慢性肾脏病基础上急性肾损伤的病因和预后分析——附38例报告

目的:探讨慢性肾脏病(chronic kidney disease,CKD)基础上急性肾损伤(acute kidney injury,AKI)的病因和预后的影响因素.方法:对38例CKD基础上的AKI患者按照RIFLE标准对AKI进行分层诊断,并对38例患者的病因、预后等临床资料进行数理分析.结果:38例中,符合R标准2例(5%)、I标准3例(8%)、F标准5例(13%),L标准11例(29%),E标准17例(45%);其中符合F、L、E标准33例,占87%.导致AKI最常见的病因是恶性高血压(32%)和严重感染(21%).CKD患者发生AKI后的血清肌酐较发生AKI前明显升高,GFR则明显降低(均为P＜0.01).需要肾脏替代治疗28例(74%),其中发生终末期肾脏病(end-stage renal disease,ESRD)21例,占55%;无需肾脏替代治疗7例(18%);死亡3例,病死率8%.多变量Logistic 回归分析显示,恶性高血压分别是CKD基础上的AKI患者需要肾脏替代治疗(r＝2.42,P＜0.05)和发生ESRD(r＝2.08,P＜0.05)的独立危险因素;而少尿、感染和CKD的基础病因与患者的肾脏预后无关 (P＞0.05).结论:恶性高血压和严重感染是CKD患者并发AKI的主要病因,恶性高血压是这类患者肾脏预后不良的独立危险因素,严格控制血压是预防CKD患者并发AKI和改善患者预后的关键措施之一.

Analysis on causes and outcome of the patients with acute kidney injury on chronic kidney disease——a report of 38 cases

Objective:To study the etiology and to evaluate the outcome of acute kidney injury(AKI) on chronic kidney disease(CKD).Methods:Thirty-eight patients with AKI on CKD were diagnosed hierarchically according to RIFLE criteria.The clinical data including etilolgy and prognosis were collected and analyzed retrospectively.Results:Among 38 cases,there were 2(5%),3(8%),5(13%),11(29%) and 17(45%) cases fulfilled R,I,F,L and E-criteria respectively.Thirty-three cases(87%) fulfilled F,L,E-criteria.The most common causes of AKI were malignant hypertension(32%) and serious infection(21%) in patients with CKD.The serum creatinine of AKI on CKD patients was increased obviously than that of baseline in CKD,while GFR was decreased(P<0.01).Twenty-eight(74%)patients with AKI on CKD needed hemodialysis,while 7 patients did not need hemodialysis any more.Twenty-one(55%)patients developed end stage renal disease(ESRD).Three(8%) patients died.By multivariate Logistic regression analysis,malignant hypertension was the independent risk factor for renal replacement therapy(r=2.42,P<0.05) and ESRD(r=2.08,P<0.05),whereas oliguria,infection and underline causes of CKD were not associated with renal outcome(P>0.05).Conclusion:Malignant hypertension and serious infection are the common causes of patients with AKI on CKD.Malignant hypertension is an independent risk factor for poor renal outcome.Hypertension sould be controlled rigorously to prevent the onset of AKI on CKD.