先天性与获得性孤立肾患儿血压 及肾功能的差异分析

Evolution of blood pressure and renal function in children with congenital and acquired solitary kidneys

摘要:

目的 探讨先天性与获得性孤立肾患儿在后期血压及肾功能上的差异。方法 该文为回顾性研究， 按一定的纳入及排除标准，共选入55 例孤立肾患儿。其中先天性孤立肾37 例、获得性孤立肾18 例。记录孤 立肾患儿在确诊时（T0）的血压及肾功能，包括肾小球滤过率、24 h 尿蛋白定量及动态血压监测。并于确诊 后第14 年（T14）对患儿进行再次随访，并收集血压及肾功能数据。利用χ2 检验或Wilcoxon 检验比较不同 时期两组患儿在血压及肾功能上的变化差异。结果 T0 与T14 比较，两组在肾小球效过滤及尿蛋白定量差异无 统计学意义（P >0.05）。76.4%（42/55）的孤立肾患儿出现血压升高。其中获得性孤立肾患儿更易患高血压。 先天性孤立肾患儿则更易引起前期高血压。组间比较，获得性孤立肾患儿较先天性孤立肾患儿出现血压增高 的比例更高。结论 长期随访观察显示，孤立肾患儿肾功能无明显恶化趋势，可长期保持稳定。先天性孤立肾 患儿与获得性孤立肾患儿在肾功能上差异无统计学意义。在血压变化上，无论何种病因，孤立肾患儿均会出 现血压增高的趋势。获得性孤立肾患儿血压增高的风险较先天性孤立肾患儿高。此外，获得性孤立肾患儿中 血压增高的形式以高血压为主，而先天性孤立肾患儿中血压增高的形式以前期高血压为主。

Abstract:

Objective To assess blood pressure and renal function changes between the children with congenital and acquired solitary kidneys. Methods According to the criteria of inclusion and exclusion, 55 cases of children with isolated kidneys were selected for this retrospective study. Among them there were 37 cases of congenital solitary kidney and 18 cases of acquired solitary kidney. Blood pressure and renal function were recorded which included glomerular filtration rate, 24-h urinary protein and dynamic blood pressure monitoring. We used the medical records of children who had been assisted in our Unit of Pediatric Nephrology for a period of 14 years (168 months). χ2 test or Wilcoxon test was used to compare the changes of blood pressure and renal function between the two groups at different periods. Results In both groups glomerular filtration rate and urinary protein demonstrated no significant differences at T0 and T14 (P > 0.05). However, after 14 years of follow-up, 76.4% of the patients (42/55) had increased levels of blood pressure. Specifically, the children with an acquired solitary functioning kidney were more likely to develop hypertension, whereas the children with a congenital solitary functioning kidney mainly developed prehypertension. The proportion of the patients with high blood pressure was higher in the children with an acquired solitary kidney than in the children with a congenital solitary kidney. Conclusions The renal function of children with solitary functioning kidneys remains stable during a follow-up of 14 years. However, these children should be carefully monitored for their tendency to develop high arterial blood pressure. The children with an acquired solitary kidney have a higher risk of blood pressure increase than the children with a congenital solitary kidney. Furthermore, the children with an acquired solitary kidney are more likely to develop hypertension, whereas the children with a congenital solitary kidney mainly develop pre-hypertension.