In recent years, the incidence of pediatric nephropathy was increasing year by year, only 11 years of age, 12-year-old child uremic patients is not uncommon. The country's 360 million children, there are about 300 million children with kidney disease, thousands of children each year progress to chronic renal failure.
Experts pointed out that acute nephritis and nephrotic syndrome is the most common kidney disease in children, but as long as the early diagnosis and treatment, treatment is better than adults. "Once the end-stage of children to the need for alternative treatment, such as dialysis treatment, kidney transplantation, not only expensive, and life-threatening." Pediatric disease diagnosis and treatment center, Fuzhou General Hospital, director of pediatrics Yuzhua chief physician to remind parents.
Genetic, infection and so can induce children with kidney disease, kidney disease or affect children to adulthood
Children with acute kidney injury are underestimated. Professor Liang Min, deputy director of the National Center for Renal Disease Clinical Research Center, deputy director of the Department of Nephrology, Nanfang Hospital, reported that the prevalence of childhood chronic kidney disease (CKD) is very low, about 15.0 ~ 74.7 per million. The incidence of acute kidney injury (AKI) in children was also significantly different, ranging from 8% to 89%.
"Recently, we led the organization to complete the 'Chinese hospitalized patients with acute kidney injury epidemiological investigation,'" said Liang Min, preliminary results show that hospitalized children with acute kidney injury incidence rate of about 18%. From this, the past, the incidence of acute kidney injury in children and the burden of disease was seriously underestimated, and there is insufficient knowledge of acute renal injury, in clinical part of the acute renal injury was missed.
Children suffer from kidney disease for many reasons. Unlike adult chronic kidney disease, children with chronic kidney disease is the main cause of congenital and hereditary abnormalities. So far, more than 150 genes have been found to regulate kidney development or to specifically regulate the function of small globules and tubules.
Liang Min introduced, in addition to congenital, there are some non-kidney disease in children with complications caused by secondary renal injury. Some infectious diseases can lead to kidney involvement, and promote the death of children. All kinds of primary, secondary glomerulonephritis is also an important reason for children's kidney health. We passed the pathological analysis of renal tissue and found that children are the most common glomerulonephritis is minimal change nephropathy, followed by Henoch-Schonlein purpura nephritis and IgA nephritis. The main risk factors of children with acute kidney injury include: pneumonia in children, congenital heart disease, major cardiac surgery, primary glomerulonephritis, neonatal asphyxia and low birth weight.
In addition, children suffering from kidney disease for many reasons, in addition to their immune dysfunction, infection and other factors, but also with the bad habits and ways of life. Such as high protein, salt, eating too much, eating too much health care products, drug abuse, excessive obesity, long-term sedentary, holding back urine.
Some adult kidney disease in children has been planted seeds. Liang Min pointed out that childhood kidney disease may lead to adult chronic kidney disease, failed to have a good control of renal disease gradually progress to the risk of renal failure. A large number of data show that adults with hypertension, proteinuria and chronic kidney disease in childhood has existed, and some even as early as intrauterine and perinatal already exist.
Guangzhou University of Traditional Chinese Medicine, First Affiliated Hospital, director of nephropathy Tang Fu pointed out that adult kidney disease is closely related with childhood, found from some adult kidney disease patients, many people have been planted in childhood root causes. Therefore, children with kidney disease need to actively and properly treated, and in the process of children's growth and close observation and follow-up. Tang Fu said, "In a small time to find kidney disease, timely treatment, to adulthood when the disease will be much lighter." Because the child's recovery ability than adults.
Urine, color Doppler ultrasound examination can identify children with early kidney disease, more than 90% of renal disease can be found by urine
Children with nephropathy, unlike the common cold, fever in children is so common, but it is indeed a great harm to the child one of the diseases. Part of the disease in children with nephropathy hidden, not easy to be found, if the parents do not have enough attention, the child is often checked out may have reached the stage of chronic renal failure. Chronic renal failure is divided into five, in the first four, children can choose drug treatment, once into the fifth period, which is the end stage, you must choose renal replacement therapy.
How to identify early childhood kidney disease? Tang Shuifu stressed that parents, especially family history, should be concerned about the child's kidney health, from childhood should be screened as early as possible, diagnosis and treatment, usually pay more attention to whether the shape of the urine changes, eyelid edema, abnormal color of urine, foam Urine, unexplained fatigue, anemia and so may be the performance of chronic kidney disease.
