Epidemiology of acute kidney injury in surgical intensive care at University Hospital in Egypt. A prospective observational study

IntroductionThe acute kidney injury (AKI) incidence in ICU patients varies widely from 3% to 30%, with mortality ranging from 36% to 90%, depending on the type of ICU, study population, the period during which the study is conducted, and the criteria used to define AKI.There have been many studies about the epidemiology and risk factors of AKI in critically ill patients in the different regions of the world. However, little data on the epidemiology of AKI in critically ill patients are available in Egypt.ObjectivesThe aim of this study was to assess the incidence of AKI among critical ill patients using RIFEL [risk (R), injury (I), failure (F), loss (L), and end-stage kidney disease (E)] classification and to determine the risk factors and outcome of patients who developed AKI in our surgical ICU.MethodsWe conducted a 6-month prospective observational study in the surgical ICU. Patients were classified daily using the RIFLE criteria. Patients were considered as having new AKI if they did not have AKI on ICU admission and subsequently reached at least class risk during their follow-up. Deterioration of AKI was diagnosed if the patient had increased in RIFLE class compared to the initial classification.ResultsOne hundred and twelve patients were studied. AKI occurred in 40 (35.7%) of patients. The most common risk factors for AKI are APACHE II score (acute physiology and chronic health evaluation score, version II.) and sepsis. APACHEII was lower in non-AKI group than AKI group (17.3 ± 7.5 versus 22.4 ± 7.4, p = 0.001), and sepsis was more common in AKI patients than non-AKI patients (77.5% versus 49% p = 0.004). Patients with AKI had a mortality rate of 67.5% which was more in patients with failure compared with risk patients. APACHEII, AKI, and needs for mechanical ventilation were independent risks for mortality.     

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.     

Incidence and risk factors of acute kidney injury in the Japanese trauma population: A prospective cohort study

IntroductionPrevious studies have reported the prevalence and risk factors of acute kidney injury (AKI) in relatively young trauma patients. The aims of this study were to identify the prevalence and risk factors of AKI among older Japanese trauma patients.MethodsWe conducted a prospective observational study in the 8-bed intensive care unit (ICU) of a Japanese tertiary-care hospital. Participants comprised trauma patients aged 18 years or older admitted to the ICU. Our primary outcome was the incidence of AKI within 10 days of admission, according to the Kidney Disease Improving Global Outcomes (KDIGO) criteria.ResultsAmong 333 patients, 66 (19.8%) developed AKI (Stage 1, n = 54; Stages 2, n = 5; and Stage 3, n = 7). Multivariate logistic regression analysis revealed that the incidence of AKI was associated with increased age (odds ratio (OR), 1.38; 95% confidence interval (CI), 1.15–1.65), male sex (OR, 2.06; 95%CI, 1.04–4.07), greater amount of red blood cell transfusions (OR, 1.61; 95%CI, 1.04–1.17), and presence of underlying chronic kidney disease (CKD) (OR, 3.97; 95%CI, 1.78-8.83). Length of stay in the ICU was significantly longer in patients with AKI (6 days) than in those without (3 days; p < 0.001). Patients ≥65 years old were more likely to develop AKI (26.2% vs 11.6%; p < 0.001). No significant differences in ICU stay (median, 4 vs 4 days; p = 0.70), hospital stay (median, 24 vs 21 days; p = 0.45), or 28-day mortality (2.1% vs 1.4%; p = 0.19) were evident between age groups.ConclusionsApproximately 20% of trauma patients developed AKI, and the elderly were more likely to develop AKI. Older age, male, greater units of red blood cell transfusions, and underlying CKD were associated with incidence of AKI.     

