The Risk Factors Of Primary Nephrotic Syndrome Complicated By AKI While In Hospital And Development And Validation Of A Prediction Model

Purposes:To investigate the risk factors of primary nephrotic syndrome complicated by acute kidney injury while in hospital,and develop and validate a nomogram for predicion of AKI in patients with primary nephrotic syndrome.Methods:We retrospectively analyzed datas from 189 cases of primary nephrotic syndrome which were collected form the nephrology department of the frist affiliated hospital of guangxi medical university during January 2014 to December 2019.We gathered the demographic data、inspection result、medical history and medication history and so on.Multivariate logistic regression were applied to identify independent risk factors to develop a risk model.This was presented with a nomogram.The performance of the nomogram was assessed with respect to its calibration 、discrimination and clinical usefulness with calibration plot、Hosmer-Lemeshow test、the receiver operator characteristics curve and desicion curve analysis.Bootstrap resampling technique was used to carry out internal validation.Results: Among 189 cases,there are 63 cases in AKI group,and 126 cases in another group.Through multivariate logistic regression,we determined five independent risk factors of primary nephrotic syndrome complicated by AKI while in hospital,including infection(OR=23.719,95% CI 2.777～202.566)、unused antiplatelet drug(OR=0.187,95% CI 0.054～0.650)、 unused immunosuppressor(OR=0.151,95% CI 0.028～0.824)、hyperhomocysteine(OR=1.102,95% CI 1.010～1.202)and low e GFR(OR=0.960,95% CI0.931～0.989).The five independent risk factors were used to bulit prediction model,and this was presented with a nomogram.The model shows good calibration,with p value of 0.230 of Hosmer-Lemeshow test and the predicitons nearly falls on a 45-degree diagonal line in calibration plot,and good discrimination,with an area under the receiver operator characteristics curve of0.921(95%confidence interval 0.884to0.957).The internal validation shows good,with a C-index of 0.910 of bootstrap rasampling tachnique.Desicion curve analysis demonstrated that the nomogram was clinically useful.There was a total of 142 patients to complete the renal biopsy in nearly three months(includig the lg A nephropathy).Membranous nephropathy and minimal change nephrotic syndrome were the main pathological types in both AKI group and non-AKI group.Compared with AKI group,the proportion of membranous nephropathy in non-AKI group was significantly higher(p<0.05).Conclusions: Infection、unused antiplatelet drug、unused immunosuppressor、hyperhomocysteine and low e GFR are the independent risk factors of primary nephrotic syndrome complicated by AKI while in hospital.The nomogram can be conveniently used to facilitate the prediction of AKI in patients with primary nephrotic syndrome.