Influence of acute kidney injury on the time to complete remission in adult minimal change nephrotic syndrome: a single-centre study
Influence of acute kidney injury on the time to complete remission in adult minimal change nephrotic syndrome: a single-centre study
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DOI：
10.1111/nep.12678
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发表时间：
2016-10-01
期刊：
影响因子：
2.5
通讯作者：
Yoshimura, Ashio
中科院分区：
文献类型：
--
作者：
Komukai, Daisuke;Hasegawa, Takeshi;Yoshimura, Ashio
目的：急性肾损伤（AKI）是微小病变肾病综合征（MCNS）的常见并发症，特别是在成人中。我们评估了成人 MCNS 发病时 AKI 的患病率，并分析了 AKI 对达到完全缓解 (CR) 持续时间的影响。 方法：对经活检证实、接受皮质类固醇治疗的首次发病成人 MCNS 患者进行回顾性、单中心、动态队列研究。 2000 年 1 月至 2014 年 4 月连续诊断为 MCNS 的 53 名患者入组。测量年龄、性别、每日尿蛋白排泄量和血清肌酐水平。为了评估诱导期间的AKI，我们使用《肾脏病：改善全球结局（KDIGO）AKI临床实践指南》，根据开始皮质类固醇治疗的前4周内血清肌酐水平的波动判断AKI分期。结果：20例患者（37.7%）符合AKI标准，所有53例患者在1年内均达到CR。 Kaplan-Meier 分析显示，AKI 患者达到 CR 的中位时间明显长于无 AKI 患者。 Cox比例风险分析显示，在调整年龄、性别、血清白蛋白、每日尿蛋白排泄量、高血压、给予25%白蛋白和甲泼尼龙冲击治疗后，与AKI存在相关的4周内达到CR的风险比(HR)为0.36。还观察到 AKI 分期与达到 CR 的 HR 之间存在分级关联。结论：诱导治疗期间 MCNS 成年患者中 AKI 的患病率较高。 AKI 是延迟 CR 时间的独立因素。
Aim: Acute kidney injury (AKI) is a common complication of minimal change nephrotic syndrome (MCNS), particularly in adults. We evaluated the prevalence of AKI at the onset of adult MCNS and analyzed the influence of AKI on the duration of achieving complete remission (CR).Methods: A retrospective, single-centre, dynamic cohort study was conducted with biopsy-proven, first-onset, adult MCNS patients treated with corticosteroids. Fifty-three consecutive patients diagnosed with MCNS from January 2000 to April 2014 were enrolled. Age, gender, daily urinary protein excretion, and serum creatinine levels were measured. To evaluate AKI during induction, we used the Kidney Disease: Improving Global Outcomes (KDIGO) Clinical Practice Guidelines for AKI and judged AKI stage according to the fluctuations in serum creatinine levels during the first 4 weeks of starting corticosteroid therapy.Results: Twenty patients (37.7%) met the AKI criteria and all 53 patients achieved CR within 1 year. Kaplan-Meier analysis showed that the median time to CR was significantly longer in patients with AKI than in patients without AKI. Cox proportional hazard analysis showed that the hazard ratio (HR) associated with the presence of AKI for achieving CR within 4 weeks was 0.36 after adjustment for age, gender, serum albumin, daily urinary protein excretion, hypertension, administration of 25% albumin, and methylprednisolone pulse therapy. A graded association was also observed between AKI stage and HR for achieving CR.Conclusions: The prevalence of AKI is high in adult patients with MCNS during induction therapy. AKI is an independent factor that delays the time to CR.