References

nid

Нефрология и диализ

Nephrology and Dialysis

1680-44222618-9801

Российское диализное общество

10.28996/2618-9801-2020-1-53-70

nid-195

Research Article

ОБЗОРЫ И ЛЕКЦИИ

REVIEWS AND LECTURES

Хроническая болезнь почек у детей: определение, классификация и диагностика

Chronic kidney disease in children: definition, classification and diagnostics

Байко

С. В.

Baiko

S. V.

baiko@yandex.ru

1-я кафедра детских болезней Белорусского государственного медицинского университетаРоссия1st Department of Pediatrics, Belarusian State Medical UniversityRussian Federation

2020

26072024

2215370

2024

Байко С.В.

Baiko S.V.

Данная работа распространяется под лицензией Creative Commons Attribution 4.0.

This work is licensed under a Creative Commons Attribution 4.0 License.

https://journal.nephro.ru/jour/article/view/195

Хроническая болезнь почек (ХБП) занимает особое место среди хронических неинфекционных болезней, поскольку связана с ухудшением качества жизни, высокой смертностью, а в терминальной стадии с необходимостью применения дорогостоящих методов заместительной терапии - диализа и трансплантации почки. Поскольку изначально понятие ХБП разрабатывалось для взрослого населения и, несмотря на наличие четких рекомендации по определению, классификации, диагностике и лечению, остается много неразрешенных вопросов на всех этапах постановки диагноза ХБП у пациентов детского возраста. В статье описаны возрастные изменения скорости клубочковой фильтрации (СКФ) у детей. Подробно изложены преимущества и недостатки эндогенных и экзогенных маркеров СКФ. Особое внимание уделено современным методам измерения концентрации креатинина и цистатина С крови и их стандартизации. Детально изложены критерии определения и классификация ХБП, особенности ее использования у детей младше 2 лет жизни. Приводится характеристика основных причин ХБП в педиатрической практике. Представлены валидированные формулы расчета СКФ для пациентов детского возраста с ХБП: «прикроватная» формула Шварца (2009), формула Шварца-Лиона (2012), формулы CKiD на основе креатинина и креатинина-цистатина С, а также скрининговые уравнения расчета СКФ для популяции здоровых детей: простая, возраст-зависимая и рост-зависимая Q формулы, FM (метаданные Фландрии) формула с учетом возможных возрастных интервалов их применения, преимуществ и ограничений. Описывается последовательность использования расчетных формул для более точного определения СКФ и стадии ХБП у детей. Также в статье описаны возрастные изменения альбуминурии, градация на стадии патологической альбуминурии, оценка которой вносит свой вклад в прогнозирование прогрессирования и исхода ХБП, служит ориентиром в адекватности проводимой ренопротективной терапии. Представленные данные направлены на своевременное установление диагноза ХБП у детей, точное градирование по стадиям ХБП и альбуминурии.

Chronic kidney disease (CKD) occupies a special place among chronic non-infection diseases because it is associated with a deterioration in the quality of life, high mortality and in the terminal stage with the need to use expensive methods of replacement therapy - dialysis and kidney transplantation. The principle of determining CKD was developed for the adult population and, despite the presence of clear recommendations for definition, classification, diagnosis and treatment, there are many unresolved issues for all stages of CKD diagnosis in pediatric patients. The article describes age-related changes in glomerular filtration rate (GFR) in children. The advantages and disadvantages of endogenous and exogenous markers of GFR are detailed. Particular attention is paid to modern methods of measuring of the creatinine and cystatin C concentrations in blood and their standardization. The criteria for definition and classification of CKD, the features of its use in children under 2 years of age are described in detail. The characteristics of the CKD causes in pediatric practice are given. Validated formulas for calculating GFR for pediatric patients with CKD are presented: “bedside” Schwartz equation (2009), Schwartz-Lyon equation (2012), creatinine and creatinine-cystatin C based CKiD equations, as well as screening equations for calculating the GFR for a healthy child population: simple, age-dependent and growth-dependent Q equations, FM (Flanders Metadata) equation, taking into account possible age ranges of their use, advantages and limitations. The sequence of using formulas for a more accurate determination of GFR and the stage of CKD in children is given. The article also describes age-related changes in albuminuria, stages of pathological albuminuria, the assessment of which contributes to predicting the progression and outcome of CKD, serves as a guide to the adequacy of renoprotective therapy. The presented data are aimed to make CKD diagnosis in children on time and accurate grading of CKD and albuminuria stages.

хроническая болезнь почекдетиклассификациядиагностикаформулы расчета скорости клубочковой фильтрацииchronic kidney diseasechildrenclassificationdiagnosticsequations for calculating glomerular filtration rate

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The authors declare that there are no conflicts of interest present.