Long-term outcome of acute tubular necrosis:: A contribution to its natural history
Long-term outcome of acute tubular necrosis:: A contribution to its natural history
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DOI：
10.1038/sj.ki.5002086
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发表时间：
2007-04-01
影响因子：
19.6
通讯作者：
Severiano, S.
中科院分区：
文献类型：
--
作者：
Liano, F.;Felipe, C.;Severiano, S.
由于急性肾功能衰竭（ARF）的长期结局研究很少且不均匀，我们研究了187例连续急性肾小管坏死（ATN）患者，这些患者既往无肾病，于10月77日至12月92日期间从我院出院并随访至12月99日（范围7-22年;中位数7.2）。在急性发作时和随访期间分析变量。2000-2001年，对82名仍然存活的患者中的58名进行了临床评价。10例患者失访，95例死亡。59%的死亡与ATN发生时的疾病有关。Kaplan-Meir生存曲线显示出院后1、5、10和15年分别为89、67、50和40%。最年轻的人、多发伤幸存者、没有合并症的人以及在重症监护室接受治疗的人的生存曲线明显更好（对数秩P < 0.001）。比例考克斯模型显示，年龄（风险比（HR）1.04/岁; P = 0.000）、存在共病因素（HR 4.29; P = 0.006）、手术入院（HR 0.45; P = 0.000）和男性（HR 1.72; P = 0.020）是与长期随访相关的变量。在评价的患者中，81%的肾功能正常。ARF后的长期预后取决于是否存在共病因素、初次入院原因和年龄。虽然晚期死亡率高，且与原发病有关，但大多数患者肾功能正常。
As long-term outcome studies of acute renal failure (ARF) are scarce and non-homogeneous, we studied 187 consecutive acute tubular necrosis (ATN) patients without previous nephropathies, discharged alive from our hospital between October 77 and December 92 and followed-up until December 99 (range 7-22 years; median 7.2). Variables were analyzed at the time of the acute episode and during follow-up. In 2000-2001 a clinical evaluation was made in 58 of the 82 patients still alive. Ten patients were lost to followup and 95 died. In 59% death was related with the disease present when the ATN developed. Kaplan-Meir survival curve showed 89, 67, 50, and 40% at 1, 5, 10, and 15 years, respectively, after discharge. Survival curves were significantly better (log-rank P < 0.001) among the youngest, those surviving a polytrauma, those without comorbidity and surprisingly those treated in intensive care units. The proportional Cox model showed that age (hazard ratio (HR) 1.04 per year of age; P = 0.000), presence of comorbid factors (HR 4.29; P = 0.006), surgical admission (HR 0.45; P = 0.000), and male sex (HR 1.72; P = 0.020) were the variables associated with long-term follow- up. In the evaluated patients renal function was normal in 81%. Long-term outcome after ARF depends on absence of co-morbid factors, cause of initial admission and age. Although the late mortality rate is high and related with the original disease, renal function is adequate in most patients.