The Distribution Of Etiology And Prognostic Factors Of Acute Kidney Injury

Objective : To analyze the etiology of acute kidney injury in the inpatients and to explore the factors influencing the prognosis of acute kidney injury.It aims to better understand acute kidney injury and provide clinical basis for prevention of acute kidney injury and improvement of prognosis.Methods: The clinical data of inpatients with acute kidney injury(AKI)were collected from the Union Hospital of Fujian Medical University from2014.09.30-2016.09.30.According to the inclusion and exclusion criteria,ultimately selected 306 cases of inpatients with AKI.Retrospectively review the clinical data of these patients,specific indicators are as follows:1)General information:age,sex,clinical department,hospitalization time,hospital or community incidence;2)laboratory indicators: record the first laboratory criteria when the patients were diagnosed with AKI,including urinary protein,microscopic red blood cells count,microscopic white blood cell count,24-hour urine volume,white blood cell count(WBC),neutrophil percentage(NE%),hemoglobin(HB),hematocrit(Hct),platelet count(PLT),fibrinogen(FIB),serum albumin(ALB),alanine aminotransferase(ALT),aspartate aminotransferase(AST),total bilirubin(TBIL),cholesterol(CHOL),triglyceride(TG),high density lipoprotein(HDL),low density lipoprotein(LDL),uric acid(UA),serum potassium,serum sodium,serum calcium,serum phosphorus,carbon dioxide binding(CO2CP),plasma osmotic pressure,serum creatinine(Scr)and serum urea nitrogen(BUN);and record the highest serum urea nitrogen value,the highest serum creatinine value and serum creatinine value during discharge of AKI;3)Others:Reading the clinical data carefully to clear the specific pathogen of AKI,and we used the time of discharge as the study cut-off point to judge the prognosis of the patients.Under the guidance of the clinical guidelines,the above factors were analyzed.According to the ages,the patients were divided into 3 groups,the youth group(?40 years old),middle aged group(41-60 years old)and elderly group(?61 years old).According to the occurrence time of AKI,the cases were divided into hospital-acquired AKI and community-acquired AKI.According to the etiology,the patients were divided into 5 groups of prerenal causes,intristic causes,postrenal causes,chronic kidney disease based on AKI and unexplained causes.Taking the time to discharge as the observation point,the results will be divided into cured group,improved group and invalid group.Applicated statistical software SPSS21.0 for statistical analysis.Metrological data with normal distribution and variance were expressed as mean ±standard deviation(`x ±s),non-normal distribution or variance of the measured data with the median(M)and quartile spacing QR(QU-QL).The Kruskal-Wallis test in the nonparametric test was used to determine the relationship between the normal distribution and the variance of the metrological data.Comparison of the ratio between groups using chi-square test,P <0.05 is as a statistical significance.Results: Among the 306 AKI patients,219(71.6%)were male and 87(28.4%)were female.The average age was 62 years old,the youth group(? 40 years)64 cases,accounting for 20.9%,middle aged group(41-60 years old)81 cases,accounting for26.5%,and the elderly group(? 61 years),accounting for 52.6%.AKI patients were distributed in various clinical departments: Nephrology 80 cases(26.1%),Hematology60 cases(19.6%),ICU 59 cases(19.3%).Prerenal acute kidney injury was the most common cause,accounting for 50%(153 cases),of which the most common cause is cardiovascular.Renal factors 124 cases,accounting for 40.5%,and drug-induced factors were the most.Then 21 cases of postrenal,accounting for 6.9%,with tumor infiltration or metastasis the most common(42.8%).There were 2 patients,accounting for 0.7%,with chronic kidney disease based on AKI and 6% with unknown cause of AKI(2.0%).143cases(46.7%)were cured,56 cases(18.3%)were improved,107 cases(35.0%)were ineffective.The levels of HB,Hct,serum sodium,TG and UA in the cured group were higher than those in the invalid group,at the same time,the TBIL,serum phosphorus and Scr peak was lower than than that of the latter,and the peak of BUN and Scr were lower than that of the improved group.While the TBIL and BUN peak in the improved group were lower than those in the ineffective group,and the level of TG and UA were higher than that of the latter.The differences between them were significant in the triglyceride(P <0.05).Conclusion: AKI is widely distributed in the major clinical departments which has high mortality.Prerenal acute kidney injury was the most common cause,and the renal factors followed.The former is mainly associated with cardiovascular,and the latter is most common in drug-related.Prevention and early diagnosis is particularly important.Postrenal AKI has the best prognosis,then prerenal factors followed.Finding the etiology of AKI earlier and taking a positive response to improve the prognosis of AKI that has important clinical significance.At the same time,the prognosis of AKI patients can be predicted by some laboratory indicators such as HB,TBIL,serum phosphorus,BUN peak,Scr peak and so on.