhood-onset nephrourological diseases were transferred from pediatric to adult renal services. IgA nephropathy, minimal change nephrotic syndrome and congenital anomalies of the kidney and urinary tract were the most frequent primary kidney diseases in adult patients with C-CKD.
These survey results indicate the need for introduction of transitional care for Japanese AYA patients with C-CKD. Consensus guidelines for the optimal clinical management of AYA patients with C-CKD are required to ensure the continuity of care from child to adult renal services.
患有儿童期起病的慢性肾脏病（C-CKD）的青少年及青年（AYA）患者从儿科肾脏服务向成人肾脏服务的过渡已受到越来越多的关注。然而，关于日本C-CKD患者过渡情况的信息有限。
过渡医学工作组与日本肾脏病学会、日本儿科肾脏病学会和日本小儿泌尿外科学会合作，于2014年对日本C-CKD患者过渡相关问题进行了一项回顾性横断面研究。
日本很少有机构为C-CKD患者制定过渡计划和/或配备过渡协调员。患者或其家属拒绝转诊、对过渡缺乏关注以及无法决定转诊是仍由儿科肾脏服务随访的患者未转诊的常见原因。约25%已结束或中断儿科肾脏服务随访的患者因与C-CKD相关的症状而就诊于成人肾脏服务。患有各种儿童期起病的肾泌尿系统疾病的患者从儿科肾脏服务转诊至成人肾脏服务。IgA肾病、微小病变肾病综合征以及肾脏和尿路先天性异常是成人C-CKD患者中最常见的原发性肾脏疾病。
这些调查结果表明，有必要为日本患有C-CKD的AYA患者引入过渡性护理。需要制定针对患有C-CKD的AYA患者最佳临床管理的共识指南以确保从儿童到成人肾脏服务的护理连续性。
