老年脓毒症相关急性肾损伤后肾功能恢复及危险因素分析

目的了解老年脓毒症相关急性肾损伤(sepsis-associated acute kidney injury, SA-AKI)患者的肾功能恢复率、临床特点及危险因素。 方法回顾性分析2018年1月至2019年12月就诊于解放军总医院国家老年疾病临床医学研究中心≥75岁的SA-AKI患者的临床资料。根据出院时肌酐(serum creatinine,Scr)恢复情况,患者分为恢复组(出院时Scr≤125%基线值)和未恢复组(出院时Scr>125%基线值)。AKI定义和诊断标准采用2012年改善全球肾脏病预后组织(Kidney Disease: Improving Global Outcomes,KDIGO)制定的标准。持续型AKI定义为AKI发生48 h时Scr无下降(>基线Scr水平)。 结果192例患者中位年龄为87(84～90)岁,男性183例,占95.3%。患者出院时21.9%(42/192)患者肾功能未恢复,78.1%(150/192)肾功能恢复。肾功能恢复组与未恢复组相比,性别比例(P<0.05)、基线Scr(P<0.001)和基础eGFR(P<0.001)差异有统计学意义。肾功能未恢复组患者AKI确诊时Scr(P<0.05)、Scr峰值(P<0.001)水平较高,肾脏替代治疗(P<0.05)和机械通气(P<0.001)需要率明显增加,持续型AKI所占比例高(P<0.001)。多因素Logistic回归分析显示两组在基础eGFR(70～79: OR＝0.258,95%CI：0.088～0.757,P<0.05;80～89: OR＝0.132,95%CI：0.041～0.421,P＝0.001;≥90：OR＝0.096,95%CI：0.015～0.627,P＝0.014)、机械通气(OR＝6.715;95%CI：2.665～16.918;P<0.001)和持续型AKI(OR＝6.706;95%CI：2.741～16.404;P<0.001)等方面差异显著。 结论高龄老年SA-AKI患者肾功能大多数可恢复,基础eGFR升高是高龄老年SA-AKI患者肾功能恢复的保护因素,机械通气和持续型AKI是高龄老年SA-AKI患者肾功能恢复的危险因素。     

住院老年人短暂性与持续性急性肾损伤发生情况及临床特点分析

目的对老年急性肾损伤(AKI)患者进行随访观察,分析短暂性AKI与持续性AKI的发生率、临床特点及相关危险因素。 方法选择2007年1月至2015年12月就诊于解放军总医院老年病房≥75岁的住院患者为研究对象。根据发生AKI后3 d时肾功能恢复情况将患者病历资料分为短暂性AKI与持续性AKI进行分析。多因素Logistic回归分析老年人发生持续性AKI的相关危险因素。 结果研究期间,共有652例住院患者发生AKI,其中男性623例,占95.6%,中位年龄87(84～91)岁。652例AKI患者,短暂性AKI 270 (41.4%)例,持续性AKI 382(58.6%)例。多因素Logistic回归分析显示Scr峰值(OR＝1.020; 95%CI: 1.015～1.026; P<0.001)、血尿素氮(BUN)增高(OR＝1.028; 95%CI: 1.000～1.056; P＝0.047)、高尿酸(OR ＝1.002; 95%CI: 1.000～1.003; P＝0.040)、伴有机械通气(OR＝1.610; 95%CI: 1.012～2.562; P＝0.044)是影响高龄老年患者发生持续性AKI的独立危险因素;平均动脉压(OR＝0.985; 95%CI: 0.971～1.000; P＝0.043)升高和血红蛋白升高(OR＝0.989; 95% CI: 0.980～0.999; P＝0.025)是影响高龄老年患者发生持续性AKI的独立保护因素。 结论住院高龄老年患者短暂性AKI的发生率高达近42%。提高临床医师的重视程度,增加对Scr的监测频率,是降低AKI漏诊率的有效手段。早期识别危险因素,可改善AKI患者的短期预后。     

