摘要
目的探讨儿童造血干细胞移植后泌尿系损伤的病因、病理以及治疗和预后。方法回顾分析81例行造血干细胞移植患儿的临床资料,并复习相关文献。结果在81例患儿中,男50例、女31例,年龄8个月~17岁。肾前性损伤30例(37%),予积极补液等对症治疗后即恢复。肾性损伤9例(11.1%),其中4例放弃或转院,预后不详;其余5例行肾活检明确病理,经积极对症、对因治疗后,4例肌酐以及肾小球滤过率均恢复正常,但在长期随访中,1例因原发疾病复发、干细胞再输注合并肾衰竭死亡,其余3例进入慢性肾脏病;1例合并肾脏血栓性微血管病进入慢性透析。肾后性损伤包括出血性膀胱炎23例(28.4%)和泌尿道感染13例(16.0%),予大量补液、碱化尿液以及抗感染等治疗后,短期内多恢复,预后良好。结论造血干细胞移植后泌尿系损伤分为肾前性、肾性及肾后性,其中肾性损伤多复发。
Objectives To investigate the etiology,renal pathology,treatment,and prognosis of children’s urinary systeminjury after hematopoietic stem cell transplantation(HSCT).Methods Clinical data of81children with urinary dysfunctionafter HSCT admitted to the Hematology Department in Children’s Hospital of Soochow University were analyzed,and relevantliteratures were reviewed.Results In81cases(50males and31females),the age ranges from8months to17years old.Thirtycases(37%)with prerenal injury were recovered after active rehydration and other symptom specific treatment.There were9(11.1%)children with renal injury,four cases were given up therapy or transferred to other hospitals,thus lead to an unknownprognosis.Kidney biopsy was performed in the remaining five cases for pathological investigation.After active symptom-speificand etiology-based treatment,serum creatinine and glomerular filtration rate of four cases return to normal.But in the long-termfollow-up,one case died of recurrence of primary disease,reinfusion of hematopoietic stem cell combined with renal failure.The remaining3patients were with chronic kidney disease(CKD).One case with renal thrombotic microangiopathy was in thechronic dialysis.Postrenal renal injuries were mainly hemorrhagic cystitis(28.4%)and urinary tract infection(16%).After a largedose of rehydration,urine alkalization and anti-infection therapy,they were recovered in the short term with a good prognosis.Conclusions Urinary injury after HSCT is mainly divided into three categories:prerenal,renal and postrenal,in which renalinjury is prone to frequent recurrence.Key words:hematopoietic stem
作者
陈如月
唐韩云
陈青
冯雅君
沈芸妍
徐勤英
朱赟
朱雪明
李晓忠
CHEN Ruyue;TANG Hanyun;CHEN Qing;FENG Yajun;SHEN Yunyan;XU Qinying;ZHU Yun;ZHU Xueming;LI Xiaozhong(Department of Nephrology Rheumatology and Immunology,Children’s Hosptial of Soochow University,Suzhou 215000,Jiangsu,China)
出处
《临床儿科杂志》
CSCD
北大核心
2017年第5期345-349,共5页
Journal of Clinical Pediatrics
基金
国家自然科学基金资助项目(No.81370787)
江苏省临床医学科技专项(No.SBL2014030237)
关键词
造血干细胞移植
移植物抗宿主病
肾毒性药物
移植后血栓性微血管病
儿童
hematopoietic stem cell transplantation
graft-versus-host disease
nephrotoxic drugs
transplantassociated thrombotic microangiopathy
child
