儿童慢性肾脏病概述

一、儿童慢性肾脏病的概况 儿童的慢性肾脏病(CKD)常进展至终末期肾病(ESRD),所以如何延缓CKD的进程备受关注~([1-3]).世界范围CKD病例不断增多,成人CKD已被认为是公众健康的主要问题.     

中医药治疗儿童慢性肾脏病

慢性肾脏病(chronic kidney disease,CKD)是肾脏病于急性期未经控制后的共同转归。近年来全球发病率逐年增高,其持续进展已成为国际国内肾脏病学界及全社会高度关注的问题。儿童CKD可由多种病因所致,包括原发性、继发性和先天/遗传性肾脏疾病以及泌尿系统疾病[1]。我国一项儿童慢性肾功能衰竭(CRF)研究结果显示,CKD     

儿童慢性肾脏病现状与防治

慢性肾脏病(chronic kidney disease,CKD)是指肾功能的不可逆性下降并逐渐进展到终末期肾病(end-stage renaldisease,ESRD)的一类肾脏疾病,已成为严重的公共卫生问题之一。美国国家肾脏病基金会肾脏病预后质量指南(NKF-D/OQI)将CKD定义为:肾脏结构与功能持续异常至少达3个月,     

儿童慢性肾脏病钙磷代谢问题

钙磷代谢紊乱是儿童慢性肾脏病(chronic kidney disease,CKD)的重要并发症之一。2005年提高全球肾脏病预后国际组织(kidney disease:improving Global Outcomes,KDIGO)明确提出慢性肾脏病的矿物质和骨代谢异常(CKD mineral and bone disorder,CKD-MBD)这一概念,将其定义为:CKD进展过程中由于肾功能损害导致机体钙磷代谢紊乱有关的全身性系统性疾病,可表现:(1)钙、磷、PTH或维生素D代谢异常;(2)骨转化、矿化、骨容量、骨骼线性生长或骨强度的异常;(3)血管或其他软组织钙化[1]。     

慢性肾脏病患儿的营养支持

儿童慢性肾脏病(chronic kidney disease,CKD)的病因学和成人相比差异较大,治疗特点也有所不同,营养支持在儿童CKD的治疗中有至关重要的作用.     

儿童慢性肾脏病

儿童慢性肾脏病(chronic kidney disease,CKD)是严重影响儿童正常生长发育的慢性进展性疾病,该病起病隐匿,部分最终进展为终末期肾病(end-stage renal disease,ESRD),需肾脏替代治疗维持生命.该文就儿童慢性肾脏病的病因、发病机制、诊断及治疗作一综述,旨在使人们更早、更全面地了解CKD,并采取积极的措施,延缓CKD的进展,防止ESRD的发生.     

儿童慢性肾脏病管理

2006年国际肾脏病学会(international society of ne-phrology,ISN)和国际肾脏基金联合会(international federa-tion of kidney foundation,IFKF)联合倡议,将每年3月份的第2个星期四定为世界肾脏日,目的是唤起全球各界人士对慢性肾脏病(chronic kidney disease,CKD)的高度关注。目前,儿童CKD的概念也已经得到较广泛的重视。根     

儿童慢性肾脏病研究现状

关于儿童慢性肾脏病(CKD)治疗的研究日益增多,但是关于儿童CKD发病率的流行病学调查结果比较有限.原因在于不同地区的研究方法不同,因此研究结果无法比较.在儿童CKD病因学研究中,由于地区不同而明显不同,可能与环境、种族、文化不同相关.     