CCU患者发生急性肾损伤的现状调查及中医证候研究

目的调查中医院冠心病重症监护室(CCU)患者急性肾损伤(AKI)的发生情况及中医证候特点。 方法回顾性研究北京中医药大学东直门医院2015年1月1日到2015年12月31日入住CCU的患者,采用KDIGO指南推荐的AKI诊断标准,将患者分为AKI组和非AKI组,比较两组的人口学资料及临床特征、治疗、转归、中医证候特点,并用多因素Logistic回归分析AKI发生的危险因素。 结果共纳入186例患者,发生AKI 65例(35.0%),漏诊率为89.2%。①人口学资料及临床基本特征：年龄、发生多脏器功能衰竭、尿素氮、血肌酐(Scr)在AKI组明显高于非AKI组(P<0.001);N末端脑钠肽(NT-BNP)升高、双下肢水肿、合并高血压、高尿酸血症在AKI组高于非AKI组(P<0.05);②治疗：利尿剂在AKI组的使用明显高于非AKI组(χ²＝17.729,P<0.001); ③多因素Logistic回归分析显示使用利尿剂(OR＝6.980,CI 2.287～21.306)、eGFR<90 ml/(min·1.73 m²)(OR＝2.201,CI 1.076～4.504)、发生非肾多脏器功能衰竭(OR＝3.733,CI 1.602～8.702)是AKI发生的独立危险因素;④转归：院内死亡在AKI组明显高于非AKI组(χ²＝16.510,P<0.001)、出院Scr在AKI组明显高于非AKI组(Z＝－7.683,P<0.001);⑤中医证候：水停证在AKI组高于非AKI组(χ²＝0.024,P<0.05);在虚证中,气虚出现频率最高、其次为阴虚;在实证中,血瘀出现频率最高、其次为痰证;AKI患者虚实夹杂所占比例最高(50.8%)。 结论中医院CCU患者AKI的发生存在着高发病率、高漏诊率的特点。临床治疗中应谨慎使用大剂量利尿剂、注重肾脏及其它重要脏器的保护。中医治疗应注重"心肾同治"及"标本兼顾",以益气养阴,活血化瘀为主,兼用利水化痰。     

老年AECOPD患者发生急性肾损伤的危险因素分析

目的探讨老年慢性阻塞性肺疾病急性加重(AECOPD)患者中急性肾损伤(AKI)的发病率及相关影响因素。方法回顾性分析本院2014年1月至2020年4月间收治的诊断为AECOPD的1 523例老年患者的临床资料, 记录患者的年龄、性别、合并症、基础疾病、实验室检查等临床指标, 按是否发生AKI分为AKI组(325例)与非AKI组(1 198例), 分析老年AECOPD患者发生AKI的危险因素。结果与非AKI组相比, AKI组的年龄偏高, 急性呼吸衰竭、肺性脑病、心血管疾病及肾脏病的比例更高, 白细胞、C反应蛋白、血钾水平偏高而血红蛋白、血白蛋白、血小板水平偏低(均P<0.05)。多因素logistic回归分析结果显示高龄(OR=1.06,P<0.001)、并发有急性呼吸衰竭(OR=1.49,P=0.015)、肺性脑病(OR=2.34,P=0.015), 高血压病(OR=1.38,P=0.032)、冠状动脉粥样硬化性心脏病(OR=1.54,OR=0.005)、心房颤动(OR=1.54,P=0.043)、慢性肾脏病(OR=4.48,P<0.001)及白细胞计数(OR=1.0...     

老年住院患者急性肾损伤的临床特点

目的 探讨院内老年急性肾损伤(acute kidney injury,AKI)患者的临床特点.方法 本研究收集2015年1月至2015年12月首都医科大学附属北京潞河医院住院期间发生AKI患者的临床资料,分析老年患者发生AKI的临床特点.结果 共纳入202例院内AKI患者,老年AKI患者103例,死亡率44.66％,非老年AKI患者99例,死亡率33.33％.肾脏缺血及感染是老年AKI患者最常见的病因.多因素Logistic回归分析显示,BNP(OR=4.531,95％ CI1.112 ～10.312,P＜0.001)、C反应蛋白(OR=1.071,95％CI1.047～ 1.096,P＜0.05)、平均动脉压(OR=2.28,95％ CI 1.761～2.983,P＜0.001)、合并脓毒血症(OR=2.28,95％ CI 1.761 ～ 2.983,P＜0.001)、合并MODS(OR=27.316,95％ CI 13.936 ～ 48.344,P＜0.001)是老年AKI患者死亡的独立危险因素.结论 老年住院患者AKI病死率高,其中BNP、低平均动脉压、高C反应蛋白、合并脓毒血症及合并MODS为住院老年AKI患者死亡的独立危险因素.     

