ПРИЧИНЫ И ТЕЧЕНИЕ ХРОНИЧЕСКОЙ БОЛЕЗНИ ПОЧЕКУ ДЕТЕЙ ДОШКОЛЬНОГО ВОЗРАСТА

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Альманах клинической медицины. 2015; : 58-65

ПРИЧИНЫ И ТЕЧЕНИЕ ХРОНИЧЕСКОЙ БОЛЕЗНИ ПОЧЕКУ ДЕТЕЙ ДОШКОЛЬНОГО ВОЗРАСТА

Абасеева Т. Ю., Панкратенко Т. Е., Буров А. А., Эмирова Х. М., Музуров А. Л.

https://doi.org/10.18786/2072-0505-2015-42-58-65

Аннотация

Актуальность. Данные о причинах и клиническом течении хронической болезни почек (ХБП) III–V стадий у детей дошкольного возраста могут помочь акушерам, педиатрам, нефрологам в диагностике и лечении этого состояния, определении прогноза. Цель – изучить причины и особенности клинического течения ХБП III–V стадий у детей дошкольного возраста. Материал и методы. Причины и клинические особенности ХБП III–V стадий исследованы у 55 детей дошкольного возраста (от 7 месяцев до 8 лет). Из них у 24 была диагностирована ХБП III–IV стадий, 31 ребенок с терминальной стадией ХБП находился на перитонеальном диализе. Результаты. 96% случаев ХБП III–V стадий у детей дошкольного возраста были обусловлены врожденной/генетической патологией почек. Предикторами начала заместительной почечной терапии до 5 лет являлись антенатальное выявление врожденных аномалий развития мочевой системы, олигогидрамнион, повышенная азотемия в период новорожденности. Распространенность анемии, гиперпаратиреоза, гиперфосфатемии, артериальной гипертонии была выше у детей на диализной стадии ХБП, у 26% этих пациентов выявлена гипертрофия миокарда и/или дилатация левого желудочка. У 42% детей диагностирована задержка роста, у 40% – задержка психоречевого развития. Заключение. Течение ХБП у дошкольников характеризуется сочетанием определенных метаболических расстройств с задержкой роста (часто выраженной) и психического развития, что существенно ограничивает возможности социальной адаптации больных детей и социальную активность их родителей. В ведении пациентов раннего возраста с ХБП III–V стадий желательно участие не только врачей-педиатров и нефрологов, но и психоневрологов, клинических психологов, педагогов.

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Almanac of Clinical Medicine. 2015; : 58-65

THE CAUSES AND THE COURSE OF CHRONIC KIDNEY DISEASE IN CHILDREN OF PRESCHOOL AGE

Abaseeva T. Yu., Pankratenko T. E., Burov A. A., Emirova Kh. M., Muzurov A. L.

https://doi.org/10.18786/2072-0505-2015-42-58-65

Abstract

Background: Data on etiology and clinical course of CKD stage 3 to 5 in children of preschool age could help obstetricians, pediatricians, and nephrologists with proper diagnostics and management of this condition and prediction of outcomes. Aim: To study causes and clinical features of CKD stage 3 to 5 in preschool children. Materials and methods: The causes and clinical features of CKD stage 3 to 5 were investigated in 55 preschool children aged from 7 months to 8 years. Twenty four had CKD stage 3 to 4 and 31 children with endstage CKD were on peritoneal dialysis. Results:96% of CKD stage 3 to 5 in preschool children were due to congenital/genetic kidney abnormalities. Predictors of renal replacement therapy beginning in the first 5 years of life were as follows: antenatal detection of congenital abnormalities of the kidney and urinary tract, oligohydroamnion, high neonatal BUN levels. Anemia, hyperparathyroidism, arterial hypertension were more prevalent in children on the dialysis stage of CKD, and myocardial hypertrophy and/or of the left ventricle dilatation were found in 26% of them. Forty two percent of children had growth retardation, and 40% had delayed speech development. Conclusion: The course CKD in preschool children is characterized by a combination of typical metabolic disorders with the growth retardation (often dramatic) and delayed mental development that significantly limits the possibilities of the social adaptation of these children and social activities of their parents. Participation of neuropsychiatrists, clinical psychologists, and teachers, rather than pediatricians and nephrologists only, is desirable in management of preschool children with CKD stage 3 to 5.

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