儿童肾功能异常的诊断思路

doi:10.12372/jcp.2022.21e1093

摘要/Abstract

摘要：

肾功能异常指多种原因,包括肾脏疾病或非肾脏疾病引起的血肌酐和尿素氮升高,伴或不伴水肿、电解质紊乱、高血压等多系统、脏器累及症状。儿科临床上很大一部分患者以肾功能异常为首发表现。笔者就儿童肾功能异常的诊断思路进行综述,提出儿童肾功能异常的诊断应该遵循病程和肾功能分期、定位、定因、并发症评估的程序,其中特别建议无论急性或慢性肾功能异常,肾功能分级均采用目前慢性肾脏病的国际分级标准,病因方面儿童肾功能异常仍以遗传性疾病最为常见。先天性肾脏和尿路畸形只是一种形态学诊断,其病因也可能仍以遗传因素为主。

关键词: 肾功能异常, 诊断思路, 儿童

Abstract:

Renal dysfunction refers to a variety of situations, including kidney diseases and other diseases, which cause the increase of creatinine and urea nitrogen, accompanied with edema, electrolyte disorder, hypertension and other multiple system related symptoms in some cases. A large proportion of patients were characterized by renal dysfunction as the primary symptom in children. The author summarized the diagnosis approach on childhood renal dysfunction, suggested that the stage on renal function should be based on the same classification standard as in chronic renal disease. Hereditary disease is the most common cause of renal dysfunction in children. Congenital anomalies of the kidney and urinary tract, which might be mainly results from developmental abnormalities, represent a broad spectrum of disorders.

Key words: renal dysfunction, diagnose approach, child

张宏文. 儿童肾功能异常的诊断思路[J]. 临床儿科杂志, 2022, 40(2): 155-159.

ZHANG Hongwen. Diagnostic approach on childhood renal dysfunction[J]. Journal of Clinical Pediatrics, 2022, 40(2): 155-159.

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畸形类型	病因	定义
肾脏数目	肾缺如（renal agenesis）	单侧或双侧,肾脏和流出道未形成
肾脏大小和形态	肾发育不全（renal hypoplasia）	单侧或双侧,肾脏外形正常,但体积小、肾单位数目减少
	肾发育不良（renal dysplasia）	单侧或双侧,肾脏外形和组织分化异常,肾单位数目减少
	多囊性肾发育不良（MCDK）	肾发育不良伴多囊性病变,肾脏外形异常
肾脏位置	马蹄肾（horseshoe kidney）	双侧肾脏后部融合形成马蹄样外形
肾脏位置	异位/盆腔肾（ectopic/pelvic kidney）	肾脏位置异常,通常位于盆腔
流出道畸形	肾盂输尿管连接部梗阻（UPJO）	单侧或双侧,肾脏和输尿管连接部梗阻,阻碍了肾盂的尿液引流入输尿管
	膀胱输尿管连接部梗阻（UVJO）	单侧或双侧,输尿管和膀胱连接部梗阻,阻碍了输尿管的尿液引流入膀胱
	膀胱输尿管反流（VUR）	单侧或双侧,膀胱输尿管连接部缺陷,导致尿液从膀胱反流进入输尿管
	双集合系统（DCS）	单侧或双侧,输尿管和肾盂重复,可伴随重复肾;流出道系统反流或梗阻
	巨输尿管（megaureter）	单侧或双侧,输尿管扩张导致尿液流出障碍
	后尿道瓣膜（PUV）	后尿道瓣膜形成,阻碍了膀胱尿液排出,仅限于男性