【摘要】：目的探討兒童造血干細(xì)胞移植后泌尿系損傷的病因、病理以及治療和預(yù)后。方法回顧分析81例行造血干細(xì)胞移植患兒的臨床資料,并復(fù)習(xí)相關(guān)文獻(xiàn)。結(jié)果在81例患兒中,男50例、女31例,年齡8個(gè)月~17歲。腎前性損傷30例(37%),予積極補(bǔ)液等對(duì)癥治療后即恢復(fù)。腎性損傷9例(11.1%),其中4例放棄或轉(zhuǎn)院,預(yù)后不詳;其余5例行腎活檢明確病理,經(jīng)積極對(duì)癥、對(duì)因治療后,4例肌酐以及腎小球?yàn)V過率均恢復(fù)正常,但在長(zhǎng)期隨訪中,1例因原發(fā)疾病復(fù)發(fā)、干細(xì)胞再輸注合并腎衰竭死亡,其余3例進(jìn)入慢性腎臟病;1例合并腎臟血栓性微血管病進(jìn)入慢性透析。腎后性損傷包括出血性膀胱炎23例(28.4%)和泌尿道感染13例(16.0%),予大量補(bǔ)液、堿化尿液以及抗感染等治療后,短期內(nèi)多恢復(fù),預(yù)后良好。結(jié)論造血干細(xì)胞移植后泌尿系損傷分為腎前性、腎性及腎后性,其中腎性損傷多復(fù)發(fā)。
[Abstract]:Objective to investigate the etiology, pathology, treatment and prognosis of urinary system injury after hematopoietic stem cell transplantation in children. Methods the clinical data of 81 children with hematopoietic stem cell transplantation were retrospectively analyzed and the related literatures were reviewed. Results there were 50 males and 31 females aged from 8 months to 17 years. Thirty cases (37%) of prerenal injury recovered after active fluid replacement therapy. Renal injury occurred in 9 cases (11.1%), of which 4 cases were abandoned or transferred to hospital, and the prognosis was unknown. Renal biopsy was confirmed in the remaining 5 cases. After active treatment, the creatinine and glomerular filtration rate returned to normal in 4 cases. But during the long term follow-up, one patient died of renal failure after primary disease recurrence, the other 3 patients with chronic renal disease and one patient with renal thrombotic microangiopathy, and one patient with renal thrombotic microangiopathy entered chronic dialysis. There were 23 cases of hemorrhagic cystitis (28.4%) and 13 cases of urinary tract infection (16.0%). Conclusion urinary system injury after hematopoietic stem cell transplantation can be divided into prerenal, renal and postrenal, among which renal injury recurs frequently.
【作者單位】： 蘇州大學(xué)附屬兒童醫(yī)院腎臟風(fēng)濕免疫科;
【基金】：國(guó)家自然科學(xué)基金資助項(xiàng)目(No.81370787) 江蘇省臨床醫(yī)學(xué)科技專項(xiàng)(No.SBL2014030237)
【分類號(hào)】：R726.9

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