急性肾损伤供肾对肾移植受者预后影响分析

目的分析发生急性肾损伤(AKI)供肾对肾移植受者及移植肾预后的影响。 方法选取2015年1月至2021年9月武汉大学人民医院器官移植科71例供肾捐献前发生AKI供者(AKI 1、2和3期分别为31、16和18例)及78例非AKI供者,AKI组对应受者136例(AKI 1、2和3期供者对应受者分别为70、32和34例),非AKI组对应受者154例。采用成组t检验或单因素方差分析比较正态分布计量资料。计数资料采用卡方检验或Fisher确切概率法比较。采用Kaplan-Meier法绘制受者/移植肾生存曲线并采用log-rank检验进行比较。P<0.05为差异有统计学意义。 结果AKI组供者入院时血清肌酐以及供肾获取时血清肌酐、尿素氮、血红蛋白和尿蛋白阳性比例分别为(91±51)μmol/L、(206±126)μmol/L、(17±16)mmol/L、(121±28)g/L、53.5%(38/71),非AKI组分别为(66±33)μmol/L、(53±24)μmol/L、(9±4)mmol/L、(108±22)g/L和21.8%(17/78),差异均有统计学意义(t＝－3.488、－10.096、－0.432和－3.066,χ²＝16.065,P均<0.05)。AKI 1期、AKI 2期和AKI 3期供者入院时血清肌酐以及供肾获取时血清肌酐和白蛋白差异均有统计学意义(F＝8.275、15.012和3.840,P均<0.05)。非AKI组对应受者术后1个月血清肌酐、术后移植肾功能延迟恢复发生及移植肾存活比例分别为(106±47)μmol/L、9.1%(14/154)和98.1%(151/158),AKI组对应受者分别为(126±82)μmol/L、25.0%(34/136)和86.8%(118/136),差异均有统计学意义(t＝－2.561,χ²＝13.234和9.445,P均<0.05)。AKI与非AKI组供者对应受者移植肾存活率差异有统计学意义(χ²＝9.445,P<0.05);AKI与非AKI组供者对应受者生存率差异无统计学意义(χ²＝3.107,P>0.05)。不同AKI分期供者对应受者移植肾及受者存活率差异均无统计学意义(χ²＝1.643和1.257,P均>0.05)。 结论高分期AKI供者供肾经过积极维护能达到与低分期AKI供者供肾相似的移植效果,高分期AKI供者供肾经专业评估筛选后可作为扩大供肾来源的途径。     

心肺转流下心脏瓣膜术后急性肾损伤的危险因素分析

目的探讨成人心肺转流(cardiopulmonary bypass,CPB)下心脏瓣膜手术后急性肾损伤(acute kidney injury,AKI)的危险因素。方法回顾性分析1 349例心脏瓣膜手术患者的临床资料,采用多因素Logistic回归分析心脏瓣膜术后AKI的危险因素。结果 1 349例心脏瓣膜手术患者AKI发生率为28.4%,多因素Logistic回归分析显示,每增加1岁(OR=1.05,95%CI 1.03~1.06,P0.001)、糖尿病史(OR=2.11,95%CI 1.22~3.68,P=0.008)、贫血(OR=1.50,95%CI1.05~2.21,P=0.026)、术前血清肌酐(Scr)值每增加1mg/dl(OR=1.01,95%CI 1.01~1.02,P=0.001)、手术时间每增加1h(OR=1.28,95%CI 1.15~1.41,P0.001)、术中输注血浆(OR=1.50,95%CI 1.14~1.97,P=0.004)是心脏瓣膜术后发生AKI的独立危险因素。结论心肺转流下心脏瓣膜术后急性肾损伤的独立危险因素是高龄、糖尿病史、贫血、术前肌酐高、手术时间长以及术中输注血浆。     

