背景:关于新生儿肾钙化病(NC)和肾结石(RC)的结局和危险因素的研究有限,并且通常不包括用于比较的对照。我们进行了病例对照分析,以确定与新生儿NC和/或RC相关的危险因素,并研究了这些异常的自然过程。
方法:从我们机构10年的新生儿重症监护病房数据库中确定了出生后第一年内超声诊断为NC/RC的婴儿和相应的妊娠年龄和性别匹配的对照。评估的危险因素包括:低出生体重,小于胎龄,肾毒性药物,呼吸支持疗法,使用父母总营养(TPN),手术,UTI的历史,出现时的肌酐,和产妇高血压病史。估计了未调整的赔率比。对二元变量进行卡方分析,对连续变量进行Mann-WhitneyU检验。检查的结果包括NC/RC解决时间,肾功能,和高血压。
结果:我们确定了22例NC/RC与相应的对照。中位随访时间为28个月(IQR0-122个月)。尿路感染史(UTI)是唯一与NC/RC存在显着相关的变量(OR5.62,95%CI1.12-31.1,p<0.013)(表)。所有其他已知的危险因素在两组中具有可比性。在诊断或最后一次随访时,两组之间的高血压发生率没有差异(OR2.94,95%CI0.40-33.82,p=0.216)。观察到NC/RC的分辨率为72.7%,中位随访12.1个月.NC/RC组的平均尿钙/肌酐比率在诊断时为2.3±1.5,在最后一次随访时为0.96±0.8。
结论:大多数婴儿的NC/RC在没有手术干预的情况下消退,但有些婴儿需要药物治疗和随访。由于现有研究的质量,新生儿NC/RC的风险因素仍然定义不清。我们的研究为混杂因素提供了进一步的调整,但样本量较小,仅限于重症监护病房的新生儿。
结论:大多数NC/RC病例无需手术干预即可自行消退。解决的平均时间是12.1个月,没有高血压方面的不良后果。UTI病史是本研究中唯一确定的危险因素,与新生儿肾钙化和/或肾结石的风险显着增加有关。需要更大规模的前瞻性研究来证实这些发现。
BACKGROUND: Studies on outcomes and risk factors for neonatal nephrocalcinosis (NC) and renal calculi (RC) are limited, and often do not include controls for comparison. We conducted a
case-control analysis to identify risk factors associated with NC and/or RC in neonates and studied the natural course of these anomalies.
METHODS: Infants diagnosed with NC/RC on ultrasound within the first year of life and corresponding gestational age- and gender-matched controls were identified from the neonatal intensive care unit database at our institution over a 10-year period. Risk factors assessed included: low birth weight, small for gestational age, nephrotoxic drugs, respiratory support therapy, use of total parental nutrition (TPN), surgeries, history of UTIs, creatinine at presentation, and history of maternal hypertension. Unadjusted odds ratios were estimated. Chi square analysis was performed for binary variables and the Mann-Whitney U test for continuous variables. Outcomes examined include time to resolution of NC/RC, renal function, and hypertension.
RESULTS: We identified 22 cases of NC/RC with corresponding matched controls. Median follow-up was 28 months (IQR 0-122 months). History of urinary tract infections (UTI) was the only variable significantly associated with the presence of NC/RC (OR 5.62, 95% CI 1.12-31.1, p < 0.013) (Table). All other known risk factors were comparable in both groups. There was no difference in the incidence of hypertension (OR 2.94, 95% CI 0.40-33.82, p = 0.216) at diagnosis or last follow-up between the groups. Resolution of NC/RC was observed in 72.7%, during a median follow-up of 12.1 months. Mean urinary calcium/creatinine ratio for the NC/RC group was 2.3 ± 1.5 at diagnosis and 0.96 ± 0.8 at last follow-up.
CONCLUSIONS: Most NC/RC in infants resolve without surgical intervention but some infants require medical therapy and follow-up. Risk factors for NC/RC in neonates continue to be poorly defined because of the quality of studies available. Our study provides further adjustment for confounders but has a small sample size and is restricted to neonates from an intensive care unit.
CONCLUSIONS: Most cases of NC/RC resolve spontaneously without surgical intervention. The mean time to resolution is 12.1 months, without untoward consequences in terms of hypertension. A history of UTIs is the only identified risk factor identified in this study which is associated with a significant increased risk of neonatal nephrocalcinosis and/or renal calculi. Larger prospective studies are warranted to confirm these findings.