儿童肾病综合征合并急性肾损伤的临床特点及危险因素分析题录

目的分析肾病综合征(nephrotic syndrome, NS)患儿合并急性肾损伤(acute kidney injury, AKI)的临床特征、预后及危险因素。方法回顾性分析2016年1月至2019年12月深圳市儿童医院住院的NS患儿, 将合并AKI患儿50例定义为NS-AKI组, 收集同期性别、年龄相匹配的NS非AKI患儿50例为对照组。NS-AKI组与对照组均为男36例(72.0%), 女14例(28.0%);年龄5.5(2.0, 8.0)岁。比较两组患儿临床特征、实验室检查指标, 分析NS患儿合并AKI的危险因素及预后情况。采用χ2检验、秩和检验、多因素logistic回归分析。结果 NS-AKI组的住院天数16(9.0, 21.3)d]、血尿28.0%(14/50)]、高血压32.0%(16/50)]、感染72.0%(36/50)]、使用他克莫司48.0%(24/50)]、尿素17.0(10.0, 24.7)mmol/L]、尿酸616.8(476.8, 764.0)μmol/L]、胱抑素C1.7(1.4, 2.4)mg/L]、纤维蛋白原5.7(4.7, 7...

Clinical characteristics and risk factors of acute kidney injury in children with nephrotic syndrome

Objective　To analyze the clinical characteristics, prognosis, and risk factors of nephrotic syndrome (NS) complicated with acute kidney injury (AKI). Methods　Children with NS were retrospectively enrolled from Shenzhen Children's Hospital from January 2016 to December 2019. Of these, 50 children with AKI were defined as the NS-AKI group, and 50 children without AKI matched by both gender and age as the control group. There were 36 males (72.0%) and 14 females (28.0%) in both NS-AKI group and control group, aged 5.5 (2.0, 8.0) years. The clinical characteristics and laboratory examination indexes of the two groups were compared, and the risk factors and prognosis of NS complicated with AKI were analyzed. χ² test, rank sum test, and multiple logistic regression analysis were used. Results　In the NS-AKI group, the length of hospital stay 16 (9.0, 21.3) d], proportions of hematuria 28.0% (14/50)], hypertension 32.0% (16/50)], infection 72.0% (36/50)], and tacrolimus use 48.0% (24/50)], and levels of urea 17.0 (10.0, 24.7) mmol/L], uric acid 616.8 (476.8, 764.0) μmol/L], cystatin C 1.7 (1.4, 2.4) mg/L], fibrinogen 5.7 (4.7, 7.2) g/L], and triacylglycerol 2.9 (2.0, 4.8) mmol/L] were higher than those in the control group 8 (5.0, 10.0) d, 6.0% (3/50), 4.0% (2/50), 50.0% (25/50), 24.0% (12/50), 4.3 (3.4, 6.0) mmol/L, 329.9 (273.7, 435.8) μmol/L, 0.9 (0.8, 1.0) mg/L, 4.7 (3.5, 5.9) g/L, and 2.0 (1.5, 3.8) mmol/L], and the levels of serum albumin 14.2 (12.5, 16.9) g/L] and serum sodium 131.8 (129.0, 134.2) mmol/L] were lower than those in the control group 17.8 (12.7, 23.6) g/L and 135.3 (133.1, 137.8) mmol/L], with statistically significant differences (all P<0.05). Multivariate logistic regression analysis indicated that urea nitrogen, cystatin C, and fibrinogen were independent risk factors for NS complicated with AKI (OR=1.516, 48.087, and 1.569; all P<0.05). At the discharge of children with NS-AKI, the renal function in 43 cases returned to normal, which was improved in 5 cases and remained unchanged in 2 cases. During the follow-up, except for 1 case developed stage 5 chronic kidney disease, the renal function in other 49 cases was normalized. Conclusions　Independent risk factors for NS complicated with AKI include increased urea nitrogen, cystatin C, and fibrinogen. Renal function can return to normal in most NS-AKI children.