Bettinelli A, Bacchini M, Paterlini G L, Longaretti A, Mazzucchi E, Edefonti A
Istituto di Clinica Pediatrica, Università di Milano, Italia.
Child Nephrol Urol. 1988;9(6):323-5.
We performed a retrospective study on 47 children over 1 year of age with severe acute renal failure (ARF) treated with hemodialysis (HD) at our Center from 1978 to 1986 in order to evaluate the diagnostic and prognostic value of growth indexes at hospital admission as a criterion to distinguish cases of ARF without previous chronic renal failure (CRF) from cases in which CRF was not previously diagnosed. The age of the patients ranged from 17 months to 13 years. The cause of ARF was identified in 41 children; 5 of them remained on HD for different reasons (hemolytic uremic syndrome with arteriolar involvement in 3 cases; renal vein thrombosis in 1; endoextracapillary glomerulonephritis in 1). No apparent cause of ARF was found in the other 6 children who remained on chronic HD. A careful history showed that these 6 children had had uremic symptoms for many years. When height was expressed as height standard deviation score (HSDS), the 6 children with ARF of unknown etiology showed significantly lower HSDS values compared with the other 41 children in whom a cause of ARF was diagnosed (p less than 0.001). In conclusion, growth failure in children requiring HD for ARF of unknown etiology is an important criterion that suggests a previously undiagnosed CRF and thus consequently a negative long-term prognosis.
我们对1978年至1986年期间在本中心接受血液透析（HD）治疗的47例1岁以上重症急性肾衰竭（ARF）儿童进行了一项回顾性研究，以评估入院时生长指标作为区分既往无慢性肾衰竭（CRF）的ARF病例与既往未诊断出CRF病例的标准的诊断和预后价值。患者年龄从17个月至13岁不等。41名儿童的ARF病因得以明确；其中5例因不同原因持续接受血液透析（3例为伴有小动脉受累的溶血尿毒综合征；1例为肾静脉血栓形成；1例为毛细血管内增生性肾小球肾炎）。另外6例持续接受慢性血液透析的儿童未发现明显的ARF病因。详细病史显示，这6名儿童多年来一直有尿毒症症状。当身高以身高标准差评分（HSDS）表示时，6例病因不明的ARF儿童的HSDS值显著低于另外41例已确诊ARF病因的儿童（p<0.001）。总之，因病因不明的ARF而需要进行血液透析的儿童生长发育迟缓是一个重要标准，提示存在既往未诊断出的CRF，因此长期预后不良。
