Abstract：
Patients with chronic kidney disease (CKD) sometimes experience gastrointestinal symptoms, such as nausea and vomiting. In addition, hypertension and CKD are closely linked, and sustained hypertension in children is associated with the progression of CKD, leading to early cardiomyopathy and premature atherosclerosis. These symptoms substantially affect the quality of daily life of CKD patients, and particularly in children with CKD, they may cause growth retardation. Therefore, establishing effective management methods to alleviate these symptoms is very important. Here, we report a case of a male patient who was born at 34 weeks of gestation weighing 1400 g. At birth, abdominal ultrasonography displayed left multicystic dysplastic kidney. From 6 months after birth, he was frequently hospitalized owing to refractory periodic vomiting. At 9 months old, he was diagnosed as having stage 3a CKD, and at 20 months old, he presented with stage 2 high blood pressure. In Japan, the uremic toxin adsorbent AST-120 and angiotensin-converting enzyme inhibitor-I (ACE-I) are not strongly recommended for CKD patients. However, after the patient underwent combination therapy of AST-120 and ACE-I, his frequent hospitalizations for refractory periodic vomiting ceased, and his blood pressure decreased. These results indicate that AST-120 and ACE-I are effective for refractory periodic vomiting and hypertension associated with CKD. The patient\'s height, weight, and mental development are catching up smoothly. The cause of the patient\'s refractory periodic vomiting remains unclear. However, his impaired kidney function owing to congenital anomalies of the kidney and urinary tract may have caused the refractory periodic vomiting and dehydration. The production of uremic toxins in CKD patients is thought to lead to the secretion of proinflammatory cytokines into the circulation. However, our patient had low serum levels of proinflammatory cytokines, and his serum levels of the chemokines CX3CL1 and CCL2 decreased with age, together with improvement in his clinical course. Therefore, some specific chemokines might be diagnostic and/or prognostic biomarkers of CKD.
摘要：
慢性肾脏病（CKD）患者有时会出现胃肠道症状，如恶心和呕吐。此外,高血压和CKD密切相关，儿童的持续性高血压与CKD的进展有关，导致早期心肌病和过早的动脉粥样硬化。这些症状严重影响CKD患者的日常生活质量,特别是在患有CKD的儿童中，它们可能会导致生长迟缓。因此,建立有效的管理方法来缓解这些症状非常重要。这里,我们报告了一例男性患者，在妊娠34周时出生，体重为1400克。出生时，腹部超声显示左侧多囊性发育不良肾。从出生后6个月，他经常因顽固性周期性呕吐而住院。9个月大的时候，他被诊断患有3a期CKD,在20个月大的时候，他出现了第二阶段高血压。在日本,尿毒症毒素吸附剂AST-120和血管紧张素转换酶抑制剂-I(ACE-I)不强烈建议用于CKD患者.然而,患者接受AST-120和ACE-I联合治疗后，他因顽固性周期性呕吐而频繁住院，他的血压下降了.这些结果表明AST-120和ACE-I对与CKD相关的难治性周期性呕吐和高血压有效。病人的身高,体重,智力发育正在顺利追赶。患者顽固性周期性呕吐的原因尚不清楚。然而,由于肾脏和泌尿道的先天性异常，他的肾功能受损可能导致难治性周期性呕吐和脱水。CKD患者中尿毒症毒素的产生被认为导致促炎细胞因子分泌到循环中。然而,我们的患者血清促炎细胞因子水平较低，并且他的趋化因子CX3CL1和CCL2的血清水平随着年龄的增长而下降，以及他临床课程的改进。因此,一些特异性趋化因子可能是CKD的诊断和/或预后生物标志物.
