急性肾脏病患者的临床特征及肾脏病理相关性研究  

Correlation Between Clinical Manifestations and Renal Pathology in Patients with Acute Kidney Disease

作　　者：翁沁婕 胡晓帆[1] 唐晓晴 王鑫鹭 高琛妮 汪知玉 姜梦迪 徐婷婷 任红[1] 张文[1] 潘晓霞[1] 徐静[1] WENG Qinjie;HU Xiaofan;TANG Xiaoqing(Department of Nephrology,Ruijin Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai,200025)

机构地区：[1]上海交通大学医学院附属瑞金医院肾脏科,上海200025

出　　处：《中国中西医结合肾病杂志》2023年第6期488-492,共5页Chinese Journal of Integrated Traditional and Western Nephrology

基　　金：上海市临床重点专科建设项目(No.shslczdzk02502);国家自然科学基金资助项目(No.81900606)。

摘　　要：目的:通过了解急性肾脏病(AKD)患者的临床-肾脏病理特征,进一步提高临床医生对AKD,尤其是非急性肾损伤(非AKI)的认识,早识别、早诊断和早治疗。方法:收集2009年01月—2018年12月于我院肾脏科住院肾活检的AKD患者的临床、病理资料,按照病程中有无AKI,分为AKD(AKI)与AKD(非AKI)两组,分析其临床-病理特点。结果:共纳入630例AKD患者,占10年肾穿刺活检总例数的11.4%,其中AKD(非AKI组)占81.0%(510/630),中位年龄50岁,男女比1.23∶1。非AKI组的入院肌酐(Scr)(243.5 vs 321.5μmol/L)和病程中最高Scr(286 vs 506.5μmol/L)均明显低于AKI组(P<0.01)。两组在蛋白尿和血尿方面差异无统计学意义。影像学提示AKI组患者肾脏偏大的比例高于非AKI组(P<0.01)。肾脏病理方面,43.0%以肾小球急性病变为主(271/630),42.1%以肾小管间质急性病变为主(265/630),14.9%以肾小血管急性病变为主(94/630),其中,非AKI组以肾小球急性病变为主,AKI组以肾小管间质急性病变为主。单因素及多因素回归分析提示,临床初诊不考虑急性肾衰竭、无明显低蛋白血症、伴有高血压、肾间质炎细胞浸润>25%、有肾小球毛细血管腔内细胞增多及节段纤维素样坏死的患者,倾向非AKI组。结论:AKD发生率并不低,多见于中老年男性,病理显示肾小球、肾小管间质、肾小血管均可累及,明确肾脏病理类型对于AKD的早期诊断、治疗至关重要。Objective:Background we investigated the clinical and pathological characteristics of patients with acute kidney disease(AKD)in order to improve our understanding and promote early identification,diagnosis and treatment of patients with AKD,especially non-acute kidney injury(non-AKI).Methods:We collected the clinical and pathological data of patients with AKD who underwent renal biopsy in our hospital from January 2009 to December 2018.They were divided into AKD-AKI and AKD-non-AKI groups according to the presence of AKI in the course of the disease.The clinical and pathological data were analyzed.Results:630 AKD patients were included,which accounted for 11.4%of the total renal biopsy cases in 10 years.81.0%(510/630)patients were in AKD-non-AKI group,whose median age was 50 years old and male-to-female ratio was 1.23:1.The admission serum creatinine(Scr)(243.5 vs 321.5μmol/L)and the highest Scr(286 vs 506.5μmol/L)was significantly lower in non-AKI group than in AKI group(P<0.01).There were no significant differences in proteinuria and hematuria between the two groups.Imaging examination showed that the ratio of larger kidneys of AKI group were higher than non-AKI group(P<0.01).In terms of renal pathology,43.0%of the patients(271/630)had acute glomerular lesions,while 42.1%(265/630)had tubulointerstitial acute lesions and 14.9%(94/630)had acute renal small vessel lesions.Patients in non-AKI group mainly had acute glomerular lesions,while patients in AKI group mainly had acute tubulointerstitial lesions.Univariate and multivariate regression analysis showed that patients who were not considered as acute renal failure at first,no obvious hypoalbuminemia,with hypertension,renal interstitial inflammatory cell infiltration>25%,increased glomerular capillary endothelial cells and segmental necrosis were tended to be in the non-AKI group.Conclusion:The incidence of AKD is not very low.It is more common in middle-aged and elderly patients.Pathologic lesions could involve glomeruli,tubulointerstitium and renal small blo

关 键 词：急性肾脏病 非急性肾损伤 临床特征 肾脏病理 

分 类 号：R692[医药卫生—泌尿科学]