老年髋部骨折患者术前营养不良的危险因素分析

目的分析老年髋部骨折患者术前营养不良的危险因素。 方法回顾性分析2011年1月至2015年12月间东南大学附属中大医院收治的798例年龄≥65岁髋部骨折患者的临床资料,采用多因素Logistic回归分析老年髋部骨折患者术前营养不良的危险因素。 结果老年髋部骨折患者术前营养状况较差,营养不良患者约占34.80~78.43%。老年股骨转子间骨折患者营养状况比股骨颈骨折患者更差,血红蛋白[（108±18）g/L,（123±16）g/L,t=11.617,P<0.001]、白蛋白[（34±6）g/L,（36±5）g/L,t=5.133,P<0.001]两指标差异均有统计学意义。高龄老年患者术前营养状况比普通老年患者更差,血红蛋白[（112±18）g/L,（121±18）g/L,t=6.772,P<0.001]、总淋巴细胞计数[（1.1±0.7）cells/ml,（1.3±0.6)cells/ml,t=3.247,P=0.001]和白蛋白[（34±5）g/L,（36±6）g/L,t=4.577,P<0.001]差异均有统计学意义。多因素Logistic回归分析示年龄（OR：0.567,95% CI：0.419~0.768,P<0.001）和脑梗塞（OR：0.699,95% CI：0.500~0.980,P=0.037）是老年髋部骨折患者术前营养不良的主要危险因素。 结论老年髋部骨折术前营养状况较差,特别是股骨转子间骨折患者和高龄老年患者,年龄和脑梗塞是老年髋部骨折患者术前营养不良的主要危险因素。     

非清髓性外周造血干细胞移植后早期急性肾损伤的多中心临床研究

目的 观察白血病患者非清髓性外周造血干细胞移植后早期急性肾损伤（AKI）的患病率、危险因素及对生存的影响。 方法 对象为2002年1月至2007年5月,在东南大学附属中大医院、南京医科大学附属淮安医院、江苏大学附属镇江第一人民医院3个移植中心接受非清髓性外周造血干细胞移植的白血病患者。观察移植前、移植后100 d内肾功能改变情况及并发症,并随访观察1年。AKI分为3期：1期,Scr升高 ≥26.5 μmol/L,或升高50%~200%;2期,Scr升高>200%~300%;3期,Scr升高>300%,或升高>353.6 μmol/L（急性升高≥44.2 μmol/L）。 结果 62例患者移植后造血均顺利恢复。18例（29%）患者出现不同程度的AKI,其中1期11例,2期6例,3期1例。Logistic多因素回归分析表明,人类白细胞抗原（HLA）不完全匹配、移植后并发症（感染、肝静脉闭塞病、急性移植物抗宿主病）是AKI的独立危险因素,其优势比OR（95% CI）分别为3.6（1.1~13.0）、12.1（2.4~62.4）。移植后1年患者总的病死率为27.4%,且病死率随着AKI的严重程度逐渐增加（log-rank检验,P < 0.01）。 结论 AKI是非清髓性外周造血干细胞移植后的常见并发症之一。HLA不完全匹配、移植后并发症是发生AKI的独立危险因素。AKI对患者移植后1年生存率有重要影响。     

神经外科手术患者急性肾损伤的发生率及危险因素分析

目的分析神经外科手术患者急性肾损伤(acute kidney injury, AKI)的发生率及危险因素。方法本研究为单中心、回顾性研究。研究对象为2017年1月1日至2020年12月31日因颅内肿瘤和颅内血管疾病在首都医科大学宣武医院神经外科普通病房住院治疗的患者, 收集入选者人口学、临床资料及实验室检查结果。根据AKI诊断标准将患者分为AKI组和非AKI组, 比较两组患者临床参数以及用药的差异。采用Logistic回归模型分析神经外科手术患者发生AKI的危险因素。结果纳入神经外科手术患者4 509例, 年龄(51.93±16.03)岁, 男性2 361例, 女性2 148例, AKI发生率为3.37%(152/4 509), 其中因颅内肿瘤手术的患者AKI发生率为3.69%(84/2 278), 因颅内血管疾病手术的患者AKI发生率为3.05%(68/2 231)。AKI组患者平均住院时间(t=4.897, P<0.001)和手术时间(t=5.496, P<0.001)均长于非AKI组。AKI组患者中合并糖尿病比例、术前血肌酐、血尿素氮、糖化血红蛋白、血乳酸、纤维蛋白原...     

Prediction of acute kidney injury complicated by sepsis with sTREM - 1 and NGAL as early marker

