IgA肾病合并急性肾损伤患者尿沉渣镜检及临床病理改变分析  

Urinary sediment findings and clinicopathologic features of IgA nephropathy patients with acute kidney injury

作　　者：郑茜子[1] 李惊子[1] 赵酉璐 杨宏宇[1] 王素霞[1] 张宏[1] 杨莉[1] Zheng Xizi;Li Jingzi;Zhao Youlu;Yang Hongyu;Wang Suxia;Zhang Hong;Yang Li(Renal Division,Peking University First Hospital,Institute of Nephrology,Peking University,Key Laboratory of Renal Disease,Ministry of Health of China,Key Laboratory of Chronic Kidney Disease Prevention and Treatment,Ministry of Education of China,Research Units of Diagnosis and Treatment of Immune-Mediated Kidney Diseases,Chinese Academy of Medical Sciences,Beijing 100034,China)

机构地区：[1]北京大学第一医院肾内科、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(北京大学)中国医学科学院免疫介导肾病诊治创新单元,北京100034

出　　处：《中华肾脏病杂志》2023年第6期414-421,共8页Chinese Journal of Nephrology

基　　金：北京市科技新星计划(2021051);北京高校卓越青年科学家计划(BJJWZYJH01201910001006);首都卫生发展科研专项(首发2022-1-4071);中国医学科学院医学与健康科技创新工程项目(2019-I2M-5-046)。

摘　　要：目的探讨IgA肾病(IgA nephropathy,IgAN)合并急性肾损伤(acute kidney injury,AKI)患者尿沉渣镜检及临床病理特点。方法该研究为回顾性研究。选取2013年1月31日至2015年7月31日在北京大学第一医院经肾活检确诊的IgAN患者为研究对象,根据肾活检时是否合并AKI将患者分为AKI组和非AKI组。肾活检当日留取中段晨尿样本行尿沉渣镜检,观察尿液中细胞及管型等有形成分改变。比较AKI组和非AKI组IgAN患者临床资料、尿沉渣及肾脏病理检查结果的差异。Logistic回归分析法分析临床病理和尿沉渣指标与AKI及尿沉渣指标与IgAN牛津病理分型评分的相关性。结果该研究纳入IgAN患者502例,年龄(36.1±12.1)岁,男性261例(52.0%)。IgAN患者肾活检时合并AKI 57例(11.4%),包括肉眼血尿相关AKI 10例、急性肾小管间质性肾炎10例、新月体性IgAN 9例、恶性高血压肾损伤6例及多种病因或病因不明22例。与非AKI组相比,AKI组患者男性比例、合并恶性高血压比例、24 h尿蛋白量、尿红细胞数及肉眼血尿、白细胞尿、尿沉渣有肾小管上皮细胞、颗粒管型比例均较高(均P<0.05)。肾病理改变方面,AKI组肾小管萎缩/间质纤维化(T2)及细胞/细胞纤维性新月体形成(C2)比例均高于非AKI组(均P<0.05)。Logistic回归分析结果显示,性别、24 h尿蛋白量、尿沉渣红细胞数、颗粒管型及肾小管萎缩/间质纤维化(T)评分均与AKI相关(均P<0.05)。尿沉渣中有红细胞、白细胞、红细胞管型、白细胞管型、颗粒管型及脂肪管型与毛细血管内增殖(E)及细胞/细胞纤维性新月体评分(C)均存在相关性(均P<0.05);尿沉渣中有红细胞与系膜细胞增殖(M)评分存在相关性(OR=2.613,95%CI 1.520~4.493,P=0.001);有红细胞(OR=1.723,95%CI 1.017~2.919,P=0.043)和脂肪管型(OR=2.646,95%CI 1.122~6.238,P=0.026)与节段硬化/粘连(S)评分存在相关性;有白细胞(OR=1.645,95%CI 1.154~2.347,P=0.006)和脂肪管型(OR=2.344,95%CObjective To investigate the urinary sediment findings and the clinicopathologic features of IgA nephropathy(IgAN)patients with acute kidney injury(AKI).Methods It was a retrospective study.The patients with renal biopsy-proven primary IgAN in Peking University First Hospital from January 31,2013 to July 31,2015 were selected.According to whether AKI occurred at renal biopsy or not,the patients were divided into AKI group and non-AKI group.Morning urine samples were obtained on the day of renal biopsy.Urine sediments,including various cells and casts,were examined.The clinical data,urinary sediments,and renal pathological changes were compared between the two groups.Logistic regression analysis was performed to identify the association between clinical pathological changes,urinary sediment indicators and AKI,or clinical pathological changes and urinary sediment indicators.Results There were 502 IgAN patients enrolled in this study,with age of(36.1±12.1)years old and 261 males(52.0%).The incidence of AKI was 11.4%(57/502)among the enrolled patients at the time of renal biopsy.Common causes of AKI included gross hematuria-induced AKI(10 cases),acute tubulointerstitial nephritis(10 cases),crescentic IgAN(9 cases),malignant hypertensive renal damage(6 cases),and multiple etioloqy or unknown etiology(22 cases).Compared with non-AKI group,AKI group had higher proportions of males and malignant hypertension,higher levels of proteinuria and urinary erythrocyte counts,and higher frequencies of gross hematuria,leukocyturia,renal tubular epithelial cells,and granular casts(all P<0.05).AKI group also had higher proportions of severe tubular atrophy/interstitial fibrosis(T2)and cellular/cellular fibrous crescent formation(C2)than non-AKI group(both P<0.05).Logistic regression analysis results showed that,there were statistically significant differences in the correlation between AKI and gender,24 h urinary protein,urinary erythrocyte counts,granular casts and renal tubular atrophy/interstitial fibrosis(T)scores(all P<0.05).H

关 键 词：急性肾损伤 肾小球肾炎 IgA 显微镜检查 血尿 白细胞尿 

分 类 号：R692.31[医药卫生—泌尿科学]