儿童尿路结石及其致急性肾功能衰竭临床分析

目的 探讨儿童尿路结石的高危因素、临床特点及其导致急性肾功能衰竭的诊断及处理方法 .方法 回顾分析2002至2007年我院收治的35例尿路结石病例,分析其临床表现、治疗及转归,以总结出儿童尿路结石的临床特点及治疗方法 .结果 所有患儿均采用腹部B超及腹平片检查确诊;24例患儿并发急性肾功能衰竭,病程与血尿素氮、肌酐水平正相关(r=0.549,P=0.007:r=0.575,P=0.004);肾功能衰竭组X线阳性结石少于非肾功能衰竭组(X2=8.70,P=0.006);尿酸水平高于非肾功能衰竭组(t=3.04,P=0.009);肾功能衰竭组予内科保守或血液透析治疗,同时行膀胱镜逆行引流术,解除梗阻后患儿尿量增加,尿毒症症状消失,肾功能恢复正常.结论 小儿尿路结石临床表现不典型,腹部B超是最好的诊断方法 ;结石导致急性肾功能衰竭需早期诊断及治疗,及时解除结石梗阻至关重要,同时应注意纠正水电解质紊乱及对症治疗;应长期随访,预防结石复发.

Clinical analysis of urinary calculus and acute renal failure due to urinary calculus in children

Objective The incidence of urinary calculus in children has increased in last years.We were aimed to explore the high risk factors causing urinary calculus,clinical presentation,diagnosis and treatment methods for acute renal failure caused by ureterolith in pediatric patients.Methods There were 35 admitted patients of urinary calculus in our hospital from 2002 to 2007,we described their presentation features as well as diagnosis methods,medical treatment and prognosis.Results All the patients were diagnosed by B-ultrasonics and KUB X-ray.Twenty four patients of all were combined with acute renal failure(ARF),the course waspositively correlated to blood urea nitrogen(r=0.549,P=0.007)and creatinine(r=0.575,P=0.004). The ratio of the patients with radiopaque calculus in ARF group was less than that of the patients without ARF(X2=8.70,P=0.006).The level of serum uric acid was significantly higher in ARF gmup than that of the patients without ARF(t=3.04,P=0.009).We treated the ARF patients with cistoscope drainage as well as conservative treatment or hemodialysis.All obstructed kidneys were relieved with medical treatment,and no renal sequel remained.The urine volume of them was increased,symptoms of urinemia were disappeared,BUN and creatinine were normal after operations.Conclusion Most children with urinarv calculus have no classical symptoms.B-ultrasonics is the best way for diagnosing the obstruction of upper urinary tract resulted from multiple lithiasis.Acute renal failure caused by ureterolith should be diagnosed and treated as soon as possible.Removing the ureterofith is the most important.Correcting water and electrolyte disturbance is also important,Preventing recurrence of stones and follow-up is advised.