Airede A, Bello M, Weerasinghe H D
Department of Paediatrics, University of Maiduguri Teaching Hospital, Borno State, Nigeria.
J Paediatr Child Health. 1997 Jun;33(3):246-9. doi: 10.1111/j.1440-1754.1997.tb01589.x.
To describe an experience from a developing country of newborn renal disease particularly those without advanced neonatal care.
Prospective evaluation from a referral hospital, North-East of Nigeria between 1 July 1990 and 30 June 1994. Babies admitted for any morbidities who were diagnosed as being in acute renal failure (ARF) during the study period (non-oliguric inclusive). Onset of ARF; day on which oliguria or anuria detected, or serum urea first exceeded 10 mmol/L. Urine output quantitated from carefully bagged urine and suprapubic bladder aspiration, and venous blood regularly obtained for serum electrolytes, urea and creatinine. Fractional excretion of sodium (FE(Na)) and renal failure index (RFI) were determined on some babies.
Forty-three neonates (M:F; 3.3:1) with ARF, the majority (27) of whom were out-born, and 14, 26 and three were preterm, full-term and post term, respectively. Encountered incidence was 3.9/1000 live births with a high prevalence rate; 34.5/1000 admissions. A significantly greater incidence was seen in the latter half of study; 10.7 vs 53.7/1000, P < 0.05. Early ARF occurrence (aged; 0-5 days) in 33 (77%) of babies. The aetiology was comprised of perinatal asphyxia, sepsis, obstructive uropathy and miscellaneous in 53.4%, 32.6%, 9.3% and 4.7%, respectively. Twenty-two (51.2%) deaths occurred; however, the exact causes were indeterminable. Fractional excretion of sodium (FE(Na)) and renal failure index (RFI) were of < 1.75% and < or = 2.0, respectively, significantly differentiated sepsis (intrinsic) from perinatal asphyxial (pre-renal) ARF; P < 0.01. No case of persistent renal failure occurred.
Our FE(Na) value (although less than reported in previous literature from affluent societies) remained sensitive (along with RFI) in differentiating aetiological group of ARF. Our data and medical management outcome, despite absence of level-III care, support the need for good resuscitation, careful monitoring and constant re-evaluation. The effect of salbutamol on hyperkalaemia is emphasized.
描述一个发展中国家新生儿肾病的情况，尤其是那些没有高级新生儿护理条件下的病例。
对尼日利亚东北部一家转诊医院在1990年7月1日至1994年6月30日期间进行前瞻性评估。纳入研究期间因任何疾病入院且被诊断为急性肾衰竭（ARF）的婴儿（包括非少尿型）。ARF的发病时间为检测到少尿或无尿的日期，或血清尿素首次超过10 mmol/L的日期。通过仔细收集袋内尿液和耻骨上膀胱穿刺术对尿量进行定量，并定期采集静脉血检测血清电解质、尿素和肌酐。对部分婴儿测定了钠排泄分数（FE(Na)）和肾衰竭指数（RFI）。
43例患有ARF的新生儿（男:女 = 3.3:1），其中大多数（27例）为院外出生，早产、足月和过期产的分别有14例、26例和３例。发病率为3.9/1000活产儿，患病率较高；34.5/1000入院病例。研究后半期发病率显著更高；分别为10.7/1000和53.7/1000，P < 0.05。33例（77%）婴儿在早期（0 - 5天）发生ARF。病因分别为围产期窒息、败血症、梗阻性尿路病和其他原因，占比分别为53.4%、32.6%、9.3%和4.7%。22例（51.2%）死亡；然而，确切死因无法确定。钠排泄分数（FE(Na)）和肾衰竭指数（RFI）分别< 1.75%和<或 = 2.0，这显著区分了败血症（内在性）与围产期窒息（肾前性）ARF；P < 0.01。未发生持续性肾衰竭病例。
我们的FE(Na)值（尽管低于富裕社会先前文献报道的值）在区分ARF病因组方面（与RFI一起）仍然敏感。尽管缺乏三级护理，我们的数据和医疗管理结果支持良好复苏、仔细监测和持续重新评估的必要性。强调了沙丁胺醇对高钾血症的作用。
