臨牀透析 Vol.34 No.9(10)


特集名 小児腎不全―移行期医療の管理
題名 新生児急性腎障害の現況と長期予後
発刊年月 2018年 08月
著者 澤田 真理子 倉敷中央病院小児科
【 要旨 】 2016年,急性腎障害(AKI)診療ガイドラインが出版され,新生児AKIの診断基準が明記された.すべての新生児にこのAKI診断基準を画一的に用いるにはいくつかの問題点はあるが,このガイドラインによって新生児AKIの定義が統一された.現在,この診断基準に基づいた新生児AKI の病態解明が急速に進んでいる.新生児AKIは未熟性に強く関連し,発症率は8~54%,原因は脱水,敗血症,新生児仮死,心疾患などである.新生児AKIは短期および長期の予後に関連し,思春期・若年成人期に高血圧・蛋白尿・慢性腎臓病(CKD)の発症リスクが高い.新生児AKIでは,急性期管理のみならず,長期フォローアップと適切なCKD管理が重要である.
Theme Pediatric end-stage kidney disease -- management of transition
Title Long-term outcomes of neonatal acute kidney injury
Author Mariko Sawada Department of Pediatrics, Kurashiki Central Hospital
[ Summary ] Practical guidelines about acute kidney injury (AKI) have been published and include the definition of neonatal AKI. Although there are concerns about this definition, these guidelines have standardized the definition of neonatal AKI for many subsequent reports on neonatal AKI. Neonatal AKI strongly correlates with prematurity, and its incidence is 8-54 %. The main causes are hypovolemia, sepsis, neonatal asphyxia, medicines, and cardiac surgery. Neonatal AKI leads to poor short-and long-term outcomes, including mortality and morbidity. Some papers have reported high rates of AKI survivors progressing to hypertension, proteinuria, and CKD. Mechanisms of the development of CKD due to neonatal AKI involve nephron loss, glomerular hyper-filtration, and glomerulosclerosis. Kidney function tests of neonates with AKI should be initiated early in management of CKD and followed over a long period of time.
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