Yu Zihua suggested that parents as long as careful observation, or can find some traces of kidney disease. First, mild swelling of the eyelids and early morning (such as perineal) edema, or sedentary for a long time after the dorsal edema, swollen fingers, etc .; Second, the urine after the bubble pool was significantly increased, and after a long time Can not subside. Third, visible hematuria and microscopic microscopic hematuria can be found under the microscope, these are prompted kidney disease is an important signal.
Urine routine screening is the "gold standard" for kidney disease screening. Clinical data show that children with abnormal urine rate of 1%. Kidney disease can be expressed as early hematuria, proteinuria, clinical urine is usually used to check the appearance of hematuria, proteinuria and the amount, as evaluation of renal involvement in children, to determine the prognosis of one of the indicators. More than 90% of kidney disease, can be found through routine urinalysis disease, commonly used in acute glomerulonephritis, chronic glomerulonephritis, nephrotic syndrome, hereditary kidney disease and other diseases.
In addition, by renal ultrasound, can show the location of the kidney, size, shape, internal structure, but also observe the kidney and its surrounding various lesions, no pain, no trauma, is the ideal method of examination. Since the first application of percutaneous nephrolithotomy in 1951, the improvement of the puncture needle and the increased accuracy of image localization have made renal biopsy a routine examination for kidney disease.
Liang Min also recommended: 1. Conventional prenatal fetal ultrasound can be found in many urinary system abnormalities. 2. A careful understanding of family history of kidney disease, some kidney disease has a clear genetic and family history; if necessary, genetic testing confirmed. 3. To carry out proteinuria, hematuria and urinary tract infection screening, children's physical examination should increase the urine test items. 4. Some special children, such as low birth weight children, premature children are kidney disease, high blood pressure and other diseases of high-risk groups, the need for these children focus on long-term monitoring and prevention of kidney disease; should avoid the use of nephrotoxic drugs.
Indiscriminate use of antipyretic analgesics, beware of children with kidney disease
Children are very common cold fever, many parents will be free to the children to eat some cold medicine. But Liang reminded that some antipyretic analgesics on children with side effects, and some with strong renal toxicity of antibiotics, as well as Chinese herbal medicine can cause liver and kidney damage, once the indiscriminate use of the child will bring irreversible kidney disease.
Note gentamicin and other nephrotoxic drugs. Liang Min pointed out that the clinical can see a variety of drugs used improperly or overdose and "kidney injury" of small patients. Many parents like their children when they are sick medication, such as antibiotics from the purchase itself is also more common. Does not know that children with kidney development is not perfect, and its function is different from adults, some of the renal toxicity of drugs if used a little longer or slightly larger, it may cause acute renal injury in children, the baby grow up, easy to develop For chronic kidney disease.
Liang Min, the most common nephrotoxic drugs are: aminoglycoside antibiotics (such as gentamicin), non-steroidal anti-inflammatory drugs (antipyretic analgesics), antineoplastic drugs, diuretics and so on. Some Chinese herbal medicines have also been shown to have nephrotoxicity. These include Chinese herbal medicines containing aristolochic acid, such as Guanmutong, Angelica sinensis, Radix Fragaria, Aromaticum, and Manna Pills, Longdanxiegan Pills, . Tripterygium preparation can cause liver, kidney, blood system and reproductive system damage, prohibit the use of children.
Can not superstitious medicine remedies. Yu also reminded, do not superstitious medicine prescriptions. The so-called recipe, there are three cases: First, the accumulation of experience passed down. Some remedies, although some cases have been cured, but its treatment mechanism need to use modern medical knowledge and methods to be confirmed; the second is some symptomatic, rather than the root of the problem; Third, some even fake. Nephrotic syndrome, different causes, different clinical types, the nature and severity of the lesion is different, the treatment method can not be the same, with a recipe to treat all kidney disease is obviously not correct.
Children with kidney disease should be selected to do a large hospital standard treatment, not free to self-withdrawal
For children with kidney disease, should choose regular large hospitals to receive regular treatment until the nature and extent of disease diagnosis and then consider the treatment program. Yu pointed out that most of the delay to the end of the cases are in the early stages of illness did not receive standardized treatment.
