成人微小病变肾病综合征发生急性肾损伤的相关影响因素分析

目的探讨成人微小病变肾病综合征发生急性肾损伤( AKI)的相关影响因素。 方法回顾性分析2002年1月1日至2015年12月31日在解放军总医院病理诊断为微小病变肾病，临床表现为首发肾病综合征的成年患者。记录其横断面临床及病理指标，并将其分为AKI组及非AKI组进行比较。用单因素及多元Logistic回归分析与AKI发生相关的影响因素。并对AKI相关的各影响因素进行交互作用检验。 结果共纳入403例患者，男女比例为1∶1.13，肾活检时平均年龄为(39.5 ± 15.1)岁，其中118(29.3%)例发生了AKI。AKI组与非AKI组相比，年龄、性别、尿蛋白定量、血清白蛋白、血肌酐、血尿素氮、估算的肾小球率过滤、肾小管萎缩、肾间质病变差异均有统计学意义(P<0.05)。单因素Logistic回归分析显示高龄、男性、尿蛋白定量多、肾小管萎缩、肾间质水肿、间质纤维化及炎细胞浸润、高血压是成人微小病变肾病发生AKI的危险因素。交互作用检验表明血清白蛋白对AKI的作用受到肾间质纤维化的显著影响(P＝0.0 050)，且在调整年龄分组、性别、高血压、尿蛋白定量、肾小管萎缩、肾间质水肿、肾间质炎细胞浸润混杂因素后，其交互作用仍显著(P＝0.0 263)。从多元Logistic回归分析可见，在无肾间质纤维化的人群中，血清白蛋白水平的升高是AKI的独立保护因素(调整后的OR 0.8，95%CI 0.7～ 0.9，P<0.001)。在有肾间质纤维化人群中，血清白蛋白的升高对AKI肾脏的保护作用不显著(调整后的OR 1.0，95%CI 0.9～1.0，P＝0.0 278)。 结论高龄、男性、尿蛋白定量多、肾小管萎缩、肾间质水肿、间质纤维化及炎细胞浸润、高血压是成人微小病变肾病综合征发生AKI的危险因素。血清白蛋白升高对AKI的保护作用受到肾间质纤维化的影响。

Analysis of related factors of acute kidney injury in adult minimal change nephrotic syndrome

ObjectiveTo investigate the related factors of acute kidney injury (AKI) in adult minimal change disease (MCD). MethodsA retrospective analysis was made in the patients (>18 years old) with first-presented nephrotic syndrome and biopsy-proven MCD from January 1, 2002 to December 31, 2015. The patients were divided into two groups: the AKI group and the non-AKI group. Univariate and multivariate logistic regression were used to analyze the influencing factors associated with the occurrence of AKI. And the interaction of AKI related factors was tested. ResultsA total of 403 patients were included. The ratio between males and females was 1∶1.13. The average age at renal biopsy was 39.5 ± 15.1 years. AKI occurred in 118 cases (29.3%) of the 403 patients. The AKI group had statistically significant differences in age, gender, urinary protein quantification, serum albumin, serum creatinine, blood urea nitrogen, estimated glomerular filtration rate (eGFR), tubular atrophy, and renal interstitial lesions compared with the non-AKI group (P<0.05). Univariate logistic regression analysis showed that the elderly age, maleness, higher urinary protein, tubular atrophy, renal interstitial edema, interstitial fibrosis, inflammatory cell infiltration, and hypertension were the risk factors for the occurrence of AKI in adult MCD. Interaction tests showed that the effect of serum albumin on AKI was significantly affected by renal interstitial fibrosis (P=0.005), and this interaction was still significant after adjustment of such factors as age group, gender, hypertension, urinary protein quantification, tubular atrophy, renal interstitial edema, and renal interstitial cell infiltration (P=0.0 263). In the non-interstitial fibrosis patients, serum albumin increase was an independent protective factor for AKI (adjusted OR, 0.8; 95%CI, 0.7-0.9, P<0.001). In the interstitial fibrosis patients, the influence of serum albumin increase on AKI was not significant (adjusted OR 1.0, 95%CI, 0.9- 1.0, P=0.0 278). ConclusionElderly age, maleness, higher proteinuria, renal tubular atrophy, renal interstitial edema, renal interstitial fibrosis, inflammatory cell infiltration, and hypertension, were risk factors for the occurrence of AKI in adult MCD. The protective effect of serum albumin increase on AKI was influenced by the renal interstitial fibrosis.