Analysis of related factors of acute kidney injury in adult minimal change nephrotic syndrome

doi:10.3877/cma.j.issn.2095-3216.2018.01.007

Abstract

Abstract:

Objective

To investigate the related factors of acute kidney injury (AKI) in adult minimal change disease (MCD).

Methods

A retrospective analysis was made in the patients (>18 years old) with first-presented nephrotic syndrome and biopsy-proven MCD from January 1, 2002 to December 31, 2015. The patients were divided into two groups: the AKI group and the non-AKI group. Univariate and multivariate logistic regression were used to analyze the influencing factors associated with the occurrence of AKI. And the interaction of AKI related factors was tested.

Results

A total of 403 patients were included. The ratio between males and females was 1∶1.13. The average age at renal biopsy was 39.5 ± 15.1 years. AKI occurred in 118 cases (29.3%) of the 403 patients. The AKI group had statistically significant differences in age, gender, urinary protein quantification, serum albumin, serum creatinine, blood urea nitrogen, estimated glomerular filtration rate (eGFR), tubular atrophy, and renal interstitial lesions compared with the non-AKI group (P<0.05). Univariate logistic regression analysis showed that the elderly age, maleness, higher urinary protein, tubular atrophy, renal interstitial edema, interstitial fibrosis, inflammatory cell infiltration, and hypertension were the risk factors for the occurrence of AKI in adult MCD. Interaction tests showed that the effect of serum albumin on AKI was significantly affected by renal interstitial fibrosis (P=0.005), and this interaction was still significant after adjustment of such factors as age group, gender, hypertension, urinary protein quantification, tubular atrophy, renal interstitial edema, and renal interstitial cell infiltration (P=0.0 263). In the non-interstitial fibrosis patients, serum albumin increase was an independent protective factor for AKI (adjusted OR, 0.8; 95%CI, 0.7-0.9, P<0.001). In the interstitial fibrosis patients, the influence of serum albumin increase on AKI was not significant (adjusted OR 1.0, 95%CI, 0.9- 1.0, P=0.0 278).

Conclusion

Elderly age, maleness, higher proteinuria, renal tubular atrophy, renal interstitial edema, renal interstitial fibrosis, inflammatory cell infiltration, and hypertension, were risk factors for the occurrence of AKI in adult MCD. The protective effect of serum albumin increase on AKI was influenced by the renal interstitial fibrosis.

Key words: Acute kidney injury, Adult, Minimal change disease, Nephrotic syndrome, Serum albumin

Chen Yang, Guangyan Cai, Pu Chen, Jinling Meng, Jie Wu, Xueguang Zhang, Yong Wang, Shuwen Liu, Di Wu, Xiangmei Chen. Analysis of related factors of acute kidney injury in adult minimal change nephrotic syndrome[J]. Chinese Journal of Kidney Disease Investigation(Electronic Edition), 2018, 07(01): 28-33.

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References 22

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?	非AKI组	AKI组	检验值	P值
总例数	284	118	?	?
年龄(岁)	37.6 ± 13.5	44.1 ± 17.8	4.028	0.001
男性[例(%)]	107 (37.7 )	82 (69.5 )	33.873	<0.001
血清白蛋白(g/L)	21.0 ± 5.1	18.9 ± 4.4	3.899	<0.001
尿蛋白定量(g/d)	5.5 ± 3.3	6.5 ± 3.4	2.746	0.007
血尿素氮(mmol/L)	5.3 ± 2.5	10.7 ± 6.3	12.427	<0.001
血肌酐(μmol/L)	70.4 ± 18.9	148.2 ± 96.3	13.037	<0.001
eGFR[ml/(min·1.73 m²)]	104.7 ± 19.8	62.1 ± 30.4	16.604	<0.001
血红蛋白(g/L)	142.9 ± 18.7	142.6 ± 21.0	0.124	0.953
肾小管蛋白管型[例(%)]	118 (41.5 )	60 (50.8 )	2.921	0.087
肾小管萎缩[例(%)]	97 (34.2 )	61 (51.7 )	10.751	0.001
肾间质水肿[例(%)]	39 (13.9 )	28 (23.7 )	5.770	0.016
肾间质炎细胞浸润[例(%)]	87 (30.6 )	67 (56.8 )	24.114	<0.001
肾间质纤维化[例(%)]	107 (37.7 )	63 (53.4 )	8.434	0.004
肾小动脉透明样变性[例(%)]	27 (9.5 )	16 (13.6 )	1.433	0.231
肾小动脉内膜增厚[例(%)]	74 (26.1 )	35 (29.7 )	0.548	0.459
合并高血压[例(%)]	27 (9.5 )	48 (40.7 )	53.372	<0.001
合并糖尿病[例(%)]	6 (2.1 )	4 (3.4 )	0.560	0.454