Objective To determine whether triggering receptor expressed on myeloid cells-1 (sTREM - 1) and urinary neutrophil gelatinase - associated lipocalin (NGAL) were early biomarkers of acute kidney injury (AKI) secondary to sepsis. Methods A total of 141 eligible patients were enrolled in this prospective study. Blood and urine samples were collected at different time points as soon as sepsis was diagnosed. The concentrations of serum creatinine (Scr), urine sTREM-1 and NGAL were measured. According to AKI criteria, patients were divided into the AKI group and non - AKI group. Dynamic changes of levels of Scr, urine sTREM-1 and NGAL were observed in two groups. The receiver operating characteristic curves were used to evaluate the early diagnostic value of urine sTREM-1 and NGAL. Results Among 141 septic patients, 44 (31.2%) cases had concomitant AKI. Twenty four hours after sepsis diagnosed, the level of Scr rose to 1.91 times of the baseline [(140.5±13.6) vs (82.6±15.3) μmol/L, P＜0.05], which met the diagnostic criteria of AKI. In the AKI group, urinary concentrations of sTREM-1 and NGAL at 8 h after the diagnosis of sepsis began to rise significantly from baseline [(100.5±17.4) vs (38.9±14.7) ng/L; (144.6±51.9) vs (56.2±43.8) μg/L, both P＜0.05].And at the following time points, urinary concentrations of sTREM - 1 and NGAL were significantly higher than the baseline levels and that of the non-AKI group (all P＜0.05). At 8 h time point, the area under the curve of urine sTREM-1 was 0.877 (95%CI 0.756-0.914), the sensitivity was 89.1% and specificity was 82.0% with a cutoff value of 70 ng/L. At 8 h time point, the area under the curve of urine NGAL was 0.862 (95% CI 0.703-0.958),the sensitivity was 87.4% and specificity was 85.5% with a cutoff value of 90 μg/L. Conclusions Urinary concentrations of sTREM-1 and NGAL at 8 h time point after the diagnosis of sepsis have predictive value for AKI and their diagnostic time is much earlier than that of Scr. Therefore, urinary sTREM-1 and NGAL can be used as early biomarkers of septic AKI.     

Value of serum bicarbonate in prediction of the long-term prognosis of renal function after acute kidney injury

Objective To evaluate the value of serum bicarbonate concentration as a prognostic indicator of renal function by following up the renal function in the acute kidney injury (AKI) patients. Methods 169 cases of AKI patients were enrolled in the study. Clinical data were collected prospectively. Risk factors of the renal outcome were evaluated. The patients were followed up for average 19 months. Results The serum bicarbonate concentration on AKI (r=-0.302, P＜0.001), 3 months after AKI (r=-0.363, P＜0.363), and 6 months after AKI (r=-0.591, P＜0.001) were all negatively correlated with serum creatinine. Compared with renal function recovered group, the serum bicarbonate concentration of renal function unrecovered group on AKI (21.92 mol/L vs 24.58mol/L), 3 months after AKI (22.58 mol/L vs 25.54 mol/L), 6 months after AKI (21.89 mol/L vs 25.42 mol/L), 12 months after AKI (19.85 mol/L vs 24.07 mol/L) were all significantly decreased (all P＜0.05). When AKI occurred, the Scr, serum bicarbonate concentration, the combined value of Scr and serum bicarbonate concentration to predict prognosis of kidney, area under the receiver-operating characteristic (ROC) curves were 0.840, 0.667, 0.837, sensitivity were 68.6%, 51%, 80.4%, specificity were 88.9%, 80.9% and 73.6%, respectively. 3 months AKI after, the Scr, serum bicarbonate concentration, the combined value of Scr and serum bicarbonate concentration to predict prognosis of kidney, area under the ROC curves were 0.838, 0.732, 0.848, sensitivity was 83.3%、 69.2%、91.7%, specificity were 79.5%, 70.8% and 74.4%, respectively. 6 months the after AKI, Scr, serum bicarbonate concentration, the combined value of Scr and serum bicarbonate concentration to predict prognosis of kidney, area under the ROC curves were 0.948, 0.798, 0.952, sensitivity were 100%, 80%, 100%, specificity were 84%, 80% and 88%, respectively. Combined 3 time points of serum bicarbonate concentration when AKI occurred, 3 month and 6 months after AKI, the area under the ROC curve was 0.850, sensitivity was 85.7%, specificity was 84.2%. When combined 3 time points of the Scr levels of AKI occurred, 3 months and 6 months after AKI, area under the ROC curve was 0.940, sensitivity was 100%, specificity was 84.2%.When combined 3 time points of combined value of Scr levels and serum bicarbonate concentrations of AKI occurred, 3 months and 6 months after AKI, the area under the ROC curve was 0.962, sensitivity was 100% and specificity was 94.7%. The Kaplan-Meier survival curve analysis showed that the serum bicarbonate concentration on AKI＜21.65 mmol/L, serum bicarbonate concentration 3 months after AKI＜24.3 mmol/L or serum bicarbonate concentration 6 months after AKI＜23.5 mmol/L were all significantly correlated with poor renal prognosis. Conclusion Serum bicarbonate concentration is helpful to predict the renal ont come after AKI. Combination of serum bicarbonate concentrations and serum creatinine levels increased the accuracy of prediction.     

