Chronic renal failure in children

[Summary] Chronic renal failure, referred to as chronic renal failure, is reduced due to disruption of the nephron, resulting in a series of disturbances in water and electrolyte, acid-base balance caused by serious impairment of renal excretion regulating function and endocrine and metabolic function Symptoms, signs and complications. The cause of chronic renal failure in children and the first detection of renal failure is closely related to the age of children. Chronic renal failure under 5 years of age is often the result of anatomical abnormalities, such as renal hypoplasia, renal dysplasia, urinary tract obstruction and other congenital malformations; after 5 years of chronic renal failure is later acquired glomerular diseases such as glomerulonephritis, Hemolytic uremic syndrome or hereditary diseases such as alport syndrome, renal cystic lesions.

  【Treatment】 Treatment of children with chronic tightness to be monitored in children with clinical (physical examination and blood pressure) and laboratory tests, including heme, electrolytes (hyponatremia, hyperkalemia, acidosis), blood urea nitrogen and creatinine determination, Calcium and phosphorus levels and alkaline phosphatase activity. Regularly check the level of parathyroid hormone and bone x-ray in order to detect early osteodystrophy. Chest radiography and echocardiography may help to understand cardiac function. Nutritional status can be regularly checked serum albumin, zinc, iron, iron and folic acid levels to monitor.

    1. Chronic renal failure diet When children with glomerular filtration of less than 50% of normal, the growth rate of children decreased, the main reason for the intake of calories. Although not aware of renal insufficiency, the appropriate amount of calories intake is, but as much as possible to calorie intake equal to or higher than the age group of children. Unrestricted carbohydrates can be used to increase calorie intake in the diet, such as sugar, jam, honey, glucose polymers, and fats, such as medium chain triglycerides, with the patient's tolerance. Patients with niacin above 30 mmol / l (80 mg / dl) may experience nausea, vomiting and anorexia, which may be alleviated by limiting protein intake. Because children still need a certain amount of protein in renal failure for growth, so the protein 1.5g / (kg · d), and should be given contain large amounts of essential amino acids, high-quality protein (eggs and lean meat) such as eggs, milk Followed by meat, fish, chicken and poultry. Milk phosphorus is too high, should not be multi-purpose, to be used glucose, peanut oil, a class of food to add calories. Due to inadequate intake or dialysis loss, children with renal insufficiency, there may be a lack of water-soluble vitamins, to be routinely added. If trace elements are iron, zinc and other lack of supply, fat-soluble vitamins such as a, e, k do not have to add.

    2. Treatment of water and electrolytes In children with renal insufficiency, it is rare to limit the amount of ingestion due to brain and "thirst center" regulation, unless the development of end-stage renal failure, dialysis should be used. The vast majority of children with renal insufficiency with the right diet to maintain normal sodium balance. Some patients with anatomical abnormalities occur when renal insufficiency, loss of large amounts of sodium from the urine, the diet should be supplemented by sodium; conversely patients with hypertension, edema or congestive heart failure to be limited sodium, and sometimes combined furosemide, 1 ~ 4mg / (kg · 24h). Such as further deterioration of renal function, to be done dialysis treatment. Hyperkalemia may be the first to try to control the dietary intake of potassium plus oral alkaline or potassium-lowering resin (sodium polystyrene sulfonate, kayexalate) treatment. Almost all children with renal insufficiency, acidosis, generally do not need to deal with, unless serum bicarbonate is less than 20mmol / l, you must use sodium bicarbonate to be corrected.

    3. Renal osteodystrophy When there is hyperphosphatemia, hypocalcemia, increased levels of parathyroid endocrine and serum alkaline phosphatase activity, often complicated by renal osteodystrophy. When the glomerular filtration rate is generally below 30% of the normal, the serum phosphorus levels rise. Serum calcium decreased, secondary hyperparathyroidism. Hypophosphatemia can be low phosphorus diet, calcium bicarbonate or antacids can also be used orally to promote phosphorus from the intestine. Children also need to pay attention to the problem of aluminum poisoning, to be regularly monitored serum aluminum levels. Serious renal insufficiency and vitamin d (vit.d) lack of vit.d for sustained hypocalcemia, x-ray showed rickets and serum alkaline phosphatase activity increased.

    4. Anemia Most patients with hemoglobin stable at 60 ~ 90g / l (6 ~ 9g / dl), without blood transfusions, such as hemoglobin less than 60g / l then carefully enter red blood cells 10ml / kg (small amount can reduce the risk of blood circulation overload. ).

    5. Hypertension Hypertension may be sublingual nifedipine or intravenous diazoxide that is suboptimal (5mg / kg, the maximum amount of 300mg, within 10 seconds). Hyperuricemia (2 ~ 4mg / kg, speed 4mg / min) may be given to patients with severe hypertension complicated with blood circulation overload. Renal insufficiency, be careful to use sodium nitroprusside, because there may be accumulation of thiocyanate. In short, should strive for early diagnosis, removal of the cause, if found too late, although the removal of the cause of kidney damage has been difficult to recover. If the cause of urinary tract obstruction, surgical treatment should be done accordingly, but often in children with renal dysfunction, can not tolerate too much surgery, can be done first renal fistula or suprapubic cystostomy to facilitate drainage. If persistent or intermittent pyuria, should actively control the infection, and follow-up review. In patients with end-stage renal disease or refractory renal failure, chronic hemodialysis (artificial kidney, also known as long-term intermittent hemodialysis) has been used in recent years to enable many patients to survive or resume normal life. The current long-term regular dialysis, dialysis is generally 2 to 3 times per week, dialysis during sleep at night. In children receiving chronic hemodialysis treatment, the development of secondary sexual characteristics, weight gain, etc. had no significant effect, only slightly affected height. In recent years, the implementation of foreign chronic hemodialysis has been transferred from the hospital to the patient's family, in children with dialysis for up to 4 to 5 years. Peritoneal dialysis has also been used for chronic renal failure, mainly in the peritoneal long-term fixed catheter, daily dialysis on time, in the family can follow the doctor's advice. End-stage renal failure in children with the ultimate goal of renal transplantation. The success rate of pediatric kidney transplantation in children over 5 years old abroad is the same as that of adults. Before the kidney transplantation (in order to prolong the life of the child to wait for the appropriate donor kidney) or kidney transplantation, the rejection phenomenon depends on the effective chronic Hemodialysis.

  [Clinical manifestations] In patients with renal insufficiency, often diagnosed with kidney disease such as glomerular or hereditary lesions. It may progressively develop to renal failure. Although the patient has anatomical abnormalities, his performance may be nonspecific such as headache, tiredness, drowsiness, anorexia, vomiting, polydipsia, polyuria, and growth retardation. Physical examinations can be seen even significant abnormalities, but the vast majority of patients with renal failure showed pale, weakness and high blood pressure and may have growth retardation and rickets.

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