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首页> 外文期刊>Journal of pediatric urology >A case control analysis investigating risk factors and outcomes for nephrocalcinosis and renal calculi in neonates
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A case control analysis investigating risk factors and outcomes for nephrocalcinosis and renal calculi in neonates

机译：案例控制分析研究新生儿肾癌和肾结石的危险因素和结果

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Summary Introduction Studies on outcomes and risk factors for neonatal nephrocalcinosis (NC) and renal calculi (RC) are limited, and often do not include controls for comparison. We conducted a case-control analysis to identify risk factors associated with NC and/or RC in neonates and studied the natural course of these anomalies. Study design Infants diagnosed with NC/RC on ultrasound within the first year of life and corresponding gestational age- and gender-matched controls were identified from the neonatal intensive care unit database at our institution over a 10-year period. Risk factors assessed included: low birth weight, small for gestational age, nephrotoxic drugs, respiratory support therapy, use of total parental nutrition (TPN), surgeries, history of UTIs, creatinine at presentation, and history of maternal hypertension. Unadjusted odds ratios were estimated. Chi square analysis was performed for binary variables and the Mann–Whitney U test for continuous variables. Outcomes examined include time to resolution of NC/RC, renal function, and hypertension. Results We identified 22 cases of NC/RC with corresponding matched controls. Median follow-up was 28 months (IQR 0–122 months). History of urinary tract infections (UTI) was the only variable significantly associated with the presence of NC/RC (OR 5.62, 95% CI 1.12–31.1, p ? Table ). All other known risk factors were comparable in both groups. There was no difference in the incidence of hypertension (OR 2.94, 95% CI 0.40–33.82, p ?=?0.216) at diagnosis or last follow-up between the groups. Resolution of NC/RC was observed in 72.7%, during a median follow-up of 12.1 months. Mean urinary calcium/creatinine ratio for the NC/RC group was 2.3?±?1.5 at diagnosis and 0.96?±?0.8 at last follow-up. Discussion Most NC/RC in infants resolve without surgical intervention but some infants require medical therapy and follow-up. Risk factors for NC/RC in neonates continue to be poorly defined because of the quality of studies available. Our study provides further adjustment for confounders but has a small sample size and is restricted to neonates from an intensive care unit. Conclusion Most cases of NC/RC resolve spontaneously without surgical intervention. The mean time to resolution is 12.1 months, without untoward consequences in terms of hypertension. A history of UTIs is the only identified risk factor identified in this study which is associated with a significant increased risk of neonatal nephrocalcinosis and/or renal calculi. Larger prospective studies are warranted to confirm these findings. Summary Table Selected risk factors for NC/RC. Summary Table Controls ( n ?=?22) Cases ( n ?=?22) OR (95% CI) p -Value Ventilator support, days, median (IQR) 2 (0–38) 2.5 (0–28) – 0.883 Nephrotoxic drug exposure 15 (68.1) 16 (72.7) 1.24 (0.28–5.61) 0.741 Small for gestational age 8 (36.3) 6 (27.2) 0.65 (0.14–2.81) 0.517 Previous urinary tract infection 4 (18.1) 10 (45.4) 5.62 (1.12–31.1) 0.013 Chi-square test for binary variables. Mann–Whitney U test for continuous variables.
机译：发明内容介绍新生儿肾细胞（NC）和肾结石（RC）的结果和危险因素的研究有限，并且通常不包括对比进行对照。我们进行了案例控制分析，以识别新生儿中与NC和/或RC相关的危险因素，并研究了这些异常的自然过程。研究设计婴儿在寿命的第一年和相应的妊娠年龄和性别匹配的对照中诊断出在超声中进行超声波，并在10年期间从新生儿重症监护室数据库中确定了新生儿重症监护室数据库。评估的风险因素包括：出生体重低，胎龄小，肾毒性药物，呼吸道支持治疗，使用总父母营养（TPN），utis，utis历史，呈现术历史，呈现出培养的历史，母体高血压病史以及母体高血压的历史。估计未经调整的差距比率。对二元变量和曼诺惠特尼进行连续变量进行CHI方分析。检查的结果包括分辨NC / RC，肾功能和高血压的时间。结果我们确定了22例NC / RC，相应的匹配对照。中位后续时间为28个月（IQR 0-122个月）。泌尿道感染史（UTI）是唯一与NC / RC的存在显着相关的变量（或5.62,95％CI 1.12-31.1，P？表）。所有其他已知的风险因素在这两组中都是可比的。高血压发生率（或2.94,95％CI 0.40-33.82，p？= 0.216）在组之间的最后一次随访中没有差异。在12.1个月的中位随访期间，在72.7％中观察到NC / RC的分辨率。 NC / RC组的平均尿钙/肌酐比率为2.3？±1.5，在最后一次随访时为0.96？±0.8。讨论婴儿的大多数NC / RC在没有手术干预的情况下解决，但有些婴儿需要医疗治疗和随访。由于有可用的研究质量，NC / RC的危险因素继续定义不足。我们的研究提供了对混凝器的进一步调整，但具有小的样本尺寸，仅限于精密护理单位的新生儿。结论大多数NC / RC病例自发地解决，没有手术干预。分辨率的平均时间是12.1个月，在高血压方面没有不足的后果。 UTI的历史是该研究中唯一确定的危险因素，其与新生儿肾癌和/或肾结石的显着增加有关。需要更大的前瞻性研究来确认这些调查结果。摘要表选择NC / RC的风险因素。摘要表控制（n？=？22）案例（n？=Δ22）或（95％ci）p-value呼吸机支持，天，中值（IQR）2（0-38）2.5（0-28） - 0.883肾毒性药物暴露15（68.1）16（72.7）1.24（0.28-5.61）0.741，用于妊娠期8（36.3）6（27.2）0.65（0.14-2.81）0.517先前的尿路感染4（18.1）10（45.4）5.62 （1.12-31.1）对二进制变量的0.013 Chi-Square测试。 Mann-Whitney U测试连续变量。

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