Analysis Of Clinical And Pathological Features And Prognosis Of 211 Patients With AKI

Objective:The clinical and pathological data of patients with acute kidney injury(AKI)included in this study were retrospectively analyzed to understand their clinical and pathological characteristics and disease spectrum,and to explore the risk factors leading to adverse renal outcome events in patients discharged from the hospital,and to provide more basis for future clinical practice.Methods:Patients who were diagnosed with nephrogenic AKI and underwent renal puncture biopsy at the Second Hospital of Jilin University from July 2013 to June 2022 were selected for retrospective analysis.According to the study population,they were divided into 3 groups: 1)211 study subjects were divided into AKI stage 1 group,AKI stage 2 group,and AKI stage 3group according to the 2012 Clinical Practice Guidelines for AKI of the Kidney Disease Improvement Global Prognosis Organization(KDIGO);2)211 study subjects were divided into 2013-2017 group and 2018-2022 group according to the year of renal puncture.3)The remaining study subjects were divided into dialysis group,non-dialysis group according to the patients’ discharge from dialysis,excluding 2 deceased patients.The general,laboratory and pathological data of the patients were collected and the corresponding statistical analysis was performed using SPSS25.0 software.Results:1.A total of 211 patients were included in this study,109(51.66%)were male and 102(48.34%)were female,with a median age of 53(18-79)years,and the age distribution was predominantly elderly(that is,age ≥60 years),with a total of 76(36.0%)cases.114(54.03%)cases had hypertension,96(45.5%)cases had a diagnosis of AKI at the time of hospitalization.A total of 114 cases(54.03%)had hypertension,96 cases(45.5%)had AKI diagnosis at hospital,and 2 cases(0.95%)died in hospital.2.There were 58 cases(27.5%)in the AKI stage 1 group,34 cases(16.1%)in the AKI stage 2 group,and 119 cases(56.4%)in the AKI stage 3 group.The three groups had a high incidence of length of stay,hospitalization cost,AKI diagnosis rate,incidence of hypertension,systolic blood pressure,immunosuppressant application rate,antibiotic application rate,antifungal application rate,infection rate,dialysis discharge rate,continuous renal replacement therapy(CRRT)performed in hospital,hemoglobin,total white blood cell count,D-dimer prothrombin time,international normalized ratio,glomerular filtration rate,CO2 binding capacity,urea nitrogen,creatinine at renal puncture,creatinine at baseline,creatinine at discharge,cystine protease inhibitor C(Cys C),blood retinol binding protein(RBP),C-reactive protein,and albumin were statistically significant(P<0.05).3.Primary glomerular disease was the most common,accounting for 59.24% of all cases,and the most common pathological types were MCD and crescentic glomerulonephritis(Cr GN).The differences in the composition ratios of MCD,membranous nephropathy(MN),ANCA-associated vasculitis(AAV),and Cr GN between the three groups were statistically significant(P<0.05).4.In the both time periods 2013.7-2017.12 and 2018.1-2022.6,patients showed an increasing trend in age of onset in recent years,with a statistically significant difference(P<0.05).5.Among the discharged dialysis patients,the pathological types were mainly Cr GN(17cases,35.4%)and AAV(10 cases,20.8%);among the discharged non-dialysis patients,the pathological types were more common in MCD(43 cases,26.7%)and lupus nephritis(18 cases,11.2%).The composition ratios of Cr GN,sclerosing glomerulonephritis,AAV,and thrombotic microangiopathy(TMA)were higher in the discharged dialysis group than in the non-dialysis group,and the composition ratios of Ig A nephropathy,MCD,and tubulointerstitial nephritis were lower than in the non-dialysis group,with statistically significant differences(P<0.05).6.Prognostic analysis of discharge was performed in 209 patients,which showed that Cys C,discharge creatinine level,application of antibiotics,and in-hospital CRRT were independent risk factors for patients discharged from dialysis.Conclusions:1.The most common type of pathology in AKI patients is MCD,followed by Cr GN.2.AKI has a high rate of missed diagnoses,occurring mainly in patients with stage 1 AKI.The age of AKI patients is on the rise,and this difference is particularly evident in the older age group.3.Cys C,creatinine level at discharge,application of antibiotics,and in-hospital CRRT are independent risk factors for poor short-term prognosis of patients.