关注儿童用药后的肾损伤

药物性肾损伤是儿童急性肾损伤的主要原因之一。药物经由肾脏代谢排泄时导致肾小管上皮细胞损伤、肾脏免疫炎症,或导致肾内血流动力学改变,或形成结晶堵塞肾小管。临床主要表现为急性肾损伤、急性肾小管坏死、急慢性间质性肾炎、结晶性肾病、肾病综合征、肾小管功能障碍等。应用生物标志物可以早期监测药物性肾损伤。临床工作中应及时纠正药物性肾损伤的高危因素,及时停用相关药物和监测肾功能,力求早期诊断,早期干预,改善预后。     

新生儿窒息后急性肾损伤的诊治进展

新生儿窒息后急性肾损伤发生率可达56％,易导致多脏器损伤及新生儿死亡.该文综述了近年来国内外窒息后肾损伤的早期诊断生物学标记物、尿蛋白、尿酶、脉冲多普勒超声肾血流检查及治疗的新进展,对新生儿窒息后急性肾损伤的早期诊断、治疗,提高窒息新生儿的存活率、改善预后具有重要意义.     

急性肾损伤的生物标志物研究进展

急性肾损伤是临床常见病,但病情凶险,发病率及总体病死率升高,轻度的肾功能减退即可导致并发症的发生。因此,急性肾损伤的早期诊断至关重要,选择敏感度高的、特异性强的生物标志物进行检测是急性肾损伤早期诊断的保证。     

急性肾损伤生物标记物的临床研究进展

急性肾损伤是一组以急性肾功能减退为特征的临床综合征,是危重症患者的常见并发症之一,治疗棘手,病死率高.临床上大多数使用血肌酐和尿量作为急性肾损伤的诊断标准,不能及时和准确反映肾功能变化.目前一些新的生物学标记物的出现为急性肾损伤的早期诊断和治疗提供了可能,本文就目前研究较热的几种生物学标记物作一简单综述.     

早期诊断急性肾损伤的生物学标志物研究现状

急性肾损伤(AKI)是一种常见的严重疾病.由于缺乏诊断AKI的早期生物学标志物,往往导致早期有效治疗的延误.目前对于诊断AKI新的生物学标志物的研究已发展到了临床研究阶段,最有希望成为早期诊断AKI的生物学标志物包括中性粒细胞明胶酶相关脂质运载蛋白、IL-18、肾损伤分子-1和L-脂肪酸结合蛋白.本文就近年来关于上述几种生物学标志物的研究作一综述,为应用早期诊断AKI的生物学标志物提供理论依据.     

早期诊断急性肾损伤的生物学标志物研究现状

急性肾损伤(AKI)是一种常见的严重疾病.由于缺乏诊断AKI的早期生物学标志物,往往导致早期有效治疗的延误.目前对于诊断AKI新的生物学标志物的研究已发展到了临床研究阶段,最有希望成为早期诊断AKI的生物学标志物包括中性粒细胞明胶酶相关脂质运载蛋白、IL-18、肾损伤分子-1和L-脂肪酸结合蛋白.本文就近年来关于上述几种生物学标志物的研究作一综述,为应用早期诊断AKI的生物学标志物提供理论依据.     

急性肾损伤的诊断与治疗进展

急性肾损伤除继发于肾脏本身的疾病外,也可继发于多器官功能障碍综合征、新生儿呼吸窘迫综合征、脓毒症、胃肠道液体丢失、心脏外科手术及使用肾毒性的药物或食物等多种其他系统的疾病.近年来,国际上多个学科的专家,对急性肾损伤的定义、诊断分期、治疗和预后等统一认识,有了新的观点,发布了新的指南.另外,用于早期设别急性肾损伤的生物学标志有较多的报道,为了解急性肾损伤的诊疗现状,现通过改善全球肾脏病预后组织2012年3月发布的《急性肾损伤的临床实践指南》和近年有关文献,对急性肾损伤的临床实用知识,尤其是新的观念作一综述.     

