Acute renal impairment in coronavirus-associated severe acute respiratory syndrome.
Acute renal impairment in coronavirus-associated severe acute respiratory syndrome.
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DOI：
10.1111/j.1523-1755.2005.67130.x
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发表时间：
2005-03
影响因子：
19.6
通讯作者：
Lai KN
中科院分区：
文献类型：
--
作者：
Chu KH;Tsang WK;Tang CS;Lam MF;Lai FM;To KF;Fung KS;Tang HL;Yan WW;Chan HW;Lai TS;Tong KL;Lai KN
冠状病毒相关的严重急性呼吸综合征患者的急性肾损害。严重急性呼吸综合征(SARS)是一种新出现的新型冠状病毒(SARS-CoV)感染。除了发烧和呼吸道并发症外，一些SARS患者还出现了急性肾功能损害。在此，我们描述了这种新的病毒感染并发急性肾损害的临床、病理和实验室特征。我们回顾分析了536名首次出现临床症状的SARS患者的血肌酐浓度和其他临床参数，这些患者是在2003年3月香港发生重大疫情后入住两家地区医院的。对另外7例尸检患者的肾组织进行了光镜和电子显微镜观察。在这536名SARS患者中，36名(6.7%)出现急性肾功能损害，发病时间中位数为病毒感染后20天(5-48天)，尽管首次临床表现时血肌酐水平正常。急性肾损害反映了在多器官衰竭的情况下造成肾损害的不同的肾前和肾因素。最终，33例SARS急性肾功能损害患者(91.7%)死亡。SARS合并急性肾损害患者的死亡率显著高于SARS合并急性肾损害患者(91.7%vs.8.8%)(P<；0.0001)。肾组织主要表现为急性肾小管坏死，没有肾小球病理的证据。调整后的与急性肾损害相关的死亡相对危险度为4.057(P<；0.001)。多因素分析显示，急性呼吸窘迫综合征和年龄是预测SARS患者发生急性肾损害的最显著独立危险因素。急性肾损害在SARS中并不常见，但具有很高的死亡率。急性肾损害很可能与多器官衰竭有关，而不是与病毒的肾脏趋向性有关。急性肾损害的发展是影响SARS患者生存的一个重要的负面预后指标。
Acute renal impairment in coronavirus-associated severe acute respiratory syndrome. Severe acute respiratory syndrome (SARS) is a newly emerged infection from a novel coronavirus (SARS-CoV). Apart from fever and respiratory complications, acute renal impairment has been observed in some patients with SARS. Herein, we describe the clinical, pathologic, and laboratory features of the acute renal impairment complicating this new viral infection. We conducted a retrospective analysis of the plasma creatinine concentration and other clinical parameters of the 536 SARS patients with normal plasma creatinine at first clinical presentation, admitted to two regional hospitals following a major outbreak in Hong Kong in March 2003. Kidney tissues from seven other patients with postmortem examinations were studied by light microscopy and electron microscopy. Among these 536 patients with SARS, 36 (6.7%) developed acute renal impairment occurring at a median duration of 20 days (range 5–48 days) after the onset of viral infection despite a normal plasma creatinine level at first clinical presentation. The acute renal impairment reflected the different prerenal and renal factors that exerted renal insult occurring in the context of multiorgan failure. Eventually, 33 SARS patients (91.7%) with acute renal impairment died. The mortality rate was significantly higher among patients with SARS and acute renal impairment compared with those with SARS and no renal impairment (91.7% vs. 8.8%) (P < 0.0001). Renal tissues revealed predominantly acute tubular necrosis with no evidence of glomerular pathology. The adjusted relative risk of mortality associated with the development of acute renal impairment was 4.057 (P < 0.001). By multivariate analysis, acute respiratory distress syndrome and age were the most significant independent risk factors predicting the development of acute renal impairment in SARS. Acute renal impairment is uncommon in SARS but carries a high mortality. The acute renal impairment is likely to be related to multi-organ failure rather than the kidney tropism of the virus. The development of acute renal impairment is an important negative prognostic indicator for survival with SARS.
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DOI：
10.1016/s0140-6736(03)13077-2
发表时间：
2003-04-19
期刊：
Lancet (London, England)
影响因子：
--
作者：
Peiris JS;Lai ST;Poon LL;Guan Y;Yam LY;Lim W;Nicholls J;Yee WK;Yan WW;Cheung MT;Cheng VC;Chan KH;Tsang DN;Yung RW;Ng TK;Yuen KY;SARS study group
通讯作者：
SARS study group
影响因子：
3.1
作者：
Lai, Kar Neng;Tsang, Kenneth W.;Ooi, Clara G. C.
通讯作者：
Ooi, Clara G. C.
DOI：
10.1016/s0140-6736(03)13265-5
发表时间：
2003-05-10
期刊：
Lancet (London, England)
影响因子：
--
作者：
So LK;Lau AC;Yam LY;Cheung TM;Poon E;Yung RW;Yuen KY
通讯作者：
Yuen KY
影响因子：
6.1
作者：
Tang, HL;Cheuk, A;Tong, KL
通讯作者：
Tong, KL
DOI：
10.1016/s0140-6736(03)13412-5
发表时间：
2003-05-24
期刊：
Lancet (London, England)
影响因子：
--
作者：
Peiris JS;Chu CM;Cheng VC;Chan KS;Hung IF;Poon LL;Law KI;Tang BS;Hon TY;Chan CS;Chan KH;Ng JS;Zheng BJ;Ng WL;Lai RW;Guan Y;Yuen KY;HKU/UCH SARS Study Group
通讯作者：
HKU/UCH SARS Study Group