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登革热患儿的肾脏受累情况:孟加拉国一家三级护理医院的研究

Renal Involvement in Children with Dengue Fever: A Study in Tertiary Care Hospital of Bangladesh.

作者信息

Sultana Azmeri, Rumana Jubaida, Roy Smrity, Sonia Seikh Farzana, Rahat Farhana, Parvin Ruma, Afroze Sharmin

机构信息

Fellowship in Pediatric Nephrology (NUH, Singapore), Dr MR Khan Children Hospital and Institute of Child Health Affiliated by BCPS (Bangladesh College of Physician and Surgeon), BSMMU (Bangabandhu Sheikh Mujib Medical University), Singapore.

Fellowship in Pediatric Nephrology (India), Asgar Ali Hospital, Dhaka, Bangladesh.

出版信息

Int J Nephrol. 2020 Jan 7;2020:4025267. doi: 10.1155/2020/4025267. eCollection 2020.

Abstract

: Dengue has emerged globally as the most relevant viral infection transmitted by a mosquito bite and represents a major threat to public health. Dengue-related renal manifestations such as proteinuria, hematuria, acute kidney injury (AKI), and rhabdomyolysis are not uncommon, and acute kidney injury (AKI) is a serious complication of dengue fever. There is relatively few data on the renal manifestations of dengue fever in children. Hence, this study was conducted to evaluate the incidence, characteristics, and clinical outcome of dengue fever with renal manifestations. . This prospective cross sectional study was conducted in Dr. M R Khan Children Hospital and Institute of Child Health, Dhaka, over a period of 1 year from January 2018 to December 2018. The study was approved by the ethical committee of the institute. A total number of 316 patients were admitted with the diagnosis of dengue fever either NS1 positive or antibody IgM positive or both IgM and IgG positive. Data were collected in a structured questionnaire form and were analyzed by SPSS version 20.0. The disease severity was classified according to the World Health Organization criteria. Renal manifestations were divided into AKI groups using pRIFLE criteria. Proteinuria was defined as urinary protein >1+ (30 mg/dL) by dipstick test. Hematuria was defined as red blood cell (RBC) >5/L in a fresh uncentrifuged urine specimen. . Among 316 dengue patients, thirty-one patients (9.8%) had renal involvement. Most of the patients (54.83%) with renal manifestations were aged between 1 and 5 years. A total of 14 patients were found to have proteinuria (4.4%). Nephrotic-range proteinuria was seen in only one patient (0.3%). AKI was defined by pRIFLE criteria and was seen in 13 patients (4.1%); among AKI 6 (46.15%) had risk, three patients (23.07%) had injury and 4 (30.7%) had failure and needed peritoneal dialysis. Death occurred in 3 patients (9.6%) in dengue with AKI who had failure. The incidence of renal manifestations (proteinuria, hematuria, and AKI) is as high as 9.8% among patients with dengue, and those with AKI had significant morbidity and mortality. . Renal involvement in children with dengue is not uncommon. Dengue associated with AKI had significant mortality and morbidity.

摘要

登革热已在全球范围内成为通过蚊虫叮咬传播的最主要病毒感染,对公众健康构成重大威胁。登革热相关的肾脏表现,如蛋白尿、血尿、急性肾损伤(AKI)和横纹肌溶解并不罕见,急性肾损伤(AKI)是登革热的严重并发症。关于儿童登革热肾脏表现的数据相对较少。因此,本研究旨在评估有肾脏表现的登革热的发病率、特征及临床结局。 这项前瞻性横断面研究于2018年1月至2018年12月在达卡的M R Khan儿童医院和儿童健康研究所进行,为期1年。该研究获得了研究所伦理委员会的批准。共有316例诊断为登革热的患者入院,这些患者NS1阳性或抗体IgM阳性或IgM和IgG均阳性。数据以结构化问卷形式收集,并采用SPSS 20.0版进行分析。疾病严重程度根据世界卫生组织标准分类。肾脏表现根据pRIFLE标准分为急性肾损伤组。蛋白尿定义为试纸条检测尿蛋白>1+(30mg/dL)。血尿定义为新鲜未离心尿液标本中红细胞(RBC)>5/L。 在316例登革热患者中,31例(9.8%)有肾脏受累。大多数有肾脏表现的患者(54.83%)年龄在1至5岁之间。共发现14例患者有蛋白尿(4.4%)。仅1例患者(0.3%)出现肾病范围蛋白尿。急性肾损伤根据pRIFLE标准定义,13例患者(4.1%)出现;在急性肾损伤患者中,6例(46.15%)处于风险期,3例(23.07%)处于损伤期,4例(30.7%)处于衰竭期且需要腹膜透析。在有急性肾损伤且处于衰竭期的登革热患者中,3例(9.6%)死亡。登革热患者中肾脏表现(蛋白尿、血尿和急性肾损伤)的发生率高达9.8%,而急性肾损伤患者有显著的发病率和死亡率。 登革热患儿出现肾脏受累并不罕见。与急性肾损伤相关的登革热有显著的死亡率和发病率。

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