单中心住院患者急性肾损伤患病现况调查及预后分析

目的探讨住院患者急性肾损伤(acute kidney injury,AKI)患病及预后情况,并对预后相关的危险因素进行分析。方法通过石河子大学医学院第一附属医院检验科数据检索系统筛选出2015年1月至2015年12月所有住院患者58 444例,根据改善全球肾脏病预后组织(Kidney Disease:Improving Global Outcomes,KDIGO)发布的最新AKI临床指南中血肌酐的定义标准,对于符合的患者组成队列研究,回顾性分析住院患者AKI的患病情况,采用Logistic回归分析患者死亡和肾脏预后的危险因素。结果符合入选标准的AKI患者609例,AKI患病率1.04%(609/58 444),男、女发病比率为2.07:1,平均年龄(66.3±16.1)岁。根据KDIGO指南AKI分期标准,Ⅰ期249例(占40.9%),Ⅱ期263例(占43.2%),Ⅲ期97例(占15.9%)。导致住院患者发生AKI的原因中,肾前性原因431例(占70.6%),肾性原因131例(占21.5%),肾后性原因48例(占7.9%)。在发生AKI第7天观察时,病死率25.5%(155/609);以出院作为观察节点时,病死率29.1%(177/609);在观察患者肾脏预后中,29.9%的患者肾功能未恢复,18.7%的患者肾功能完全恢复,41.2%的患者肾功能部分恢复。多因素Logistic回归分析,年龄(OR=1.598)、AKI分期(OR=1.538)、昏迷(OR=2.659)、慢性肝脏病(OR=2.134)是患者死亡的独立危险因素。肾外脏器衰竭(P0.01,OR=2.548,95%CI:1.717~3.783)是患者肾功能未恢复的独立危险因素。结论 AKI是住院患者越来越普遍并且或将成为影响预后的严重并发症。年龄、AKI分期、昏迷、慢性肝脏病是患者死亡的独立危险因素。肾外脏器衰竭是患者肾功能未恢复的独立危险因素。     

Septic acute kidney injury in critically ill patients – a single-center study on its incidence,clinical characteristics,and outcome predictors

Purpose The objective of this study is to examine the incidence, clinical characteristics, and outcome (90-day mortality) of critically ill Chinese patients with septic AKI. Methods Patients admitted to the ICU of a regional hospital from 1 January 2011 to 31 December 2013 were included, excluding those on chronic renal replacement therapy. AKI was defined using KDIGO criteria. Patients were followed till 90 days from ICU admission or death, whichever occurred earlier. Demographics, diagnosis, clinical characteristics, and outcome were analyzed. Results In total, 3687 patients were included and 54.7% patients developed AKI. Sepsis was the most common cause of AKI (49.2%). Compared to those without AKI, AKI patients had higher disease severity, more physiological and biochemical disturbance, and carried significant co-morbidities. Ninety-day mortality increased with severity of AKI (16.7, 27.5, and 48.3% for KDIGO stage 1, 2, and 3 AKI, p?<?0.001). Full renal recovery was achieved in 71.6% of AKI patients. Compared with non-septic AKI, septic AKI was associated with higher disease severity and required more aggressive support. Non-recovery of renal function occurred in 2.5% of patients with septic AKI, compared with 6.4% in non-septic AKI (p?<?0.001). Cox regression analysis showed that age, emergency ICU admission, post-operative cases, admission diagnosis, etiology of AKI, disease severity score, mechanical ventilation, vasopressor support, and blood parameters (like albumin, potassium and pH) independently predicted 90-day mortality. Conclusions AKI, especially septic AKI is common in critically ill Chinese patients and is associated with poor patient outcome. Etiology of AKI has a significant impact on 90-day mortality and may affect renal outcome.     

