Assessment of KDIGO Definitions in Patients with Histopathologic Evidence of Acute Renal Disease
Assessment of KDIGO Definitions in Patients with Histopathologic Evidence of Acute Renal Disease
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DOI：
10.2215/cjn.06150613
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发表时间：
2014-07-07
影响因子：
9.8
通讯作者：
Yang, Li
中科院分区：
文献类型：
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作者：
Chu, Rong;Li, Cui;Yang, Li
背景和目的AKI是一种临床综合征，其病因多样，累及肾小球、间质、肾小管和肾血管。急性肾脏病(AKD)是一个新的概念，它既包括AKI，也包括与亚急性肾功能减退相关的疾病(AKD/非AKI)。本研究旨在探讨急性肾小管坏死(AKI/AKD)的临床表现与肾活检弥漫性组织学标准的相关性。研究对象为2009年1月至2011年12月经肾活检确诊为急性肾小管坏死(ATN)、急性肾小管间质性肾炎、细胞性新月体肾炎、急性血栓性微血管病变或复杂病变的303例患者。结果273例(90.1%)患者符合AKD标准，198例(65.3%)患者按血肌酐(Scr)和尿量标准分类为AKI。尿量标准使SCR标准增加了4.3%，并将6.7%的AKI病例重新分类为更高的阶段。在病理诊断为ATN的患者中，79.2%的患者符合AKI标准；这一比例高于那些有其他个别病理损害的患者(50%-%)。未被定义为AKI的主要原因是Scr增加慢于AKI定义所要求的SCR(98，93.3%)。与非AKI组相比，AKI组患者的临床症状更重，近期肾脏转归更差。结论肾活检定义的弥漫性急性异常与临床表现定义的AKI是两个不同的实体。大多数有弥漫性急性组织学发现的患者符合AKD的标准，而只有三分之二的患者符合AKI的定义。
Background and objectives AKI is a clinical syndrome with various causes involving glomerular, interstitial, tubular, and vascular compartments of the kidney. Acute kidney disease (AKD) is a new concept that includes both AKI and the conditions associated with subacute decreases in GFR (AKD/non-AKI). This study aimed to investigate the correlation between AKI/AKD defined by clinical presentation and diffuse histologic criteria for acute abnormalities based on renal biopsy.Design, setting, participants, & measurements All 303 patients who were histologically diagnosed as having acute tubular necrosis (ATN), acute tubulointerstitial nephritis, cellular crescentic GN, acute thrombotic microangiopathy, or complex lesions on renal biopsy from January 2009 to December 2011 were enrolled in the study. The 2012 Kidney Disease Improving Global Outcomes AKD/AKI definitions were applied to classify patients as follows: AKI, AKD/non-AKI non-AKD, or unclassified.Results A total of 273 patients (90.1%) met the AKD criteria; 198 patients (65.3%) were classified as having AKI according to serum creatinine (SCr) and urine output criteria. The urine output criteria added 4.3% to the SCr criteria and reclassified 6.7% of the AKI cases into higher stages. Of patients with ATN on pathology, 79.2% met AKI criteria; this was a higher percentage than for those who had other individual pathologic lesions (50%-64%). The major cause of not being defined as having AKI was a slower SCr increase than that required by the definition of AKI (98, 93.3%). Patients with AKI had more severe clinical conditions and worse short-term renal outcome than those in the non-AKI group.Conclusions Diffuse, acute abnormality defined by renal biopsy and AKI defined by clinical presentation are two different entities. Most patients who have diffuse acute histologic findings met the criteria for AKD, whereas only two thirds met the definition of AKI.