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首页> 外文期刊>Blood purification >Acute Kidney Injury and Special Considerations during Renal Replacement Therapy in Children with Coronavirus Disease-19: Perspective from the Critical Care Nephrology Section of the European Society of Paediatric and Neonatal Intensive Care
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Acute Kidney Injury and Special Considerations during Renal Replacement Therapy in Children with Coronavirus Disease-19: Perspective from the Critical Care Nephrology Section of the European Society of Paediatric and Neonatal Intensive Care

机译：急性肾脏损伤和冠状病毒疾病儿童肾脏替代治疗期间的特殊考虑因素 - 19：欧洲小儿科和新生儿重症监护社会关键护理肾病的透视

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Children seem to be less severely affected by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) as compared to adults. Little is known about the prevalence and pathogenesis of acute kidney injury (AKI) in children affected by SARS-CoV-2. Dehydration seems to be the most common trigger factor, and meticulous attention to fluid status is imperative. The principles of initiation, prescription, and complications related to renal replacement therapy are the same for coronavirus disease (COVID) patients as for non-COVID patients. Continuous renal replacement therapy (CRRT) remains the most common modality of treatment. When to initiate and what modality to use are dependent on the available resources. Though children are less often and less severely affected, diversion of all hospital resources to manage the adult surge might lead to limited CRRT resources. We describe how these shortages might be mitigated. Where machines are limited, one CRRT machine can be used for multiple patients, providing a limited number of hours of CRRT per day. In this case, increased exchange rates can be used to compensate for the decreased duration of CRRT. If consumables are limited, lower doses of CRRT (15-20 mL/kg/h) for 24 h may be feasible. Hypercoagulability leading to frequent filter clotting is an important issue in these children. Increased doses of unfractionated heparin, combination of heparin and regional citrate anticoagulation, or combination of prostacyclin and heparin might be used. If infusion pumps to deliver anticoagulants are limited, the administration of low-molecular-weight heparin might be considered. Alternatively in children, acute peritoneal dialysis can successfully control both fluid and metabolic disturbances. Intermittent hemodialysis can also be used in patients who are hemodynamically stable. The keys to successfully managing pediatric AKI in a pandemic are flexible use of resources, good understanding of dialysis techniques, and teamwork.
机译：与成年人相比，儿童似乎受到严重急性呼吸综合征冠状病毒-2（SARS-COV-2）的严重影响。关于受SARS-COV-2影响的儿童急性肾损伤（AKI）的患病率和发病机制很少。脱水似乎是最常见的触发因子，细致的流体状态的关注是必要的。与非Covid患者的冠状病毒疾病（Covid）患者有关的起始，处方和并发症的原则是相同的非Covid患者。连续肾脏替代疗法（CRRT）仍然是最常见的治疗方式。何时启动以及要使用的模态取决于可用资源。虽然儿童往往不那么严重，但受到严重影响，但所有医院资源转移到管理成人浪涌可能会导致CRRT资源有限。我们描述了如何减少这些短缺。当机器有限时，一个CRRT机器可用于多个患者，每天提供有限的CRRT小时。在这种情况下，可以使用增加的汇率来补偿CRRT的持续时间下降。如果消耗品有限，则24小时的较低剂量的CRRT（15-20ml / kg / h）可能是可行的。导致频繁过滤凝固的高焦化是这些儿童的重要问题。增加了不可用的肝素的剂量，肝素和区域柠檬酸盐抗凝的组合或可能使用前列腺素和肝素的组合。如果输注泵提供抗凝血剂是有限的，则可能考虑低分子量肝素的给药。或者，在儿童中，急性腹膜透析可以成功地控制液体和代谢干扰。间歇性血液透析也可用于血流动力学稳定的患者。在大流行中成功管理儿科AKI的钥匙是灵活地利用资源，对透析技术的良好了解和团队合作。

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