Incidence of acute kidney injury in hospitalized children

Objective To investigate the prevalence, missed diagnosis rate and causes of acute kidney injury (AKI) in hospitalized children, and its impact on hospitalization cost, length of stay and outcome. Methods The data of children admitted in Children's Hospital Affiliated to Capital Institute of Pediatrics from December 1st to 31st 2014 were collected, and those whose serum creatinine (Scr) were measured at least two times were selected. Patients were diagnosed as AKI according to the diagnostic criteria of 2012 Kidney Disease: Improving Global Outcomes, then divided into AKI group and non-AKI group, the former of which was further divided into AKI1 group (Scr peak value in normal range) and AKI2 group (Scr peak value above normal range). The causes and impact of AKI on hospitalization cost, length of stay and outcome in different groups were compared and analyzed. Results (1) Among 921 patients with at least two Scr results, 170 patients met with the diagnostic criteria of AKI, including 100 males and 70 females. There were 112(65.9%) in AKI stage 1, 43(25.3%) in stage 2, and 15(8.8%) in stage 3. The overall prevalence of AKI was 18.5%. With only 7 cases getting diagnosed, the diagnostic rate was 4.1%, while 95.9% of patients missed diagnosis. (2) Among AKI patients, 67 cases had pre-renal causes, 103 cases had intra-renal causes and mixed factors. 100(58.8%) cases got complete recovery, 34(20.0%) cases recovered partially and 36(21.2%) cases did not improve, including 4 cases of death. (3) The prevalence of AKI among those below 1-year old was higher than children elder than 1-year (23.0% vs 15.5%, P=0.004). The prevalence of AKI in surgical ward was higher than medical ward (30.7% vs 15.8%, P＜0.001). (4) Compared with those in non-AKI group, there was lower age [1.1(0.2, 3.5) year vs 2.0(0.3, 4.9) year] and higher hospitalization time[12.5(8.0, 20.0) d vs 8.0(6.0, 11.0) d], hospitalization costs [25 279.2(13 822.8, 48 856.7) yuan vs 12 616.9(8680.1, 19 345.1) yuan] and mortality (2.4% vs 0.3%) in AKI group (all P＜0.05). (5) There were 126 cases in AKI1 group and 44 cases in AKI2 group. The costs of hospitalization, outcome and mortality showed no difference between two groups (all P＞0.05). The hospitalization time in AKI2 group was shorter than that in AKI1 group (P=0.038). Conclusions Among hospitalized children the missed diagnosis rate of AKI is high. Pre-renal factor is the main cause of AKI. Children younger than 1-year old are more susceptible to AKI. AKI children have lower age and higher hospitalization time, hospitalization costs and mortality than non-AKI children. The effect of Scr fluctuation within normal levels needs to be further studied.     

Clinical characteristics and prognosis of peritoneal dialysis treatment in children with acute kidney injury

Objective To investigate the efficiency and safety of peritoneal dialysis (PD) in pediatric patients with acute kidney injury (AKI). Method A retrospective study of children who underwent PD for AKI in the First Affiliated Hospital of Xi’an Jiaotong University from 2003 to 2013 was performed, and the laboratory examinations, the causes, the complication, the prognosis and the risk factors were evaluated. Results The study included 48 children, with the age of (67.6±51.7) months (ranging from 3 months to 15 years old), including 31 males (64.6%) and 34 co-infections (70.8%). Primary glomerulonephritis (27.1%) was the most common cause of AKI, followed by the hemolytic uremic syndrome (18.7%) and drug induced AKI (18.7%). Peritoneal dialysis was performed manually using percutaneous or adapted catheters. The duration of PD during hospitalization was 11(7,14) days. PD treatment was highly effective in attenuation of toxics retention and correction of electrolyte disturbances (all P＜0.05). There were 3 cases of PD-related complications, including 1 case of peritonitis, 1 case of catheter outflow obstruction, 1 case of catheter exit site hematoma, and no child patient died of PD complications. Among the AKI children, 37 cases (77.1%) recovered with the PD treatment and had the catheter successfully removed till discharge, 7 cases (14.6%) needed further peritoneal dialysis and 4 cases (8.3%) died. The serum albumin level was significantly higher in patients who got recovered with PD treatment than other unrecovered cases [(32.6±6.7) g/L vs (23.2±4.3) g/L, t=-3.994, P＜0.001]. Conclusions PD can be safely and efficiently performed for the treatment of pediatric AKI. Low albumin level may be related to poor prognosis of AKI.     

静脉使用对比剂后急性肾损伤发生率的Meta分析

目的采用Meta分析评价静脉注射对比剂后急性肾损伤的发生率。方法于PubMed、Web of Science、Cochrane Library、中国知网、维普中文科技期刊数据库和万方数据库中,检索1980年1月—2017年9月发表的有关静脉使用对比剂(对比剂组)与未使用对比剂(对照组)患者急性肾损伤(AKI)发生率对比的文献,按照纽卡斯尔渥太华规模标准对文献质量进行评价,采用RevMan 5.0软件进行Meta分析。结果 14篇文献(共54 769例患者)纳入研究,结果显示:对比剂组与对照组的AKI发生率差异无统计学意义[P=0.66,相对危险度(RR)=0.95,95%CI(0.77,1.18)]。亚组分析显示:肾功能不全患者中,对比剂组与对照组间[P=0.67,RR=1.04,95%CI(0.86,1.26)]、低渗对比剂组与对照组间[P=0.61,RR=1.09,95%CI(0.79,1.51)]、等渗对比剂组与对照组间[P=0.88,RR=1.03,95%CI(0.70,1.52)]AKI发生率差异均无统计学意义。不同类型对比剂组患者AKI发生率差异无统计学意义。结论与未使用对比剂的患者相比,静脉注射对比剂患者急性肾损伤发生率并未增加。     

