Gusmano R, Perfumo F
Nephrology Department, G. Gaslini Institute, Genoa, Italy.
Kidney Int Suppl. 1993 Jun;41:S31-5.
Incidence of chronic renal failure in children is not yet clearly known. In recent years it has been evaluated on the basis of the number of patients accepted into dialysis-transplantation programs and is thus underestimated, as registries do not list children who are not treated for technical reasons, lack of facilities or health policy. The number of new patients per year per million child population varies widely. Differences among countries are mainly related to economic development. In developed countries the incidence of CRF remains stable or decreases slowly owing to early diagnosis, improved conservative treatment, prevention of genetically-transmitted diseases, whereas the prevalence increases steadily as a consequence of improved replacement therapy. Causes of primary renal diseases have been analyzed in several series totaling over 9400 children. The most frequent cause is chronic primary glomerulonephritis followed by pyelonephritis, including obstructive uropathies and vesico-ureteral reflux. Differences in geographical distribution of etiologies are also analyzed. The relative contribution of chronic peritoneal dialysis and hemodialysis in the treatment of children with ESRF varies from country to country. Several problems regarding CRF in children are briefly discussed: prevention of renal failure, extension of treatment opportunities to more children, quality of replacement therapy, and clinical rehabilitation of children.
儿童慢性肾衰竭的发病率尚不清楚。近年来，一直根据进入透析 - 移植项目的患者数量进行评估，因此存在低估情况，因为登记处未将因技术原因、缺乏设施或卫生政策而未接受治疗的儿童列入其中。每年每百万儿童人口中的新患者数量差异很大。国家之间的差异主要与经济发展有关。在发达国家，由于早期诊断、保守治疗改善、遗传性疾病预防，慢性肾衰竭的发病率保持稳定或缓慢下降，而由于替代治疗的改善，患病率稳步上升。在总计超过9400名儿童的几个系列研究中分析了原发性肾脏疾病的病因。最常见的病因是慢性原发性肾小球肾炎，其次是肾盂肾炎，包括梗阻性尿路病和膀胱输尿管反流。还分析了病因地理分布的差异。慢性腹膜透析和血液透析在治疗儿童终末期肾病中的相对贡献因国家而异。简要讨论了有关儿童慢性肾衰竭的几个问题：肾衰竭的预防、将治疗机会扩展到更多儿童、替代治疗的质量以及儿童的临床康复。
