Clinical Characteristics Of Patients With Acute Kidney Injury And The Factors Of TCM Syndrome

Objective:Through the analysis of the characteristics of patient hospitalized for acute kidney injury(AKI),then summarized the incidence, etiology, risk factors, treatment and prognosis, according to the correlation of AKI different etiology, risk factors and TCM syndrome elements, to provide guidance for the early prevention and treatment of AKI patients in hospital.Methods:Using a prospective survey to collect the clinical data of patients with AKI of Affiliated Hospital of Shandong University of TCM from July 2014 to December 2015,add up to 54 case.Recorded patients with basic situation, basic disease, etiology, AKI stage,risk factors, laboratory index, treatment, prognosis and the information of TCM, and for 3 months of follow-up.Using SPSS 17.0 to describe the data,summarized the clinical characteristics in patients with AKI,got the correlation of AKI different etiology and risk factors and TCM syndrome elements,investigate the distribution of AKI of TCM syndrome elements.Results:1.(1)Patients mainly come from the department of internal medicine, such as the renal department, ICU, cardiovascular department etc.(2)The male and female ratio was 1.45:1, the average age was 63.59±22.08 years old, mainly in the elderly, the average length of stay time was 20.93±13.44 days, and the fatality rate was 42.59%.(3) High blood pressure, cardiovascular disease, chronic kidney disease were the main underlying diseases,and most of the concomitant occurrence were infection,MODS,acute heart failure and gastrointestinal bleeding, etc.(4) The incidence of AKI in each period is roughly the same,and normal kidney size account for the majority. 2.(1) There were 48 cases(88.89%) had a single factor leading to AKI,and two factors involved in AKI were 6 patients(11.11%).(2) There were 31 cases(57.41%) prerenal etiology of renal disease, followed by the renal factors.(3)The primary disease of prerenal AKI is insufficient blood volume. Then is the relative blood volume reduction which caused by the heart output.(4) The antibiotics was the leading cause of renal factors.(5) The urinary tract tumors were more common in the posterior renal factors.(6)There are 16 cases(29.63%) with hospital acquired acute kidney injury(HA-AKI), prerenal factors account for majority,the reduction of cardiac output and drug-induced AKI accounted for 25%.(7)There are 36 cases(66.67%) of elderly patients with AKI, mainly to the prerenal factors.The drug factors is the first risk factors of senile AKI, accounting for 16.67%, followed by infection, cardiac output decreased, urinary tumor,etc.(8)There are 11 patients(20.37%) with sepsis AKI, mainly were the prerenal factors. 3.The single factor analysis showed that age, oliguria, Ha-AKI, MODS, intervention treatment of department of nephrology, hemoglobin level, blood white blood cell level, urine protein quantity, chronic kidney disease and diabetes is related to AKI prognosis. Multivariate logistic regression analysis showed that hospital acquired, MODS, chronic kidney disease and diabetes are independent risk factors of AKI patients; Department of Nephrology timely and effective intervention is the key impacting AKI cure rate, and the etiology and prognosis of AKI no significantly correlated. 4.(1) The analysis of TCM Syndromes of 54 cases of AKI patients showed that the disease was in the spleen and stomach and kidney. Among them, the kidney and the later AKI are mostly in kidney; the former AKI disease is mostly in the spleen and stomach.(2) The disease is more common with the intermingled deficiency and excess,Qi deficiency appears the highest frequency, yin deficiency is more common with renal factors; excess marked with blood stasis and damp heat syndrome.(3) The elderly patients with AKI are located in the spleen and stomach, kidney and lung, with the deficiency and excess mixture and more performance for Qi deficiency. Non-elderly patients appear in the spleen and stomach, with the actual situation of inclusion and empirical class based, mainly for water wet.(4) Different staging of TCM syndromes distribution is different, among the second stage of AKI yin deficiency syndrome perform the main, turbidity toxin syndrome correlated with AKI stage.(5)The disease involved in the lung and yang deficiency syndrome is the independent risk factor of death in AKI patients.Conclusion:1.Hospitalized patients with AKI of Affiliated Hospital of Shandong University of TCM characterized by elder and high case fatality rate.The disease is common with internal medicine system,accompanied by hypertension, cardiovascular disease, chronic kidney disease may increase AKI incidence, and patients easily complicated with infection, MODS, acute heart failure and hemorrhage of digestive tract, so clinical should pay attention to and timely intervention. 2.Hospitalized patients with AKI of Affiliated Hospital of Shandong University of TCM is dominated by prerenal factor.Drugs perform mainly in renal factors. HA-AKI put drugs and cardiac output decreased as the main cause. Prerenal factor is the main factor of elderly AKI, also to prevent the drug caused by AKI. Hospital acquired, MODS, chronic kidney disease and diabetes are affecting the prognosis of patients with AKI independent risk factors; Department of Nephrology timely and effective intervention is the key impacting AKI cure rate, and the etiology and prognosis of AKI have no significant correlation. 3.Hospitalized patients with AKI of Affiliated Hospital of Shandong University of TCM is dominated by intermingled deficiency and excess, Qi deficiency appears the highest frequency, yin deficiency is more common with renal factors; excess marked with blood stasis and damp heat syndrome.The diseases are mainly in the spleen and stomach and kidney.The elderly AKI are located in the spleen and stomach, kidney and lung, the Qi deficiency is the main syndrome. Non-elderly AKI appear in the spleen and stomach, water wet is the main syndrome.Yin deficiency syndrome play an important part in the second stage of AKI, turbidity toxin syndrome correlate with AKI stage.The lung and yang deficiency syndrome is the independent risk factor of death in AKI patients.