慢性肾脏病并发急性肾损伤和无慢性肾脏病基础急性肾损伤的预后比较分析

目的 分析不同分期慢性肾脏病（CKD）并发急性肾损伤患者的预后,了解急性肾损伤与CKD短期预后的关系.方法 回顾性分析2010年1月～2013年6月我院临床和病理确诊为CKD并发急性肾损伤住院患者的临床和病理资料,并比较其与无CKD基础急性肾损伤患者在短期（6个月）预后上的差异.按基础肾功能情况将CKD并发急性肾损伤患者分为4组,即CKD1期组、CKD2期组、CKD3期组和CKD4期组;按照危险、损伤、衰竭、肾功能丧失和终期肾脏病（RIFLE）标准将CKD并发急性肾损伤和无CKD基础急性肾损伤分别分级.结果 57例CKD并发急性肾损伤患者水肿、高血压、肾病范围蛋白尿、肾病综合征和血尿的发生率高于无CKD基础急性肾损伤患者,差异有统计学意义（P＜0.05）;前者的血红蛋白值高于后者（P＜0.05）,血清白蛋白值低于后者（P＜0.05）,肉眼血尿发生率比较,差异无统计学意义（P＞0.05）;两组患者肾功能各有不同程度的恢复,无CKD基础急性肾损伤患者肾功能恢复比例相对高,但两者比较差异无统计学意义（P＞0.05）;两组患者恢复时间比较,差异有统计学意义（P＜0.01）,无CKD基础急性肾损伤肾功能恢复时间相对短.结论 急性肾损伤影响CKD的预后,加速CKD的病情进展;无论有无CKD基础,急性肾损伤均是CKD和终末期肾病（ESRD）的危险因素.

A retrospective contrast analysis of outcome between acute kidney injury with and without chronic kidney disease

Objective To compare outcome between acute kidney injury （AKI） on the basis of chronic kidney disease（CKD） and AKI without CKD. Methods Data of 57 cases of CKD with AKI and of 15 cases of AKI without CKD admitted to Second Affiliated Hospital of Xingtai Medical College from January 2010 to June 2013 were retrospectively analyzed. Kidney biopsy was performed on all of these pa- tients. Differences of clinicopathology and short period （ six months） outcome between CKD with AKI and AKI without CKD were compared. Results The incidence of edema, high blood pressure,nephrotic level of proteinuria（24 h proteinuria~〉3.5 g） ,nephrotic syndrome and hematuria in CKD with AKI were signif- icantly higher than those AKI without CKD （ all P 〈 0.05 ）. The hemoglobin of patients with AKI on basis of CKD was significantly higher than those AKI without CKD （P = 0.046 ）, and the hypoproteinemia of the former was lower than the latter（ P = 0. 019 ） o There was no significant difference between groups （P 〉 0.05 ）. The incidence of complete and partial recovery of renal function and ESRD stage were not signifi- cant between the two groups （ P 〉 0.05 ）. The period of renal function recovery in CKD with AKI was shorter than AKI without CKD （ P = 0.006）. Conclusions AKI affects the outcome of CKD, and accelerates progressive CKD. AKI is a risk factor of CKD and ESRD on the basis of CKD or not.