?	非AKI组	AKI组	检验值	P值
总例数	284	118	?	?
年龄(岁)	37.6 ± 13.5	44.1 ± 17.8	4.028	0.001
男性[例(%)]	107 (37.7 )	82 (69.5 )	33.873	<0.001
血清白蛋白(g/L)	21.0 ± 5.1	18.9 ± 4.4	3.899	<0.001
尿蛋白定量(g/d)	5.5 ± 3.3	6.5 ± 3.4	2.746	0.007
血尿素氮(mmol/L)	5.3 ± 2.5	10.7 ± 6.3	12.427	<0.001
血肌酐(μmol/L)	70.4 ± 18.9	148.2 ± 96.3	13.037	<0.001
eGFR[ml/(min·1.73 m²)]	104.7 ± 19.8	62.1 ± 30.4	16.604	<0.001
血红蛋白(g/L)	142.9 ± 18.7	142.6 ± 21.0	0.124	0.953
肾小管蛋白管型[例(%)]	118 (41.5 )	60 (50.8 )	2.921	0.087
肾小管萎缩[例(%)]	97 (34.2 )	61 (51.7 )	10.751	0.001
肾间质水肿[例(%)]	39 (13.9 )	28 (23.7 )	5.770	0.016
肾间质炎细胞浸润[例(%)]	87 (30.6 )	67 (56.8 )	24.114	<0.001
肾间质纤维化[例(%)]	107 (37.7 )	63 (53.4 )	8.434	0.004
肾小动脉透明样变性[例(%)]	27 (9.5 )	16 (13.6 )	1.433	0.231
肾小动脉内膜增厚[例(%)]	74 (26.1 )	35 (29.7 )	0.548	0.459
合并高血压[例(%)]	27 (9.5 )	48 (40.7 )	53.372	<0.001
合并糖尿病[例(%)]	6 (2.1 )	4 (3.4 )	0.560	0.454

?		OR (95%CI)	P值
起病时年龄(岁)		1.0 (1.0～ 1.0)	<0.001
年龄分组		?	?
?	青年(<45岁)	参考	?
?	中年(≥45岁)	1.7 (1.0～ 2.8)	0.045
?	老年(≥60岁)	3.7 (1.9～ 7.2)	<0.001
男性(比女性)		3.8 (2.4～6.0)	<0.001
血清白蛋白(g/L)		0.9 (0.9～1.0)	<0.001
尿蛋白定量(g/d)		1.1 (1.0～1.2)	0.007
血尿素氮(mmol/L)		1.4 (1.3～1.5)	<0.001
血肌酐(μmol/L)		1.1 (1.1～ 1.1)	<0.001
eGFR[ml/(min·1.73 m²)]		0.9 (0.9～1.0)	<0.001
血红蛋白(g/L)		1.0 (1.0～1.0)	0.901
肾小管萎缩(%)		2.1 (1.3～3.2)	0.001
蛋白管型(%)		1.5 (0.9～ 2.2)	0.088
肾间质水肿(%)		2.0 (1.1～ 3.4)	0.015
肾间质炎细胞浸润(%)		3.0 (1.9～4.6)	<0.001
肾间质纤维化(%)		1.9 (1.2～2.9)	0.004
肾小动脉内膜增厚(%)		1.2 (0.7～ 1.9)	0.459
肾小动脉透明样变性(%)		1.5 (0.8～ 2.9)	0.234
合并高血压(%)		6.5 (3.8～11.2)	<0.001
合并糖尿病(%)		1.6 (0.5～ 5.9)	0.458

?		OR (95%CI)	P值
起病时年龄(岁)		1.0 (1.0～ 1.0)	<0.001
年龄分组		?	?
?	青年(<45岁)	参考	?
?	中年(≥45岁)	1.7 (1.0～ 2.8)	0.045
?	老年(≥60岁)	3.7 (1.9～ 7.2)	<0.001
男性(比女性)		3.8 (2.4～6.0)	<0.001
血清白蛋白(g/L)		0.9 (0.9～1.0)	<0.001
尿蛋白定量(g/d)		1.1 (1.0～1.2)	0.007
血尿素氮(mmol/L)		1.4 (1.3～1.5)	<0.001
血肌酐(μmol/L)		1.1 (1.1～ 1.1)	<0.001
eGFR[ml/(min·1.73 m²)]		0.9 (0.9～1.0)	<0.001
血红蛋白(g/L)		1.0 (1.0～1.0)	0.901
肾小管萎缩(%)		2.1 (1.3～3.2)	0.001
蛋白管型(%)		1.5 (0.9～ 2.2)	0.088
肾间质水肿(%)		2.0 (1.1～ 3.4)	0.015
肾间质炎细胞浸润(%)		3.0 (1.9～4.6)	<0.001
肾间质纤维化(%)		1.9 (1.2～2.9)	0.004
肾小动脉内膜增厚(%)		1.2 (0.7～ 1.9)	0.459
肾小动脉透明样变性(%)		1.5 (0.8～ 2.9)	0.234
合并高血压(%)		6.5 (3.8～11.2)	<0.001
合并糖尿病(%)		1.6 (0.5～ 5.9)	0.458

?	例数	无调整		模型Ⅰ		模型Ⅱ
?	例数	OR(95%CI)	P值	OR(95%CI)	P值	OR(95%CI)	P值
无肾间质纤维化	233	0.8 (0.8～ 0.9)	<0.001	0.8 (0.7～ 0.9)	<0.001	0.8 (0.7～ 0.9)	<0.001
有肾间质纤维化	170	1.0 (0.9～1.0)	0.188	0.9 (0.9～ 1.0)	0.139	1.0 (0.9～1.0)	0.245
总体	403	0.9 (0.9～1.0)	<0.001	0.9 (0.8～0.9)	<0.001	0.9 (0.8～1.0)	0.001
交互作用检验^a	-	-	0.0050	-	0.0197	-	0.0263

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