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儿童慢性肾脏病的临床表现和评估

Authors
Craig S Wong, MD
Bradley A Warady, MD
Tarak Srivastava, MD
Section Editor
Tej K Mattoo, MD, DCH, FRCP
Deputy Editor
Melanie S Kim, MD
Translators
黄建萍, 主任医师，教授

引言

慢性肾脏病(chronic kidney disease, CKD)是指可导致肾功能进行性下降的一种不可逆性的肾脏损害和/或肾功能降低的状态。这一术语目前被儿科肾脏病学界所接受，取代了慢性肾衰竭(chronic renal failure, CRF)和慢性肾功能不全(chronic renal insufficiency, CRI)这两个临床术语，后两个术语在本质上描述的是从重度到轻度不等的肾功能不全。CKD更明确地将肾功能不全界定为一个连续的过程，而非不连续的变化，本专题全文将采用这一名称。

儿童CKD的临床表现、诊断及评估将总结在此。儿童CKD的病因、流行病学、自然病程及治疗将单独讨论。 (参见“儿童慢性肾脏病的流行病学、病因及病程”和“儿童慢性肾脏病的管理概述”)

定义和诊断

改善全球肾脏病预后组织(Kidney Disease: Improving Global Outcomes, KDIGO)2012年对CKD评估和治疗的临床实践指南(Clinical Practice Guideline, CPG)修订了2002年美国肾脏病预后质量倡议(Kidney Disease Outcomes Quality Initiative, KDOQI)关于CKD的CPG对儿童CKD的分类[1,2]。KDIGO分类包括病因、基于肾小球滤过率(glomerular filtration rate, GFR)的肾功能，以及是否存在白蛋白尿排泄及其排泄率。

KDIGO儿童CKD的诊断需满足下列临床标准之一：

  • GFR小于60mL/(min·1.73m2)持续3个月以上并可能对健康造成影响，无论是否存在其他CKD指标。
  • GFR大于60mL/(min·1.73m2)，伴有结构性损害的证据或功能性肾脏异常的其他标志物，包括蛋白尿、白蛋白尿、肾小管疾病，或通过组织学检测发现的或通过影像学检查推断的病理学异常。

                               

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Literature review current through: 2017-06 . | This topic last updated: 2016-10-11.
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