关注儿童脓毒症急性肾损伤

阐述儿童脓毒症急性肾损伤的临床流行病学特点、主要发病机制、早期诊断指标及治疗要点,提醒儿科临床医师要关注儿童脓毒症急性肾损伤的救治。     

小儿急性肾衰竭诊断标准及治疗进展

急性肾衰竭是儿科临床常见的危重症肾脏疾病。早期诊断、早期治疗是改善儿童急性肾衰竭预后、提高患儿生存率的关键。现重点介绍小儿急性肾衰竭诊断标准及治疗方案研究进展，从急性。肾损伤的定义、诊断标准和分期到急性肾衰竭的治疗措施进行阐述。     

川崎休克综合征致急性肾损伤1例报告

目的探讨川崎休克综合征并发急性肾损伤的临床特征及治疗。方法回顾分析1例川崎休克综合征合并急性肾损伤患儿的临床资料。结果 12岁女性患儿,因发热、呕吐起病,诊断脓毒性休克,逐渐出现急性肾损伤;患儿于发热10天后热退,5次连续性肾脏替代治疗后尿量恢复,血压稳定,尿素氮和肌酐恢复正常。后期复查心脏彩超提示冠脉扩张,修正诊断为川崎休克综合征,加用阿司匹林口服出院。长期随访心脏彩超示冠脉扩张消失。结论川崎休克综合征早期诊断需与脓毒性休克鉴别,一旦并发急性肾损伤,积极采用血液净化治疗可有效改善预后。     

Biomarkers of acute kidney injury in neonatal encephalopathy

Acute kidney injury (AKI) is a common complication of neonatal encephalopathy (NE). The accurate diagnosis of neonatal AKI, irrespective of the cause, relies on suboptimal methods such as identification of rising serum creatinine, decreased urinary output and glomerular filtration rate. Studies of AKI biomarkers in adults and children have shown that biomarkers can improve the early diagnosis of AKI. Hypoxia–ischaemia is the proposed aetiological basis of AKI in both NE and cardiopulmonary bypass (CPB). However, there is a paucity of studies examining the role of AKI biomarkers specifically in NE. Urinary cystatin C (CysC), neutrophil gelatinase-associated lipocalin (NGAL), interleukin-18, kidney injury molecule-1, liver-type fatty acid-binding protein, serum CysC and serum NGAL all show good ability to predict early AKI in a heterogeneous critically ill neonatal population including infants post-CPB. Moreover, serum and urinary NGAL and urinary CysC are early predictors of AKI secondary to NE. These findings are promising and open up the possibility of biomarkers playing a significant role in the early diagnosis and treatment of NE-related AKI. There is an urgent need to explore the role of AKI biomarkers in infants with NE as establishing the diagnosis of AKI earlier may allow more timely intervention with potential for improving long-term outcome.     

新生儿急性肾损伤的早期诊断临床分析

目的 探讨新生儿重症监护病房（NICU）中新生儿急性肾损伤（AKI）发生率和病死率, 比较不同的AKI早期诊断标准评估新生儿AKI的发生率和病死率的差异, 探讨新生儿AKI早期诊断标准的重要性。 方法　采用前瞻性队列研究, 将2012年6月至2012年8月就诊于复旦大学附属儿科医院NICU的新生儿作为研究对象, 分别收集并记录每小时尿量以及入院当天、 48 h内的血肌酐等临床、 实验室指标及治疗等情况, 依照AKIN 2005年儿童AKI和AKIN 2012年新生儿AKI早期诊断标准进行分组, 比较新生儿AKI的发病情况、 病死率及临床特点。结果　按照AKIN 2005年儿童AKI的早期诊断标准共确诊AKI患儿20例,发生率为14.71%;在AKI组中,死亡9例,病死率为45%。按照AKIN 2012年新生儿早期诊断标准共确诊AKI患儿35例,发生率为25.73%;其中AKI新生儿死亡18例,病死率为51.43%;2012年AKIN早期诊断标准对新生儿AKI诊出率明显高于2005年的标准,两种早期诊断标准所致的新生儿AKI发生率差异存在统计学意义（P＝0.024）,但两种诊断标准所致的病死率差异无统计学意义（P＝0.646）。结论 新生儿AKI在NICU中发生率、病死率高,诊断困难,AKIN 2012年新生儿AKI早期诊断标准较AKIN 2005年儿童AKI早期诊断标准有助于新生儿AKI的早期诊断。     

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??Objective??To investigate the morbidity and mortality of neonatal AKI in NICU??evaluate the the performance of the different AKI diagnosis criteria of the Acute Kidney Injury Network ??AKIN?? and to study the importance of early diagnosis criteria for neonatal AKI. Methods??This is a prospective cohort study performed in NICU??Children Hospital of Fudan University. We prospectively followed the neonates??less than 28 days?? admitted from June1st??2012 to August 31??2012??until their discharge or death. For all the neonates we collected the clinical data at admission. Results??AKI was diagnosed in 35 neonates??the incidence of neonatal AKI was 25.73% according to the diagnosis criteria of AKIN in 2012. The mortality of neonatal AKI group was 51.43%??18/35??. Meanwhile??AKI was diagnosed only in 20 neonates??incidence of AKI being 14.71% in the same study with the other diagnosis criteria of AKIN in 2005 and the mortality of neonatal AKI group was 45%??9/20??. Conclusion??AKI is a common and severe clinical problem in NICU with high morbidity and mortality in NICU and is hard to diagnose. The criteria of AKIN in 2012 can improve the early diagnosis of newborn AKI in PICU.     

