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논문KCI 등재

소아 만성 신질환 진행의 위험인자 분석-단일기관 연구

Risk Factors for the Progression of Pediatric Chronic KidneyDisease-A Single Center Study

최현진|이현경|이성하|최용|이범희|조희연|정해일|하일수|한경희
대한소아신장학회 (The Korean Society Of Pediatric Nephrology)|2007.10|Childhood Kidney Diseases (Childhood Kidney diseases)|제11권 제2호|pp. 239-246

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참고문헌

주제분류소아과학

초록

목 적 : 소아에서 진행하는 신기능 저하는 그들의 인생에 일생 동안 심각한 영향을 준다. 소아 만성 신질환의 치료에 있어서 궁극적인 목표는 생명을 연장시키는 것뿐 아니라 만성 신질환에 이환됨으로써 발생하는 여러 합병증을 예방하고 성장과 발달을 향상시키는 것이다. 저자들은 소아 만성 신질환에서 신기능 감소와 관련된 위험요인을 분석하고자 하였다. 방 법 : 1999년 8월부터 2007년 3월까지 만성 신질환 2기에서 4기에 해당하는 환자들의 임상적 특성을 후향적으로 조사하였다. 추정 사구체여과율은 혈중 크레아티닌과 키를 이용하여 Schwartz공식으로 계산하였다. 연간 eGFR변화는 연구 시작 시의 eGFR과 마지막 추적 관찰 시의 eGFR 간의 차이를 추적 관찰 기간으로 나누어 계산하였다. 환자들을 추적 관찰 중에 측정한 혈청 칼슘과 무기인과 함께 연령과 성별 및 원인 신질환도 연간 eGFR 변화와의 관련성을 조사하였다. 결 과 : 전체 환자는 61명이었고 이중 남자는 44명, 여자는 17명이었다. 연구 시작 시 환자들의 연령은 7.1±4.7세이었다. 전체 환자들의 연간 eGFR 변화는 -1.2±11.9 mL/min/1.73m2/year이었다. 나이가 많거나(P=0.005), 저칼슘혈증이 있을 때(P=0.012), 고인산혈증인 경우(P=0.002) 신기능 감소와 유의한 관련이 있었다. 결 론 : 나이가 많거나, 저칼슘혈증과 고인산혈증은 소아 만성 신질환의 더 빠른 진행과 연관성이 있다.

Abstract

Purpose : The progressive deterioration of renal function in children can impose a serious and lifelong impact on their lives. The ultimate goal in the management of children with chronic kidney disease(CKD) is to prolong survival, to prevent complications, and to promote growth and neurodevelopment. The aim of this study is to investigate the risk factors for the decline of renal function in pediatric CKD patients. Methods : Data from patients who met the criteria for the Kidney Disease Outcomes Quality Initiative(K/DOQI) CKD stage 2 to 4 between August 1999 and March 2007 were retrospectively analyzed. The estimated glomerular filtration rate(eGFR) was calculated by the Schwartz formula, using serum creatinine levels and height. We calculated the annual eGFR change from the difference between the baseline eGFR and the last eGFR divided by the duration(years) of the follow-up period. We analyzed the association between the annual eGFR change and factors such as age, gender, K/DOQI stage, underlying renal disease, serum calcium, and inorganic phosphorous during the follow-up period. Results : Sixty one children(44 boys & 17 girls) were enrolled. The age at entry was 7.1±4.7 years. The annual eGFR change was -1.2±11.9 mL/min/1.73m2/year. Our study showed that older age(P=0.005), hypocalcemia(P=0.012), and hyperphosphatemia(P=0.002) were significantly related to more rapid decline in renal function. Conclusion : In pediatric CKD, older age, hypocalcemia and hyperphosphatemia are related to more rapid deterioration of renal function.

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