Characteristics and risk factors of acute kidney injury progressed to chronic kidney disease: a prospective,observational cohort study

Objective To prospectively investigate the characteristics of acute kidney injury (AKI) that progressed to chronic kidney disease (CKD) (AKI to CKD) in patients hospitalized for AKI, determine the risk factors of AKI to CKD, and preliminarily evaluate the performance of clinical risk factor model for predicting AKI to CKD. Methods This was a prospective, observational cohort study. Patients hospitalized for AKI and without a prior CKD [estimated glomerular filtration rate (eGFR)＜60 ml?min-1?(1.73 m2)-1] were enrolled in Nanfang Hospital of Southern Medical University from April 2015 to December 2019. Survived patients were followed 90 days after AKI and the renal function 90 days post AKI was determined. The primary endpoint was AKI to CKD, defined as new-onset CKD [eGFR＜60 ml?min-1?(1.73 m2)-1 90 days post AKI]. According to AKI progressed to CKD or not, AKI patients were divided into two groups (with or without AKI to CKD). The baseline clinical data of demographics, comorbidities, baseline renal function, AKI severity, receiving hemodialysis or not, and other lab parameters were compared between two groups. The logistic regression model was used to analyze the risk factors of AKI to CKD. Finally, receiver operator characteristic (ROC) curve was drawn to evaluate the performance of clinical risk factor model for predicting AKI to CKD. Results A total of 168 patients with AKI was enrolled in this study[male, n=91; female, n=77; age (44.0±18.4) years], in which 64 patients (38.1%) developed new-onset CKD 90 days post AKI and 104 patients (61.9%) did not. Compared to those without AKI to CKD, patients with AKI to CKD were older, and had a higher proportion of hypertension, lower levels of eGFR and hemoglobin, higher proportion of receiving hemodialysis, and higher level of discharged serum creatinine (all P＜0.05). There was no significant difference in the proportion of diabetes and use of RAS inhibitors, urine protein level, and other lab parameters between two groups. Multivariate logistic regression analysis shows that receiving hemodialysis (OR=2.516, 95%CI 1.251-5.060, P=0.010), hypertension (OR=2.446, 95%CI 1.124-5.324, P=0.024), and lower baseline eGFR (OR=0.975, 95%CI 0.950-0.999, P=0.043) were the independent risk factors for AKI to CKD. The clinical risk factor model including age, receiving hemodialysis, hypertension, and baseline eGFR produced moderate performance for predicting AKI to CKD, with the area under ROC curve of 0.712, 95%CI 0.634-0.790. Conclusions AKI survivors are at high risk for developing CKD. Receiving hemodialysis, hypertension, and lower baseline eGFR are independent risk factors for predicting AKI to CKD. More studies are needed to improve the performance of clinical risk factor model for early detecting high risk patients who will develop AKI to CKD.     

Clinical and pathological features of acute kidney injury in children

Objective: Based on the diagnostic and staging criteria of acute kidney injury (AKI), we analyze the clinical and pathological characteristics of children at different stages of AKI and explored their clinical significances. Methods: 165 children with AKI were divided into stage 1, stage 2, and stage 3 groups. Clinical and pathologic characteristics of AKI children were analyzed. Results: The three groups of patients showed significant differences in age, etiology, pathological damage, and the median recovery time of serum creatinine. Of the 165 patients, the incidence and duration of hematuria showed significant differences among the three groups, and the stage 1 group showed longer duration of proteinuria. Conclusion: The patients were largely in stage 1 and 3. The children with AKI in stage 1 were largely school-age children and acute glomerulonephritis (AGN) was the main etiology. The AKI children in stage 3 were mainly infants, of which the etiology was mainly drugs and septicemia. The pathological type was mainly acute tubulointerstitial nephritis, and the renal function recovery was slow.     

病毒性肺炎相关性急性肾损伤的危险因素及预后分析

目的 探讨病毒性肺炎患者急性肾损伤(acute kidney injury,AKI)的发病率及其危险因素,分析病毒性肺炎患者院内死亡的危险因素.方法 回顾性分析南京医科大学附属南京医院2014年1月至2019年12月病毒性肺炎患者的临床资料.采用二分类Logistic回归分析AKI的危险因素.采用Cox比例风险回归分析...     

