Clinical features of acute kidney injury in patients with nephrotic syndrome and minimal change disease: a retrospective, cross-sectional study.
Clinical features of acute kidney injury in patients with nephrotic syndrome and minimal change disease: a retrospective, cross-sectional study.
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肾病综合征和微小病变患者急性肾损伤的临床特征：一项回顾性横断面研究。
DOI：
10.1097/cm9.0000000000001218
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发表时间：
2020-11-04
影响因子：
6.1
通讯作者：
Cai GY
中科院分区：
文献类型：
--
作者：
Lin SP;Zhu FG;Meng JL;Sun XW;Cui J;Liang S;Yin Z;Sun XF;Cai GY
微小病变型肾病(MCD)是肾病综合征的一种常见病理类型，常合并急性肾损伤(AKI)。本研究旨在探讨MCD合并肾病综合征患者AKI的临床特点及相关因素。纳入中国人解放军总医院2013年1月1日至2017年12月31日收治的以肾病综合征为临床表现的病理性肾脏微血管病患者。2013年1月1日至2017年12月31日经肾活检确诊为膜性肾病(MN)的患者作为对照人群。回顾分析不同年龄段AKI患者的临床病理特点以及AKI所占比例和临床特点。我们用多元线性回归分析来评估病理特征与血肌酐的相关性。共有367名MCD患者进入分析，性别比为1.46：1(男性：女性)，年龄范围为6至77岁。在所有患者中，109例(29.7%)发生AKI，其中85例为男性(78.0%)。在586例MN患者中，27例(4.6%)发生AKI。MCD组AKI百分率显著高于MN组(χ2 = 41.063，P <； 0.001)。MCD患者AKI百分率随年龄增长而增加。50岁以上患者急性心肌梗死的发生率为52.9%(46/87)，明显高于50岁以下患者的22.5%(63/280)(χ2 = 6.347，P = 0.013)。我们观察到在年龄(43[27，59]岁vs 28[20，44]岁，Z = 5.487，P <； 0.001)、男性(78.0%vs 51.4%，χ2 = 22.470，P <； 0.001)，血清白蛋白(19.9 ± 6.1 g/L vs.21.5 ± 5.7 g/L，t = 2.376，P = 0.018)，血肌酐(129.5[105.7,171.1]μ摩尔/L vs.69.7[57.7，81.9]μ摩尔/L，Z = 14.190，P <； 0.001)、血清尿素(10.1[6.2，15.8]mmol/L vs.4.7[3.6，6.4]mmoL/L，Z = 10.545，P <； 0.001)、IgE(266.0[86.7,963.0]IU/ml比142.0[35.3,516.5]IU/ml，Z = 2.742，P = 0.007)、糖尿病病史(6.4%比1.2%，P = 0.009)、高血压病史(23.9%比5.1%，χ2 = 28.238，P <； 0.001)。多元线性回归分析显示，肾小管上皮细胞损伤(β=178.010，95%CI：147.888−208.132，P <； 0.001)和肾间质水肿(β=28.833，95%CI：11.966−45.700，P = 0.001)与血肌酸值相关。MCD患者AKI百分率明显高于MN患者。50岁以上的患者更有可能发展为AKI。肾小管上皮细胞损伤和肾间质水肿可能是MCD患者血肌酐升高的主要病理损害。
Minimal change nephropathy (MCD) is a common pathological type of nephrotic syndrome and is often associated with acute kidney injury (AKI). This study aimed to investigate the clinical characteristics and related factors of AKI in patients with MCD and nephrotic syndrome. Patients from Chinese People's Liberation Army General Hospital who were diagnosed with pathological renal MCD with clinical manifestations of nephrotic syndrome were included from January 1, 2013 to December 31, 2017. Patients diagnosed with membranous nephropathy (MN) by renal biopsy from January 1, 2013 to December 31, 2017 are included as a control population. We retrospectively analyzed the clinical and pathological characteristics of patients as well as the percentages and clinical characteristics of AKI in different age groups. We assessed the correlation of pathological characteristics with serum creatinine using multivariate linear regression analysis. A total of 367 patients with MCD were included in the analysis, with a sex ratio of 1.46: 1 (male: female) and an age range of 6 to 77 years. Among all the patients, 109 developed AKI (29.7%), and of these patients, 85 were male (78.0%). In the 586 patients with MN, 27 (4.6%) patients developed AKI. The percentage of AKI in MCD patients was significantly higher than that in MN patients (χ2 = 41.063, P < 0.001). The percentage of AKI increased with age in the MCD patients. The percentage of AKI in patients aged 50 years or older was 52.9% (46/87), which was significantly higher than that [22.5% (63/280)] in patients under 50 years (χ2 = 6.347, P = 0.013). We observed statistically significant differences in age (43 [27, 59] years vs. 28 [20, 44] years, Z = 5.487, P < 0.001), male (78.0% vs. 51.4%, χ2 = 22.470, P < 0.001), serum albumin (19.9 ± 6.1 g/L vs. 21.5 ± 5.7 g/L, t = 2.376, P = 0.018), serum creatinine (129.5 [105.7, 171.1] μmol/L vs. 69.7 [57.7, 81.9] μmol/L, Z = 14.190, P < 0.001), serum urea (10.1 [6.2, 15.8] mmol/L vs. 4.7 [3.6, 6.4] mmol/L, Z = 10.545, P < 0.001), IgE (266.0 [86.7, 963.0] IU/ml vs. 142.0 [35.3, 516.5] IU/ml, Z = 2.742, P = 0.007), history of diabetes (6.4% vs. 1.2%, P = 0.009), and history of hypertension (23.9% vs. 5.1%, χ2 = 28.238, P < 0.001) between the AKI group and the non-AKI group. According to multivariate linear regression analysis, among the renal pathological features analyzed, renal tubular epithelial cell damage (β = 178.010, 95% CI: 147.888−208.132, P < 0.001) and renal interstitial edema (β = 28.833, 95% CI: 11.966−45.700, P = 0.001) correlated with serum creatinine values. The percentage of AKI in MCD patients is significantly higher than that in MN patients. Patients over 50 years old are more likely to develop AKI. Renal tubular epithelial cell injury and renal interstitial edema may be the main pathological lesions that are associated with elevated serum creatinine in patients with MCD.