最新KDIGO急性肾损伤指南在新月体肾炎中的应用  

Validation of 2012 KDIGO AKI guideline in patients with crescent glomerulonephritis

作　　者：初荣[1,2] 刘晓静[1,2] 郑欣[1,2] 鄂洁[1,2] 王素霞[1,2] 杨莉[1,2] 刘刚[1,2] 

机构地区：[1]北京大学第一医院肾内科 [2]北京大学肾脏疾病研究所 卫生部肾脏疾病重点实验室 慢性肾脏病防治教育部重点实验室,100034

出　　处：《中华临床医师杂志（电子版）》2013年第6期16-19,共4页Chinese Journal of Clinicians(Electronic Edition)

基　　金：北京市优秀人才培养计划重点支持项目(20110009001000002)

摘　　要：目的分析2012年国际改善全球肾脏病预后组织(KDIGO)发表的急性肾损伤(AKI)和急性肾脏病(AKD)定义在不同类型的新月体肾炎中的应用。方法 2009年1月至2012年12月在北京大学第一医院肾内科住院接受肾活检其光镜病理检查超过50%肾小球内有新月体形成的患者。根据2012年KDIGO指南AKI/AKD的定义,以血肌酐(Scr)和24h尿量为指标将入选的患者分为AKI组,非AKI的AKD组,非AKD组和无法分类组。结果 AKD能够识别84.2%的新月体肾炎患者,而AKI仅能识别61.4%的患者。对于不同类型的新月体肾炎,AKI识别抗GBM抗体型最高,达91%。新月体性肾小球肾炎较肾小球肾炎伴多数新月体形成更易被AKI识别(P=0.002)。不同成分为主的新月体肾炎,AKI/AKD的识别无统计学差异。结论 2012年KDIGOAKD的定义比AKI更能够早期识别急性肾功能不全的患者。Objective To validate whether 2012 KDIGO definitions of AKI and AKD were applicable for patients with crescent glomerulonephritis.Methods Patients who were pathologically defined as ≥ 50％ of the glomeruli having crescents between 1 January 2009 and 31 December 2012 were enrolled in the study.2012 KDIGO AKD and AKI definition were applied to identify patients with AKI,AKD without AKI,non-AKD and unclassified group according to the changes of serum creatinine （Scr） and urine volume throughout the disease course.Results The AKD definition could recognize 84.2％ of the patients with crescent glomerulonephritis,while AKI could only identify 61.4％ of such patients.For different types of crescent glomerulonephritis,anti-GBM type was recognized by AKI at best （91％）.AKI could identify crescentic glomerulonephritis better than glomerulonephritis with majority crescents formation （P =0.002）.There was no statistically significance between different composition of crescent,irrespectively of AKI/AKD criterion.Conclusions The KDIGO AKD definition can detect patients with renal dysfunction of crescent glomerulonephritis earlier than AKI.

关 键 词：肾病 急性肾损伤 KDIGO 新月体肾炎 

分 类 号：R692.3[医药卫生—泌尿科学]