| Objective:In this study,clinical and pathological data of AKI patients were summarized and analyzed to explore the clinical characteristics,renal pathological characteristics and the correlation between them.Methods:In this study,222 AKI parients who were admitted in the department of nephrology of the second hospital of Jilin university and received renal biopsy from February 2011 to October 2018.Collecting the pathological diagnosis and the clinical information such as age,sex,blood pressure(systolic pressure,diastolic pressure),hemoglobin,24-hour urinary protein,serum creatinine,serum levels of CysC,RBP,proteinuria,hematuria,hospitalization days and renal replacement therapy.All of the data of enrolled patients were complete and were accorded with the diagnostic criteria of AKI according to the KDIGO guidelines.Exclusion criteria: postrenal AKI,history of chronic kidney disease,congenital urinary malformation,multiple organ dysfunction syndrome(MODS),major surgery,patients were admitted to the ICU.All the patients were graded according to the diagnostic criteria of AKI according to the KDIGO guidelines,and were divided into three groups: level 1 group,level 2 group,and level 3 group.Clinical and pathological data were compared among groups.SPSS19.0 was used to sort out and analyze the data,p<0.05 was considered statistically significant.Results:1.General and clinical data: A total of 222 patients with AKI were enrolled,including132 males and 90 females.The male to female ratio was 1.47:1.The median age of onset was 52 years old(15-85 years old).There were 112(50.45%)patients who were diagnosed with hypertension,28(12.61%)patients were diagnosed with diabetes,72(32.43%)patients who received renal replacement therapy during hospitalization,and2(0.90%)patients died during hospitalization,.The median of hospitalization time is18.5 days.Comparison between level 1 and level 2: there were statistically significant differences in serum creatinine,hemoglobin,and CysC;comparison between level 1and level 3: there were statistically significant differences in serum creatinine,hemoglobin,CysC,retinol binding protein,24-hour urinary protein,renal replacement therapy,hospitalization days and in-hospital mortality.Comparison between level 2and level 3: there were statistically significant differences in serum creatinine,hemoglobin,CysC,retinol binding protein,and renal replacement therapy.CysC and retinol binding protein were independent risk factors for AKI exacerbation,serum creatinine was an independent risk factor for hemoglobin decline and renal replacement therapy.2.Pathological data of AKI patients: generally speaking,the most common type of pathology was acute tubular injury which accounted for 16.22%(36/222).Minimal change disease(MCD)and ANCA-associated vasculitis(AAV)followed,with15.76%(35/222)and 13.96%(31/222),respectively.Among the patients with pathological manifestations of MCD,48.57%(17/35)were associated with acute renal tubular injury.In the level 1 group,MCD was the most common type,accounting for24.70%(21/85).In level 2 group,MCD was still the most common type,accounting for 19.15%(9/47).In level 3 group,AAV and acute tubular injury were the most common,accounting for 22.22%(20/90),respectively.Compared with level 3 group,the patients whose pathology type was MCD and membranous nephropathy(MN)in the level 1 group was much more than that in the level 3 group(p < 0.05).The patients whose pathology type was crescent glomerulonephritis(CrGN),AAV and acute tubular injury in level 1 group was obviously less than level 3 group(p < 0.05).Compared with level 3 group,the patients with pathological manifestations of MCD and MN was significantly more than level 3 group(p<0.05),while level 2 group with pathological manifestations of CrGN was significantly less than level 3 group(p<0.05).3.Comparion of the pathological data of AKI patients with hypertension: in general,MN is the most common type,accounting for 12.50%(14/112).In level 1group,MN is the most common type,accounting for 29.27%(12/41).In the level 2group,MCD and IgA nephropathy were the most common pathology,accounting for18.18%(4/22)respectively.Among the level 3 group,hypertensive renal arteriosclerosis was the most common type,accounting for 18.37%(9/49).Comparedwith the level 3 group,the level 1 group with pathological manifestations of MN was significantly more than the level 3 group(p<0.05),while the level 1 group with pathological manifestations of CrGN and AAV was significantly less than the level 3group(p<0.05).4.General data and clinical data of AKI patients with pathological manifestations of MCD were compared.In general,the average age of the patients was 47.17 years old(17-84 years old),the ratio of male to female was 1:2.89,and the proportion of patients with hypertension was 37.14%(13/35).Comparison between level 1 group and level 2 group: the CysC of level 1 group was significantly lower than that of level2 group(p<0.05).Comparison between level 1 group and level 3 group: the incidence of hypertension,CysC and RBP in level 1 group were significantly lower than those in level 3 group(p<0.05).5.Analysising the etiology of patients with acute tubular injury,the most important cause was nephrotoxic drug and poison intaking 38.89%,followed by special incidence and unexplained accounting for 16.67%.Conclusion:1.CysC and RBP of AKI patients who accept renal biopsy were higher than normal value,while hemoglobin was lower than normal value,and the change was more obvious with the aggravation of AKI.Patients with severe AKI were more likely to require renal replacement therapy and longer hospitalization days.2.The main renal pathological types of AKI patients were acute tubular injury,followed by MCD and AAV.Nephrotoxic drug and poison intaking is the main cause of AKI in patients with acute tubular injury.Nearly half of AKI patients with MCD are associated with acute renal tubular injury,and CysC,RBP and incidence of hypertension increases significantly with the aggravation of AKI.3.AKI patients with hypertension are mostly secondary hypertension,whose pathological types were mainly MN,followed by MCD and IgA nephropathy. |
PDF Full Text Request