背景:2012年KDIGO指南将慢性肾脏病(CKD)的G1期定义为以结构性或功能性肾脏异常为特征且肾小球滤过率无恶化的肾脏损害。由于肾小管疾病引起的白蛋白尿和电解质异常被认为是肾脏损害的功能标志物。这些指南中未明确引用肾脏水处理的变化。本研究使用了位于G1期的二巯基琥珀酸(DMSA)异常扫描儿童的大量样本。
方法:双抗,横断面研究,以评估116名儿科患者的临床病史。根据CKD指南KDIGO的分类,第一组(G1期)包括100例患者,G2-G5期包括16例患者。所有患者均进行了肾脏病理性DMSA扫描。GFR,测定了最大尿渗透压,白蛋白/肌酐和NAG/肌酐比值.
结果:GFR正常的患者,与GFR降低的患者相比,最大尿渗透压值显着升高,尿量和白蛋白/肌酐和NAG/肌酐比值显着降低。KDIGOG1期儿童中最常见的变化是涉及水肾管理的儿童,例如尿浓缩能力缺陷(29%)和尿量增加(20%)。尿白蛋白(12%)和NAG(3%)消除增加的儿童频率更低。KDIGOG2-G5阶段的所有儿童在水肾管理方面都有改变。
结论:在实质缺失和正常GFR的儿童中,与水肾管理相关的参数比白蛋白尿排泄更频繁地受到影响。
BACKGROUND: The G1 stage of chronic kidney disease (CKD) is defined in the 2012 KDIGO
Guideline as kidney damage characterized by structural or functional kidney abnormalities without deterioration of glomerular filtration rate. Albuminuria and electrolyte abnormalities due to tubular disorders are considered functional markers of kidney damage. Changes in renal water handling are not explicitly cited in these
guidelines. A large sample of children with abnormal dimercaptosuccinic acid (DMSA) scan located in the G1 stage was used in this study.
METHODS: Ambispective, cross-sectional study to evaluate the clinical histories of 116 pediatric patients. 100 patients were included in the first group (G1 stage) and 16 patients in the G2-G5 stages according to the classification of CKD
Guideline KDIGO. All the patients had a renal pathologic DMSA scan. GFR, maximum urine osmolality and albumin/creatinine and NAG/creatinine ratios were determined.
RESULTS: The patients with normal GFR, in relation to those with reduced GFR, had significantly higher values of maximum urine osmolality and significantly reduced values of urine volume and albumin/creatinine and NAG/creatinine ratios. The most frequently observed alterations in children in the KDIGO G1 stage were those involving the water renal management such as urinary concentrating ability defect (29%) and increased urinary volume (20%). The frequency of children with increased urinary elimination of albumin (12%) and NAG (3%) was more lower. All children in KDIGO G2-G5 stages had alterations in water renal management.
CONCLUSIONS: The parameters related with the water renal management are affected more frequently than albumin urinary excretion in children who have loss of parenchyma and normal GFR.