At present, many large hospitals are lack of experience in diagnosis and treatment of children with kidney disease, because of long-term treatment, and the high cost of many children parents can only give up treatment. Yu Zihua suggested that children kidney disease diagnosis process and standardization and individual treatment, should make every effort to pediatric renal biopsy, kidney disease pathological diagnosis, kidney disease gene diagnosis, pediatric dialysis and pediatric kidney transplantation 5 technology platform, the creation of pediatric kidney disease Specialist out-patient, and the establishment of pediatric nephropathy registration and follow-up system to improve the diagnosis and treatment of pediatric kidney disease level. In particular, the use of molecular genetics and human genomics technology, congenital nephrotic syndrome and hormone-resistant nephrotic syndrome, hemolytic uremic syndrome gene mutation analysis of genetic diagnosis.
"At present, the world's main drug treatment of kidney disease or hormones, although there are some side effects of hormones, but often with the disease remission, hormones gradually reduced and even reduce the gradually disappear." Yu said, many parents lack of understanding of hormone therapy, Random withdrawal, but also artificially caused the child's condition repeated.
For children suffering from kidney disease, the daily life of how to carry out scientific care? First Affiliated Hospital of Peking University, head of the kidney professional Jia Yujing stressed "how to take medicine to prevent infection (including hand hygiene), measuring weight, record access" four. Second, the dose must be accurate (dropper, syringe, divider); again, the child should not be said to drink sugar syrup or sugar to eat. Special drugs to be a good medicine to pay attention to what? Follow the treatment plan, not self - withdrawal .If you forget to take medicine, do not just fill the service, can not be taken together with the two drugs.
Liang Min suggested that parents should have a clear understanding of kidney disease, check the results a little unusual, do not need excessive tension and panic, to maintain an optimistic attitude to face. Also, proper exercise, strengthen the child's resistance, children with kidney disease are afraid of a cold, do not suspicion of kidney disease does not exercise all day to rest or even ask the child in bed, so resistance is even worse, the body but negative.
Yu also reminded, parents should be as little as possible to sick children to crowded public places, do not have contact with infected people, go out wearing masks, pay attention to well-being, suspend vaccination. Second, the diet should be treated differently. If appetite is not good, to enhance appetite; if severe edema is not subsided, there are high blood pressure, should be limited to water and the low-fat diet, such as fish, Salt intake, until the swelling subsided.
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Children with hematuria to prevent inherited progressive glomerulonephritis
"Because there is no specific symptoms of self-feeling, Alport syndrome is often overlooked, the public awareness is low, while doctors also need to raise awareness, if you encounter hematuria, proteinuria in children, should think of the possibility of this disease as soon as possible Related examination to early diagnosis. "Peking University First Hospital, vice president, pediatric Professor Ding Jie said that if early screening of urine screening, Alport syndrome can also be early detection, early diagnosis.
According to Peking University First Hospital pediatrics associate professor Wang Fang introduced, Alport syndrome, also known as hereditary progressive glomerulonephritis, the clinical manifestations in the kidney, including hematuria, proteinuria and so on. In addition, the patient will appear some "extrarenal" performance, such as sensorineural hearing loss and eye abnormalities, including maculopathy, retinopathy. Alport syndrome patients tend to develop in young adulthood (20 to 30 years) to end-stage renal disease, and therefore poor prognosis. Kidney transplantation is an effective treatment for Alport syndrome patients with end stage renal disease.
Ding Jie said that in terms of treatment, despite the current lack of radical treatment of Alport syndrome, but can use some drugs such as angiotensin converting enzyme inhibitors, angiotensin receptor antagonists and aldosterone inhibitors to reduce urinary protein levels, Delay the progression of the disease.
"To improve the awareness of patients with Alport syndrome, awareness and diagnostic tools, early diagnosis is more important, clear after diagnosis to avoid the use of some unnecessary drugs such as hormones, a variety of immunosuppressive agents, reduce family financial burden and drug side effects. "Ding Jie said that as a genetic disease, Alport syndrome is still not prevent. However, with the diagnostic level or means to improve, especially the popularity of genetic diagnosis, the future can be prenatal and postnatal care, prenatal genetic diagnosis, to avoid the birth of children.