重视急性肾损伤的临床研究

急性肾损伤(AKI)发病率和死亡率在世界范围内逐年增加。2012年改善全球肾脏病预后组织(KDIGO)指南明确了新的AKI定义与分期。AKI的新定义给基础研究和常规临床实践带来了巨大的变化,提高了AKI诊断的灵敏度,降低了漏诊率,提高了预测危重患者死亡的能力,临床实用性更强。在此基础上,中国开展了几个大型的、多中心AKI流行病学调查,初步阐明了中国AKI流行病学现状和危险因素。在急性肾损伤的治疗方面,更加强调肾脏的保护与支持,越来越认识到早期干预、液体管理、营养支持以及肾脏替代治疗(RRT)时机的综合管理对AKI预后影响的重要性。     

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。     

Incidence and mortality of postoperative acute kidney injury in non-dialysis patients: comparison between the AKIN and KDIGO criteria

Objectives This retrospective study determines whether the kidney disease: improving global outcomes (KDIGO) criteria are superior to acute kidney injury network (AKIN) criteria in detecting non-dialysis AKI events and predicting mortality in chronic kidney disease (CKD) patients after surgery. Methods Surgical patients who were admitted to the intensive care unit were enrolled. Non-dialysis AKI cases were defined using either KDIGO or AKIN creatinine criteria and stratified by CKD stages. The adjusted hazard ratios (AHRs) for in-hospital mortality are compared to those without AKI. The cumulative survival curves and the predictability for mortality are accessed by Kaplan–Meier method and calculating the area under the curve (AUC) for the receiver operating characteristic (ROC) curve, respectively. Results From a total of 826 postoperative patients, the overall in-hospital mortality rate was 11.6% (96 cases) and that for AKI according to KDIGO and AKIN criteria was 30.0% (248 cases) and 31.0% (256 cases). The cumulative survival curve stratified by CKD and AKI stages were comparable between KDIGO and AKIN criteria. The discriminative power for mortality stratified by CKD stages for KDIGO and AKIN criteria are as followed: all subjects: 0.678 versus 0.670 (both ps?<0.001); non-CKD: 0.800 versus 0.809 (both ps?<0.001); early-stage CKD: 0.676 versus 0.676 (both ps?<0.001); late-stage CKD: 0.674 versus 0.660 (ps were?<0.001 and 0.003). Conclusion The KDIGO criteria are superior to AKIN criteria in predicting mortality after surgery, especially in those with advanced CKD.     

Statins use and the risk of acute kidney injury: a meta-analysis

The association between statins use and the risk of acute kidney injury (AKI) remains elusive. We aimed to evaluate the association of statins use with AKI risk by performing a meta-analysis. Twenty-one studies were included in our meta-analysis by searching electronic databases according to predefined criteria. No significant association between statins use and AKI risk was observed in overall populations, Caucasians, Asians, and patients undergoing cardiac and elective surgery (p?=?0.816, 0.981, 0.18, 0.709, and 0.122). Statins use decreased the risk of contrast-induced AKI (CIN) (p?=?0.005) and increased AKI risk in patients with community acquired pneumonia (CAP) (p?=?0.006). Meta-regression analyses showed almost no impact on the pooled ORs of age and study length for overall populations. Exclusion of any single study had little impact on the pooled ORs. In conclusion, statins use is not associated with the risk of AKI in overall populations, Caucasians, Asians, and patients undergoing cardiac and elective surgery. Statins use decreases the risk of CIN and may increase the risk of AKI in CAP patients.     

Prevention and management of acute kidney injury in the perioperative patient

Acute kidney injury (AKI) does not just describe a set of abnormal blood results, it is also a biomarker of acute illness. It is a common and costly surgical complication, increasing perioperative morbidity and mortality. Key to managing these patients successfully and reducing the massive burden AKI and its sequelae is rapid identification and intervention, not just of patients who have developed AKI but also those at risk. Once identified, robust strategies must be in place to ensure appropriate treatment, identification and treatment of underlying causes, escalation of care and specialist referral if indicated, take place promptly.     

