Risk Factors And Prediction Model Of Adult Primary Nephrotic Syndrome Complicated Acute Kidney Injury

Objective: Acute kidney injury(AKI)has been a common complication of nephritic syndrome that could affect the prognosis of patients.To explore the risk factors of acute kidney injury with adult primary nephrotic syndrome(PNS)and build relevant prediction mode.It would be great clinical value for early detection and prevention and treatment of PNS secondary AKI.Methods: 185 patients with PNS who met the criteria were reviewed.They were divided into AKI group(n=51)and non-AKI group(n=134)according to whether complicated with AKI.The epidemiology,clinical and histological features at admission were compared between the two groups.The independent risk factors for AKI were evaluated by logistics regression analysis and the prediction model was established.The area under ROC curve was used to evaluate the prediction efficacy of the model.Results: In 51 PNS patients with AKI,the common pathological types of AKI follows Minimal change disease(29.4%),IgAnephropathy(25.5%),membranous nephropathy(17.6%).Tubular protein tubules and epithelial vacuoles in the AKI group were significantly higher than those in the group(P<0.05).The male were more likely to occur the AKI than the female(P=0.000).Patients in AKI group had lower albumin level,higher levels of random urine protein,uric acid and triglyceride than non-AKI group(all P<0.05),and the clinical manifestation of polyserous and oliguria occured more often in the AKI group(P < 0.05).The AKI patients had more diseases of high blood pressure and infections(P =0.035,P= 0.000).The multi-factor logistics regression analysis showed albumin(<25g/l),uric acid(≥400μmol/l),polyserous,diabetes,infection and tubular tubular protein were independent risk factors affecting the occurrence of AKI.The above indexes were incorporated into the prediction model of PNS: P=1/(1+exp(-6.428+2.194X1+2.878X2+1.722X3+1.617X4+2.832X5+1.960X6).The area under the ROC curve of the combined predictor was 0.909,95% confidence interval(0.867-0.952),and the optimal critical value was 0.697,its sensitivity for predicting the occurrence of AKI was 0.780,and its specificity was 0.917.Conclusion: PNS complicated by AKI associated with a variety of factors.The levels of albumin(< 25g/L)and uric acid(≥400μmol/L),polyserous,diabetes,infections,renal tubular protein type tube were the independent risk factors.The prediction model had high sensitivity and specificity and was of certain clinical value to predict the risk of PNScomplicated with AKI.