慢性肾脏病对儿童生长发育的影响

生长和发育是儿童不同于成人的重要特点。生长是指儿童身体各器官、系统的长大,可有相应的测量值来表示其的量的变化,发育是指细胞、组织、器官的分化与功能成熟。生长发育受遗传调节,营养和疾病等环境因素对其影响也十分明显。慢性肾脏病(chronic kidney diseases,CKD)对儿童的生长和发育产生抑制作用,在CKD的3、4、5期,这种抑制作用十分明显,可以导致生长显著落后,甚至是患者     

美国肾脏病基金会制定的有关儿童慢性肾脏疾病的应用指南

儿童慢性肾脏疾病(CKD)严重危害儿童和青少年健康,美国肾脏病基金会近年规范了有关CKD的定义、分期、评估及治疗,并为早期发现儿童CKD提出了推荐方案:1.一次尿尿液的蛋白/Cr比值;2.用血肌酐预测公式如Schwartz公式等评估肾小球滤过率。本文着重介绍这一指南及在应用时应注意的问题。     

早产儿视网膜病的危险因素分析及随访调查

研究早产儿视网膜病(retinopathy of prematurity,ROP)的发生率、高危因素、治疗与随访情况。方法对2005年7月-2007年12月温州医学院附属第一医院NICU收治的符合ROP筛查标准的早产儿,于生后2周开始由资深眼科医师开始行间接眼底镜检查眼底,并进行随访。结果434例早产儿中ROP的发生率为5.5%(24/434例),24例ROP中Ⅰ期19例,Ⅱ期3例,Ⅲ期2例。Ⅲ期阈值病变者行激光光凝治疗,全部患儿均恢复正常。对434例早产儿行单因素分析得出,胎龄、出生体重、住院时间、吸氧、吸氧浓度、吸氧时间、呼吸暂停、新生儿肺透明膜病(RDS)、肺表面活性剂(PS)的应用、机械通气、输血、光疗时间、感染与ROP的发生有相关性(P<0.05)。Logistic回归分析显示胎龄、出生体重、胎数、吸氧时间、光疗时间、代谢性酸中毒、母亲妊高症、颅内出血是影响ROP发生的主要因素。结论早产是ROP的根本原因,防治各种并发症、合理的氧疗是预防ROP的关键。建立完善有效的ROP筛查制度,早期发现、早期治疗ROP,可改善ROP的预后。     

术中判断肠活力三种方法的比较

术中准确地评价肠活力是外科医师面临的一个普遍问题。应用兔肠缺血模型，比较静脉荧光素、表面血氧测定和激光多普勒三种技术判断肠活力的精确性。结果：诊断效率静脉荧光素法为７８％，表面血氧测定为６８％，激光多普勒为９５％。后者精确度显著优于前二者，且操作简便、迅速，具有临床应用前景。     

Spectrum of clinical presentations of vein of Galen aneurysm

Aneurysm of the vein of Galen is a rare intracranial vascular malformation. It is known to have diverse manifestations and varying severity. Four cases with different modes of presentation and outcome are reported. A mortality of 50 per cent was encountered. Among the survivors, one had neurologic sequelae whereas the other had attained age-appropriate developmental milestones. The former was a rare case of spontaneous thrombosis of the aneurysm while the latter was a boy who underwent therapeutic embolization.     

Outcome of the Treatment of Inborn Errors of Metabolism

The use of specific dietary restrictions, cofactor administration, mobilisation of insoluble substances, environmental modifications, product replacement and selective enzyme inhibition are now established for the treatment of some inborn errors of metabolism. There is no generally accepted application for enzyme administration, cytopharmacology (manipulation of the cytoskeleton) or for cell transplantation except for bone marrow transplantation in disorders where the bone marrow is primarily at fault. The other uses of bone marrow transplantation which have been proposed require further evaluation. Results of recent research suggest that the scope of this approach is gradually being widened. There is also scope for development in the field of organ transplantation taking advantage of recent technical¹ and immunological progress. The treatment of inborn errors of metabolism by genetic modification is not yet on a practical clinical level; more laboratory and animal studies are needed before this can be attempted in man. Adenosine deaminase deficiency appears to be the disease in which this will be first attempted using a retroviral vector to insert the gene into the genome of pluripotential bone marrow cells.     

