臨牀透析 Vol.21 No.10(1)


特集名 小児腎不全 -- 発見から治療まで
題名 小児腎不全の疫学調査
発刊年月 2005年 09月
著者 服部 新三郎 熊本大学医学部保健学科
【 要旨 】 1998年から2003年までの6年間の15歳未満末期腎不全新規症例の調査結果について述べた.症例数は347例で,100万人当りの発生頻度は3例であり,性別頻度では男児が多い.原因疾患は嚢胞・遺伝性・先天性腎尿路疾患が最多である.2大原因疾患は異あるいは低形成腎と巣状分節性糸球体硬化症で,前者の増加と後者の減少の傾向がうかがえる.治療法では90%の症例で腹膜透析がなされているが,先行的腎移植が増加する傾向がとくに2002年からみられる.移植率は透析導入後5年で48.6%であり,生体腎移植が93%の症例になされている.生存率は透析導入後5年で87.7%で,死因は感染症と心循環系障害が多い.
Theme A Total Care of Renal Failure from the Onset in Children
Title Report on Japanese national registry data on pediatric end-stage renal disease patients
Author Shinzaburo Hattori Department of Human Science, School of Medicine, Kumamoto University
[ Summary ] We did a nation wide survey on patients under 15 years of age with pediatric chronic end-stage renal disease (ESRD) in Japan in the six years between 1998 and 2003. The number of patients newly introduced to renal replacement therapy was approximately 60 per year and the incidence rate over the six year period was 126 (36.3 %) at age 0 - 4 years, 61 (17.6 %) at age 5 - 9 years and 160 (46.1 %) at age 10 - 14 years. The annual incidence rate per million population was lowest in the 5 - 9 year group. Male patients had a higher incidence rate than females. The major diseases causing ESRD were renal hypoplasia / dysplasia and focal segmental glomerulosclerosis, with an increase in renal hypoplasia / dysplasia and a decrease in focal segmental glomerulosclerosis. Three patients died of uremia, 21 patients received preemptive renal transplants. Of the remaining 323 patients, 292 (90.4 %) received peritoneal dialysis and 31 (9.6 %) underwent hemodialysis. The renal transplant rate with the Kaplan-Meier method was 10.2 % one year after the replacement therapy for ERSD was initiated, and 48.6 % after five years. Living transplant patients accounted for 94 % of all transplants. The survival rates with the Kaplan-Meier method were 95.8 % one year after initiation of ERSD replacement therapy, and 87.7 % after five years. The major causes of death were cardiovascular diseases and infections.
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