Prevention and management of acute kidney injury in the perioperative patient

Acute kidney injury does not just describe a set of abnormal blood results, it is a medical emergency and biomarker of acute illness. It is a common and costly surgical complication, increasing perioperative morbidity and mortality. Key to managing these patients successfully and reducing the massive burden AKI and its sequelae has on the NHS is rapid identification and intervention, not just of patients who have developed AKI but also those at risk. Once identified, robust strategies must be in place to ensure appropriate treatment, identification and treatment of underlying causes, escalation of care and specialist referral if indicated, take place promptly.     

Value of kidney injury molecule -1 in the diagnosis of acute kidney injury: a Meta analysis

Objective To access the early diagnosis value of kidney injury molecule-1 (KIM-1) in patients with acute kidney injury (AKI) by Meta-analysis. Methods Databases MEDLINE, EMBASE, Pubmed, Elsevier Science Direct, Scopus, Web of Science, Google Scholar, Cochrane Library, China National Knowledge Infrastructure and WanFang Data were retrieved to collect the diagnostic tests on KIM-1 for AKI published before July 2013. The literatures were screened independently by two reviewers according to the inclusion and exclusion criteria, the data were extracted, and the methodological quality was assessed. Statistic software Meta-Disc 1.4 and STATA 12.0 were used to conduct analyses. Results Eighteen articles were included in this study with a total of 3 427 patients. The summary for urinary KIM-1 in the diagnosis of AKI were sensitivity 0.67(95%CI: 0.63, 0.70), specificity 0.80 (95%CI: 0.78, 0.81), positive likelihood ratio 3.53(95%CI：2.73, 4.56), negative likelihood ratio 0.30 (95%CI: 0.21, 0.42), diagnostic odds ratio 15.13(95%CI: 8.40, 27.25), and the area under the curve (AUC) of summary receiver operating characteristic curves (SROC) was 0.865 2. Subgroup analysis revealed the sensitivity, specificity and diagnostic odds ratio of urinary KIM-1 measured after 2 to12 h post operation in diagnosis of AKI after cardiac surgery were 0.88(95%CI: 0.81, 0.93), 0.75(95%CI: 0.71, 0.79) and 30.22 (95%CI: 16.19, 56.42), respectively. The AUC of SROC was 0.923 7. Conclusions KIM-1 as a single indicator has moderate accuracy for early diagnosing AKI, especially with a high diagnostic accuracy in AKI after cardiac surgery.     

解热镇痛药所致急性肾损伤的临床病理特点分析

目的通过对临床和或病理诊断为解热镇痛药急性肾损伤患者的临床资料进行分析及短期随访观察,旨在进一步了解此病的临床特点,力求早期诊断治疗,避免误漏诊。方法收集2000年1月至2012年12月我科经临床和或病理诊断为解热镇痛药所致急性肾损伤患者27例,详细记录并分析所涉及致病药物的种类、致病特点,实验室检查及临床病理的表现,治疗情况,并随访至出院后1年观察肾功能的转归。结果 27例患者表现为不同程度的急性肾损伤,起病时血肌酐109.8~730.1μmol/L。致病药物前三位者依次为含有对乙酰氨基酚者18例(占66.7%)、氨基比林者4例(占1 4.8%)和布洛芬3例(占11.1%)。服药至发病间隔时间1~60 d不等,仅有11例(占40.8%)的患者能够在发病2周内得以诊断。临床表现为肾小管间质病者26例,出现肾性糖尿以及尿α1微球蛋白显著升高,平均尿蛋白为(1.1±0.6)g/d,其中14例经肾活检证实。1例符合肾病综合征,尿蛋白达15.2 g/L,病理诊断为肾小球微小病变伴有肾小管间质病。明确诊断后,所有患者均接受泼尼松龙25~60 mg/d的治疗,5例患者联用免疫抑制剂治疗,总疗程在6个月左右。随访至出院后第1年,10例患者仍遗留明显的慢性肾损害(CKD 3~4期),1例合并乙型肝炎患者死于重症肝病。结论所有在发生急性肾损伤之前曾服用解热镇痛药的患者,均应警惕药物所致肾损害的可能,其中对乙酰氨基酚致病者最常见。肾小管间质病变是最主要临床病理表现,可同时伴有微小病变,出现大量蛋白尿,对可疑情况监测肾功能和及时停药,密切追踪,必要时应给予糖皮质激素的短期治疗。