婴幼儿法乐四联症手术治疗近期疗效的影响因素

目的 探讨影响婴幼儿法乐四联症手术治疗近期疗效的各相关因素.方法 将2003年8月至2011年2月经作者一期手术纠治的117例年龄≤3岁的法乐四联症患儿分为疗效良好、疗效较差两组.分析手术时患儿年龄、体重、术前HCT值、McGoon指数、EDVI、主动脉阻断时间、转流时间、室间隔缺损大小、升主动脉与肺动脉干直径比、...     

主动脉缩窄的治疗研究进展

主动脉缩窄(coarctation of aorta,CoA)是主动脉的局限性狭窄,狭窄最常见于峡部,是一种常见的先天性心血管畸形,占所有先天性心脏病的5％ ～8％.缩窄导致上肢血压升高,下肢血压降低,并可引起心功能下降,未经治疗的CoA预后不佳.治疗方式包括外科治疗及经皮介入治疗,不同治疗方式的并发症发生率不同,术后长期监测其并发症、心功能是评估预后的重要指标.该文对主动脉缩窄的治疗方式及术后并发症、心功能情况的研究进展作一综述.     

早产儿脑病研究进展

早产儿脑病是复杂的原发性脑损伤和继发性脑发育异常疾病.过去几年对该病有了较为深刻的认识,该文就最新的有关早产儿脑病概念演变,脑损伤后的细胞分子机制和损伤后发育障碍,尤其是活化小胶质细胞介导的少突胶质细胞损伤机制、神经/髓鞘受损和丘脑、板层下神经元及大脑皮层的受损机制或发育成熟障碍进行综述,以便对该病有更深刻的认识.     

�����뼤���ٴ�Ӧ��ע���

??Inhaled corticosteroids??ICS?? are the most effective medicine for chronic airway inflammation nowdays. Atomization inhalation has been widely applied in clinics because of its efficacy??fewer side-effects and convenience. Here??we focused on some points which should be paid attention to??including how to choose appropriate patients??how to ensure the effectiveness of inhaled steroids and how to reduce possible side-effects.     

Treatment of retinopathy of prematurity

Retinopathy of prematurity is a potentially blinding disorder of premature infants. Retinal ablation of the avascular retina originally described using cryotherapy but now most commonly undertaken with laser photocoagulation, reduces the unfavourable structural outcomes and improves the functional visual acuity outcome. The CRYO-ROP study showed the long-term benefit of treatment of threshold disease compared with no treatment, however even with cryoablation 44.4% of treated eyes had a visual acuity of 6/60 or worse at 10 year follow-up. The ETROP study of earlier treatment for high-risk pre-threshold disease, rather than treatment at threshold, has shown that pre-threshold treatment of type 1 disease produces a significantly improved outcome. Despite treatment some infants develop retinal detachment for which various surgical treatments have been described, although not always with a good functional outcome. Future treatment modalities may include the use of anti-VEGF therapies.     

Epidemiology of respiratory distress of newborns

The present prospective study was conducted to find out the incidence, etiology and outcome of respiratory distress (RD) in newborns. All newborns (n=4505), delivered at this hospital over a period of 13 months, were observed for respiratory problems. Relevant antenatal, intranatal and neonatal information was noted. Cases were investigated for the cause of respiratory distress and followed up for the outcome. The overall incidence of RD was 6.7% Preterm babies had the highest incidence (30.0%) followed by post-term (20.9%) and term babies (4.2%). Transient tachypnea of newborn (TTN) was found to be the commonest (42.7%) cause of RD followed by infection (17.0%), meconium aspiration syndrome (10.7%), hyaline membrane disease (9.3%) and birth asphyxia (3.3%). TTN was found to be common among both term and preterm babies. While Hyaline membrane disease (HMD) was seen mostly among preterms, and Meconium aspiration syndrome (MAS) among term and post-term babies. Overall case fatality ration for RD was found to be 19%, being highest for HMD (57.1%), followed by MAS (21.8%) and infection (15.6%). Our results indicate that RD is a common neonatal problem. TTN accounts for a large proportion of thhese cases. MAS and infection also contribute significantly and are largely preventable. Without adequate ventilatory support HMD and MAS carry high mortality.