摘要
目的:探讨合并肉眼血尿和急性肾损伤(AKI)IgA肾病(IgAN)患者的临床、病理特征及其影响肾功能恢复的因素。方法:回顾性分析2001年12月至2018年2月在联勤保障部队第九OO医院伴肉眼血尿和AKI的原发性IgAN患者(AKI组)30例,并随机抽取同期发生肉眼血尿但无AKI的IgAN患者60例(无AKI组),比较两组患者的临床资料和病理。结果:(1)AKI组与无AKI组,年龄≥55岁、血尿持续天数≥10 d、基础血清肌酐(SCr)、白蛋白、24 h尿蛋白定量差异有统计学差异(P<0.05),AKI组肾小管萎缩、间质细胞浸润、肾血管硬化更严重。相关因素分析发现,伴肉眼血尿的IgAN患者发生AKI的相关危险因素包括肉眼血尿持续时间≥15 d和24 h尿蛋白定量高。(2)23.3%的AKI患者在肉眼血尿消失后,肾功能未能完全恢复。肾功能恢复组与肾功能不完全恢复组在性别、收缩压、舒张压、24 h尿蛋白定量、最高SCr值均无统计学差异;在年龄、肉眼血尿持续时间、基础SCr值、球性硬化积分、肾小管萎缩差异存在统计学意义(P<0.05)。多元逐步Logistic回归模型仅发现基础估算的肾小球滤过率影响肾功能转归。结论:肉眼血尿持续时间长、蛋白尿多是IgAN患者发生AKI的危险因素,且部分基础肾功能水平较差的患者在发生AKI后肾功能不能完全恢复。
Objective:To investigate the clinical and pathological characteristics of IgA nephropathy(IgAN)patients with gross hematuria and acute renal injury(AKI),and factors affecting recovery of renal function.Methodology:From December 2001 to February 2018,30 cases of primary IgAN patients with gross hematuria and AKI(AKI group)were included in our hospital,and 60 cases of IgAN patients with gross hematuria but without AKI(nonAKI group)were randomly selected.Clinical and pathological data of two groups were compared.Results:(1)There were significant differences between AKI group and nonAKI group in age≥55 years,duration of hematuria≥10 days,baseline serum creatinine(SCr),albumin,and 24-hour urine protein(P<0.05).Renal tubular atrophy,interstitial cell infiltration,and renal arteriosclerosis were more serious in AKI group.Risk factors of AKI in IgAN patients with gross hematuria included duration of gross hematuria≥15 days,and massive 24-hour urine protein.(2)23.3%of AKI patients failed to fully recovery of renal function after treatment.There were significant differences in age,duration of gross hematuria,baseline SCr,score of glomerulosclerosis and renal tubular atrophy between partial and complete renal function recovery groups.By multivariate Logistic regression analysis,baseline eGFR was found to be the independent risk factor of recover of renal function.Conclusion:The duration of gross hematuria≥15 days and proteinuria were the risk factors of AKI in IgAN patients.Sustained gross hematuria,elderly age,high basal creatinine,decreased basal eGFR,and severe glomerulosclerosis and tubular atrophy are risk factors for incomplete recovery of renal function after AKI.
作者
陈小青
徐维佳
谢扬斌
张勇
赖素仁
杨玲婷
庄永泽
王丽萍
CHEN Xiaoqing;XU Wejia;XIE Yangbin;ZHANG Yong;LAI Suren;YANG Lingting;ZHUANG Yongze;WANG Liping(Fuzong Clinical School of Fujian Medical University,Fuzhou 350000,China;Department of Nephrology,900 Hospital of PLA Joint Logistics Support Force,Fuzhou 350000,China;First Outpatient Department,900 Hospital of PLA Joint Logistics Support Force,Fuzhou 350000,China)
出处
《肾脏病与透析肾移植杂志》
CAS
CSCD
北大核心
2023年第2期128-132,139,共6页
Chinese Journal of Nephrology,Dialysis & Transplantation
基金
国家自然基金面上项目(81373837)
福建省自然科学基金面上项目(2018J01184)
福建省自然科学基金面上项目(2021J011277)
福建省免疫性慢性肾病临床医学研究中心项目(2021Y2016)
联勤保障部队联勤医学优质专科。
关键词
IGA肾病
肉眼血尿
急性肾损伤
危险因素
IgA nephropathy
macroscopic haematuria
acute kidney injury
risk factors
