Acute kidney injury in idiopathic membranous nephropathy with nephrotic syndrome.
Acute kidney injury in idiopathic membranous nephropathy with nephrotic syndrome.
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DOI：
10.1080/0886022x.2021.1942913
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发表时间：
2021-12
期刊：
影响因子：
3
通讯作者：
Pan J
中科院分区：
文献类型：
--
作者：
Chen T;Zhou Y;Chen X;Chen B;Pan J
急性肾损伤（AKI）对特发性膜性肾病（iMN）合并肾病综合征（NS）患者肾功能进展的影响尚未有报道，我们试图调查iMN合并NS患者AKI的发生率、临床特征和预后，并确定从AKI进展到晚期慢性肾脏病（CKD）阶段的临床预测因素。我们回顾性分析了2012年1月至2018年12月期间收集的iMN与NS患者的临床和病理数据。主要肾脏终点定义为持续eGFR<45ml/min/1.73m2超过3个月。通过 Kaplan-Meier 曲线和对数秩检验进行无主要肾脏终点的生存比较。构建单变量和多变量 Cox 比例风险模型以确定与主要肾脏终点相关的自变量。 434 名患有 NS 的 iMN 患者入组。 AKI 1期、AKI 2期和AKI 3期的发生率分别为23.1%、4.8%和0.7%。 66 名（53.2%）AKI 患者肾功能完全恢复，42 名（33.9%）AKI 患者达到主要肾脏终点。 AKI 患者无主要肾脏终点的生存率比无 AKI 患者差（2 年和 4 年时分别为 67.1±5.3 和 43.7±7.3% vs 99.5±0.5 和 92.5±4.2%，p<0.001）。 AKI 与主要肾脏终点独立相关，调整后的风险比 (HR) 为 25.1 (95% CI 7.7–82.1，p<0.001)。在患有 NS 的 iMN 患者中，AKI 通常较轻且容易被忽视，但它与不良临床结果密切相关，并且是 CKD 进展的独立危险因素。
The impact of acute kidney injury (AKI) on the progression of renal function in idiopathic membranous nephropathy (iMN) with nephrotic syndrome (NS) patients have not yet been reported, we sought to investigate the incidence, clinical features and prognosis of AKI in iMN with NS patients and determine clinical predictors for progression from AKI to advanced chronic kidney disease (CKD) stage. We analyzed clinical and pathological data of iMN with NS patients retrospectively collected from Jan 2012 to Dec 2018. The primary renal endpoint was defined as persistent eGFR <45ml/min per 1.73 m2 more than 3 months. Comparisons of survival without primary renal endpoint were performed by Kaplan-Meier curves and log-rank test. Univariate and multivariate Cox proportional hazard models were constructed to determine independent variables associated with primary renal endpoint . 434 iMN with NS patients were enrolled. The incidence of AKI 1 stage, AKI 2 stage and AKI 3 stage was 23.1, 4.8 and 0.7% respectively. 66 (53.2%) patients with AKI had complete renal function recovery and 42 (33.9%) patients with AKI reached primary renal endpoint. Survival without primary renal endpoint was worse in AKI patients than No AKI patients (67.1 ± 5.3 and 43.7 ± 7.3% vs 99.5 ± 0.5 and 92.5 ± 4.2% at 2 and 4 years,p < 0.001). AKI was independently associated with primary renal endpoint, with an adjusted hazard ratio(HR) of 25.1 (95%CI 7.7–82.1, p < 0.001). AKI was usually mild and overlooked in iMN patients with NS, but it had a strong association with poor clinical outcomes and was an independent risk factor for CKD progression.