Related Factors Analysis Of Primary Nephritic Syndrome Complicated With Acute Kidney Injury

BackgroundNephritic syndrome(NS),common symptoms in glomerular diseases,is a clinical syndrome including have proteinuria(more than 3.5g/d),Hypoproteinemia(low than 30g/L),hyperlipemia and edema.According to the etiology,NS can be classified into primary and secondary NS.And the primary NS(PNS) is an exclusive diagnoses~[1]. Acute kidney injury(AKI),the most serious complication of PNS,is common in clinic practice and most of them could be recovered by early treatment.As the etiology of ARF is complex,early diagnosis and treatment is very important for PNS patients with AKI.ObjectiveTo explore the related factors of primary nephritic syndrome complicated with acute kidney injury.MethodsThe clinical(including edema,complication,24h urinary volume,hemoglobin, BUN/Scr,serum albumin,24h urinary protein) and pathological data of 128 cases with primary nephritic syndrome in Jan.2006 and Aug.2008 were analyzed respectively. ResultsAmong 128 PNS patients,18(14.1%) patients were with AKI(AKI group), including 11(8.6%)male patients and 7(5.5%)female patients;110(85.9%)patients without AKI(NAKI group),including 74(57.8%)male patients and 36(28.1%)female patients;The mean age of the patients in AKI group is 54.00±19.50 years old,while the mean age of the patients in NAKI group is 36.57±17.10 years old(P=0.00007). Both groups was no statistics' significance in gender.There were significant difference of edema degree,mean level of hemoglobin,24h urinary protein,24h urine volume and BUN/Scr(P=0.006,0.0003,0.001,0.004,0.001 respectively) between AKI group and NAKI group.While mean level of serum albumin have no significant difference between AKI group and NAKI group(P=0.19).There were significant difference of mean level of hemoglobin,BUN/Scr,and 24h urine volume(P=0.03,0.03,0.02 respectively) between prerenal group and non-prerenal group.While edema degree,mean level of serum albumin and 24h urinary protein have no significant difference between prerenal group and non-prerenal group.(P=0.39,0.92,0.15 respectively).In pathology, mesangial proliferation(56.4%) and minimal change(22.7%) were much common in NAKI group,while mesangial proliferation(38.9%) and minimal change(22.7%) were often observed in AKI group.There was significant difference in renal interstitial change between AKI and NAKI groups(P＜0.001).In etiology,there were 5 PNS patients with infection,6 with low blood volume and 7 with special renal pathological change.After treatment,the complete remission rate of AKI was 66.7%,turning to chronicity rate was 27.8%,mortality was 7.1%.ConclusionThe incidence of PNS with AKI was related with age,unrelated with gender.PNS with infection was prone to cause AKI,and the first manifestation was significantly decreasing urine volume.Serious edema and hypoproteinemia were not good judgements of low blood volume,while increasing Hb and Bun/Scr,decreasing urine volume,and the usefulness of the treatment of increasing colloid osmotic pressure always shows low blood volume.There is some relationship between the level of 24h urine protein and AKI.The mesangial proliferation and minimal change were common renal pathological type.PNS with renal interstitial change are prone to cause AKI,Many PNS patients with AKI showed good prognosis after promptly treatment.