Correlation analysis between homocysteine level and acute kidney injury after cardiac valve replacement surgery

Objective To investigate the relationship between preoperative serum homocysteine (Hcy) level and acute kidney injury (AKI) after cardiac valve replacement surgery. Methods The data of the inpatients who accepted cardiac valve replacement surgery, age ≥18 years, no renal replacement therapy before surgery, non-renal decompensation and preoperative serum creatinine (Scr)＜178 μmol/L, survival within 48 h after surgery, and with preoperative serum Hcy data in the First Affiliated Hospital of Guangxi Medical University from January 1, 2015 to December 31, 2017 was retrospectively analyzed. AKI was diagnosed in patients whose Scr increased more than 26.5 μmol/L (0.3 mg/dl) within 48 hours or 1.5 times higher than baseline within 7 days after surgery. According to this, patients were divided into AKI group and non-AKI group, and the affecting factors for AKI were compared between the two groups. Multivariate logistic regression was used to analyze the independent influencing factors of AKI. The relationship between serum Hcy level and AKI incidence was analyzed by Spearman correlation analysis. Whether the AKI occurred and serum Hcy levels were used as variables to map the receiver operating characteristic curve (ROC), and was used to assess the value of preoperative serum Hcy level for predicting AKI after cardiac valve replacement surgery. Results A total of 810 subjects were included in the study, including 375 males and 435 females. They were (50±11) years old (19-78 years old). Among them, 329 patients with AKI occurred within 7 days after heart valve replacement, and the incidence rate was 40.6% (male 45.9%, female 36.1%). The serum Hcy level in the AKI group was higher than that in the non-AKI group [(15.74±4.55) μmol/L vs (13.87±3.85) μmol/L, t=6.106, P＜0.01]. Multivariate logistic regression analysis showed age (OR=1.030, 95%CI 1.014-1.045, P＜0.001), extracorporeal circulation time (OR=1.011, 95%CI 1.007-1.016, P＜0.001), Scr (OR=1.014, 95%CI 1.005-1.023, P=0.002), serum Hcy (OR=1.059, 95% CI 1.017-1.103, P=0.006), high level of Hcy (＞13.64 μmol/L) (OR=1.465, 95%CI 1.059-2.027, P=0.021) and moderate to severe hyperhomocystinemia (16≤Hcy≤100 μmol/L) [with normal HHcy (Hcy＜10 μmol/L) as reference, OR=2.180, 95%CI 1.245-3.816, P=0.006] were independent influencing factors of AKI after cardiac valve replacement surgery. Spearman correlation analysis showed that the incidence of postoperative AKI increased with the increase of preoperative serum Hcy level (rs=0.927, P＜0.001). The results of ROC curve showed that the area under the curve of the preoperative serum Hcy level predicting AKI after heart valve replacement was 0.701, and the cutoff value was 13.64 μmol/L, with the sensitivity 61.3%, specificity 70.9%. Conclusions Preoperative serum Hcy level is an influencing factor for AKI after cardiac valve replacement surgery. The higher the level of preoperative serum Hcy, the higher the incidence of AKI after cardiac valve replacement surgery. Patients with preoperative serum Hcy levels＞13.64 μmol/L have an increased risk of AKI after cardiac valve replacement surgery.     

Klotho protein as a biomarker for the detection and prognosis of acute kidney injury among adult patients in the intensive care units