急性肾损伤与早期诊断生物标志物

急性肾损伤（acute kidney injury,AKI）是一种临床常见的综合征。目前国内外临床上对肾损伤的评估仍然依赖于血肌酐和尿量的变化,缺乏有效的生物标志物来早期识别,导致治疗延迟,AKI病死率居高不下。寻找理想的生物标志物,实现AKI早期诊治是亟待解决的临床实际问题。儿童AKI与成人相比具有一定特殊性,已发现的AKI生物学标志物是否适用于儿童及新生儿尚需进一步验证。文章通过对颇具儿科临床应用前景的几种AKI生物标志物及其作为早期识别AKI标志物的优点和局限性进行综述,为儿童AKI的早期诊断提供方向。     

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??Acute kidney injury??AKI?? is a common syndrome. Serum creatinine and urine output are the most commonly used in clinical evaluation of kidney injury??but they are poor markers for early diagnosis of AKI??which results in delayed treatment and high mortality. Research in AKI has focused on identifying biomarkers for early detection. Since AKI in children and adults is not the same??investigation is needed to explore the role of potential biomarkers for prediction of AKI in pediatriccohorts. This review serves to update the topic of promising AKI biomarkers and focuses on pediatric biomarker’s advantages and limitations to improve early detection in children.     

早产儿肾损伤及监测

急性肾损伤（AKI）是新生儿重症监护病房常见的并发症,不仅造成早产儿高病死率,还引起成年后多种慢性肾疾病。早产儿出生时肾脏发育不成熟,在生后特定时间窗内肾脏持续加速发育,但受孕期和产后多种因素影响,容易发生急性肾损伤。目前传统的评价肾损伤的指标为血清肌酐和尿量,但其早期敏感性和特异性问题日渐受到关注。最近多种新的生物学标志物被发现可用来早期识别急性肾损伤,本文就早产儿急性肾损伤、影响因素及肾功能评价和防治进行概述,为提高早产儿急性肾损伤早期诊治水平和远期生存质量提供参考。     

Acute kidney injury in a paediatric intensive care unit: comparison of the pRIFLE and AKIN criteria

Aim: The purpose of our study was to evaluate and analyse the prevalence and association of acute kidney injury (AKI) as defined by paediatric Risk, Injury, Failure, Loss of kidney function and End‐stage kidney disease (pRIFLE) and Acute Kidney Injury Network (AKIN) classifications in a paediatric intensive care unit (PICU). Methods: A prospective analysis of all patients that were admitted to our PICU between June 2009 and December 2010 was performed. Patients were classified according to AKIN and pRIFLE criteria. Results: One hundred and eighty‐nine patients (mean age 45.9 ± 54.7 months; 110 male, 79 female) were enrolled. Sixty‐three (33.3%) patients developed AKI by AKIN criteria and 68 (35.9%) patients developed AKI by pRIFLE criteria. All patients that had AKI according to AKIN criteria also had this diagnosis with pRIFLE criteria. Five patients had developed AKI only according to pRIFLE classification, four of them owing to reduction in their estimated creatinine clearance and one of them owing to changes over 1‐week period. The mean length of PICU stay was longer, need for mechanical ventilation and mortality rates were higher in patients with AKI when compared to patients without AKI. Conclusion: Although both pRIFLE and AKIN criteria were very helpful in the detection of patients with AKI even in the early stages of it, pRIFLE seems to be more sensitive in paediatric patients.     

中性粒细胞明胶酶相关脂质运载蛋白与急性肾损伤

中性粒细胞明胶酶相关脂质运载蛋白（neutrophil gelatinase-associated lipocalin,NGAL）是脂质蛋白家族成员之一,首先于中性粒细胞中分离得到的一种稳定多肽。作为新型临床早期诊断急性肾损伤的标志物,NGAL不易受机体、药物及。肾外因素影响,血液和尿液中浓度升高都可以预测急性肾损伤。动态监测NGAL可以评估临床治疗手段是否有效,对急性肾损伤的救治有参考意义。