199例儿童急性间质性肾炎临床及预后分析
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Clinical and prognostic analysis of 199 children with acute interstitial nephritis
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    目的:分析急性间质性肾炎(acute interstitial nephritis,AIN)的临床特点、治疗转归,提高对AIN的认识。方法:回顾性分析2010年1月至2017年12月重庆医科大学附属儿童医院肾内科收治的199例AIN患儿临床资料、病因、临床特点、实验室和肾脏病理结果及治疗转归情况。结果:199例AIN中,感染所致180例,以呼吸道感染最常见,其次为消化道感染;病原学以病毒为主,包括EB病毒、柯萨奇病毒、呼吸道合胞病毒等;药物所致125例(均为感染后用药),以非甾体类抗炎药(non-steroidal anti-inflammatory drugs,NSAIDs)及抗生素为主;非感染所致AIN包括蜂蛰伤、中毒、外科手术等。几乎所有患儿均有肾受累表现,包括不同程度的浮肿、少尿、血尿、蛋白尿及无菌性白细胞尿,69例有急性肾功能不全。4例行肾活检,以小管间质病变为主,肾小球及肾血管基本正常。所有患儿入院后均采取去除诱因及对症治疗,46例因急性肾衰竭(acute renal failure,ARF)、中毒行血液净化,其中6例联合使用糖皮质激素,肾功能及尿检均在短期恢复正常。结论:引起儿童AIN 最主要的诱因为感染,以病毒感染为主,其次为药物。临床表现以不明原因肾功能下降及尿检异常为主,重者可发生急性肾功能衰竭。及时诊断、去除诱因是治疗的关键,必要时行血液净化及短期糖皮质激素治疗,多数预后良好。

    Abstract:

    Objective:To analyze the clinical feature and treatment of acute interstitial nephritis(AIN),so as to enhance the knowledge of AIN. Methods:Clinical data,disease cause,clinical features,laboratory and nephritic pathological results,and treating outcome of 199 patients with AIN in our hospital from January,2010 to December,2017 were analyzed. Results:Among 199 patients,180 pa-tients were infection-induced AIN,with the most common of respiratory infections,following by digestive infection; with main etiology of virus infection,including EB virus,Coxsackie virus,respiratory syncytial virus and so on. And 125 patients were caused by drugs (all were post-infection administration),with the most common drugs of anti-inflammatory drugs(NSAIDS) and antibiotics. Almost all children had renal involvement,including edema,oliguria,hematuria,proteinuria and aseptic leukocyturia to different degrees. Besides,69 patients had acute renal insufficiency. Four patients underwent renal biopsy and results showed that the majority was tubulointerstitial lesions and the glomerulus and renal vessels were basically normal. All patients were treated with removal cause and symptomatic treatment after admission. A total of 46 patients were treated with blood purification because of acute renal failure(ARF) or poisoning and 6 of them were treated with combination of glucocorticoid,after which renal function and urine tests returned to nor-mal in the short term. Conclusion:The main cause inducing AIN in children is infection,among which viral infection takes the domi-nant position,followed by drugs. The main clinical manifestations is unexplained renal function decline and abnormal urine test,among which severe patients may have AFR. Timely diagnosis and cause remove are key to treatment. Blood purification and short-term glucocorticoid therapy are needed when necessary and most of them have a good prognosis.

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刘小庆,王墨.199例儿童急性间质性肾炎临床及预后分析[J].重庆医科大学学报,2020,45(11):1573-1578

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  • 在线发布日期: 2020-12-08
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