Objective To evaluate the clinical significance of serum Klotho protein levels in the early diagnosis and prognosis of acute kidney injury (AKI) among adult patients in the intensive care units (ICU). Methods The study was prospective and observational. Blood samples and clinical data of AKI patients admitted to the ICU of the First Affiliated Hospital of Xinjiang Medical University between July 1 and August 31, 2016 were collected. ELISA was used for the detection of Klotho and NGAL. Receiver operating characteristic curve (ROC) and the area under the curve (AUC) were used to compare the predictive performance among Klotho, NGAL and serum creatinine, evaluating the sensitivity and specificity of Klotho on the diagnosis of AKI. The correlation between Klotho and prognosis of AKI was investigated by comparing serum Klotho levels and early AKI predictors. Results The patients were divided into AKI group of 52 cases and non-AKI group of 98 cases. The baseline serum Klotho level in AKI group was significantly lower than that in non-AKI group (P＜0.001). The AUC of Klotho predicting for AKI was 0.945(95% CI: 0.892-0.997) and the best cut off value was 1.76 μg/L(sensitivity 92%, specificity 94%). The predictive ability of Klotho was significantly higher than serum creatinine (Scr), and the sensitivity is higher than NGAL (sensitivity 87%, specificity 96%). Serum Klotho combined with Scr predicted better AKI (AUC=0.958, 95% CI: 0.915-1.000, sensitivity 96%, sensitivity 92%). The level of Klotho in patients with AKI was significantly different between the renal function recovery group and non-recovery group (P=0.047), while there was no significant difference between the two groups in the level of NGAL and Scr (P＞0.05). There was no significant correlation between the Klotho level at diagnosis of AKI and peak Scr, peak eGFR, Scr at discharge and eGFR at discharge (r=0.026, P=0.853; r=-0.127, P=0.368; r=0.243, P=0.082; r=-0.187, P=0.184). Conclusion Serum Klotho may be a potential biomarker for early diagnosis of AKI, but the association between serum klotho and the prognosis of AKI requires further study.     

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。     

Value of levels of biomarkers at the time of nephrologists consultation in predicting the prognosis of acute kidney injury patients

Objective To investigate the value of biomarker levels at the time of nephrologists consultation in predicting the prognosis of acute kidney injury (AKI) patients. Methods A total of 103 hospitalized patients with AKI were enrolled at the time of nephrologists consultation. Blood and urine samples were collected when patients were diagnosed as AKI. ELISA was used to detect the concentration of urinary biomarkers including neutrophil gelatinase?associated lipocalin (NGAL), IL?6 and IL?18. Colorimetric method was used to measure urinary N?acetyl?β?D?glucosaminidase (NAG). Turbidimetry and enzymic method were applied to examine the concentration of serum cystatin C (Cys C), baseline Scr (bScr), Scr at consultation (cScr) and the peak of Scr (pScr) respectively. Patients were followed?up to evaluate the prognosis at 28 days after consultation, including patient survival and kidney survival. The levels of biomarkers between different groups, including patient survival or death, kidney recovery or lose and renal replacement therapy (RRT) or not, were compared. Area under curve (AUC) of receiver operating characteristic (ROC) curve of these biomarkers were used to evaluate the sensitivity and specificity in predicting prognosis. AKI was defined as the Scr at the time of consultation increased more than 50% of baseline Scr within 48 hours. Results (1)Mean age of 103 hospitalized AKI patients was (54.28±19.05) years old and ratio of male to female was 1.86 to 1. (2)Patient mortality was 25.2% at 28 days after consultation. The bScr, cScr and pScr were similar between survival and death group, while the concentration of urinary NGAL in death group was significantly higher than that of survival group [147.00(31.59, 221.87) mg/L vs 22.43(6.48, 89.77) mg/L, P＝0.001]. The serum Cys C, urinary IL?6 and NAG were similar between survival and death group (P＞0.05). Logistic regression analysis showed urinary NGAL was an independent risk factor of patient survival (OR＝1.011, 95%CI 1.004?1.018, P＝0.001) with AUC of 0.723. (3)Kidney lose rate was 20.4% at 28 days after consultation. The bScr, cScr and pScr were similar between patients with kidney survival and lose. The levels of urinary NAG, IL?6, NGAL and IL?18 were significantly higher in patients with kidney lose than those of kidney survival. Logistic regression analysis showed urinary IL?6 was an independent risk factor of renal survival (OR＝1.056, 95%CI 1.009?1.105, P＝0.018) with AUC of 0.705. (4)The median time from consultation to RRT was 2.17 (0?3) days. The concentrations of cScr, pScr, serum Cys C, urinary IL?6 and NGAL were significantly higher in RRT patients than thosein non?RRT patients (P＜0.05). Logistic regression analysis showed urinary NGAL was an independent risk factor of RRT (OR＝1.012, 95%CI 1.005?1.019, P＜0.01) with AUC of 0.775. Conclusions Urinary NGAL can predict the prognosis of AKI patients, including patient prognosis and RRT. Urinary IL?6 may predict kidney prognosis in hospitalized patients with AKI. More study with large samples should be done for further estimation of the results.