臨牀透析 Vol.15 No.4(1-2)


特集名 小児期の腎不全対策
題名 小児期腎不全の原因疾患と対策 (2) 泌尿器科的腎疾患
発刊年月 1999年 04月
著者 川村 猛 東京都立清瀬小児病院泌尿器科
【 要旨 】 小児期腎不全をきたす原因疾患としての泌尿器科的疾患を当科経験症例について示すとともに文献的比較を行った.膀胱尿管逆流がもっとも多く,上部尿路閉塞,神経因性膀笳,後部尿道弁が多いが,前二者では腎異/低形成の関与が大きい.早期発見には胎児期より乳児期の超音波検査が重要であり,尿路感染症の確定診断の重要性,基礎疾患の早期探索の重要性,そして腎機能荒廃速度を指標とする筆者らの危険因子分析から1歳以下の早期治療の重要性が指摘された.腎不全になりやすい腎上部尿路所見を3群に分類して,その病態例ではとくに早期治療が重要であることを指摘した.
Theme Strategy for the Treatment of Chronic Renal Failure in Children
Title Causative disorders of pediatric renal failure and their management -- Significance of urological disorders
Author Takeshi Kawamura Department of Urology, Tokyo Metropolitan Children's Hospital, Kiyose
[ Summary ] We analyzed urological disorders, which caused pediatric renal failure, experienced at our institute. Leading abnormaities were reflux and obstructive uropathy which frequently associated with renal dysmorphism. We focused on the importance of ultrasonography for early detection in both perinatal and neonatal periods. Confirmation of UTI in febrile patients and detection of underlying disease was also emphasized. In our study of risk factors associated with rate of renal dysfunction, it was suggested that early (less than 1y/o) urological intervention was most effective in suppressing kidney deterioration rates. We classified urological disorders, categorizing renal failure in 3 types, according to findings seen in upper urinary tracts and/or kidney dysmorphism, and emphasized the special considerations given to these patients.
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