Analysis of risk factors of urinary calculi-related obstructive nephropathy and post-lithotripsy acute kidney injury

doi:10.3877/cma.j.issn.2095-3216.2023.06.004

Abstract

Abstract:

Objective

To explore the risk factors of urinary calculi-related obstructive nephropathy and post-lithotripsy acute kidney injury (AKI).

Methods

Patients with urinary calculi who underwent lithotripsy treatment in the hospitals from January 2016 to January 2019 were selected. Multivariate logistic regression method was used to analyze the related factors of obstructive nephropathy and post-lithotripsy AKI.

Results

Among the 2159 patients, 373 patients (17.28%) had obstructive nephropathy. Among the patients with obstructive nephropathy, the female patients accounted for 54.2% and the male accounted for 45.8%, with an average age of 57.14±11.52 years. The multivariate logistic regression analysis after adjustment showed that older age (OR=1.054, 95%CI: 1.042-1.066, P<0.001), increased blood uric cid (OR=1.004, 95%CI: 1.003-1.005, P<0.001), increased carbon dioxide combining power (OR=0.820, 95%CI: 0.783-0.859, P<0.001), and decreased hemoglobin (OR=0.991, 95%CI: 0.983-0.998, P=0.014) were the risk factors of the obstructive nephropathy. A total of 174 patients developed AKI after the lithotripsy (8.06%). Multivariate logistic regression analysis showed that percutaneous nephrolithotripsy (OR=1.658, 95%CI: 1.209-2.274, P=0.002), elevated blood uric acid (OR=1.002, 95%CI: 1.000-1.003, P=0.019) and elevated carbon dioxide combining power were the risk factors of post-lithotripsy AKI (P<0.05).

Conclusion

Older age and increased blood uric acid were related to the obstructive nephropathy. percutaneous nephrolithotripsy and elevated blood uric acid were related to the post-lithotripsy AKI.

Key words: Obstructive nephropathy, Acute kidney injury, Urinary calculi, Blood uric acid, Risk factors

Huan Wang, Yinghui Zhang, Dewei Zhang, Yanhua Jin, Yu Xin, Wei Chen, Zhiyong Guo, Yanning Zhang, Xin Guan. Analysis of risk factors of urinary calculi-related obstructive nephropathy and post-lithotripsy acute kidney injury[J]. Chinese Journal of Kidney Disease Investigation(Electronic Edition), 2023, 12(06): 323-328.

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References 22

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性别	血清肌酐(μmol/L)	eGFR [ml/(min·1.73 m²)]
女性	≤62	144×(Scr/62)^－0.329×(0.993)^年龄
	>62	144×(Scr/62)^－1.209×(0.993)^年龄
男性	≤80	141×(Scr/80)^－0.411×(0.993)^年龄
	>80	141×(Scr/80)^－1.209×(0.993)^年龄

性别	血清肌酐(μmol/L)	eGFR [ml/(min·1.73 m²)]
女性	≤62	144×(Scr/62)^－0.329×(0.993)^年龄
	>62	144×(Scr/62)^－1.209×(0.993)^年龄
男性	≤80	141×(Scr/80)^－0.411×(0.993)^年龄
	>80	141×(Scr/80)^－1.209×(0.993)^年龄

变量	非梗阻性肾病(n＝1786)	梗阻性肾病(n＝373)	统计量	P值
性别[例(%)]			χ²＝3.733	0.053
女	869(48.7)	202(54.2)
男	917(51.3)	171(45.8)
年龄(岁)	49.9±12.0	57.1±11.5	t＝10.758	<0.001
高血压[例(%)]	537(30.1)	176(47.2)	χ²＝40.877	<0.001
糖尿病[例(%)]	271(15.2)	106(28.4)	χ²＝37.556	<0.001
血清肌酐(μmol/L)	75.0±22.0	123.0±36.0	Z＝－28.137	<0.001
尿酸(μmol/L)	371.7±101.2	433.5±116.9	t＝－10.424	<0.001
总胆固醇(mmol/L)	4.8±1.1	4.66±1.0	t＝1.458	0.145
甘油三酯(mmol/L)	2.2±1.5	2.3±1.3	t＝－0.419	0.675
LDL(mmol/L)	2.6±1.4	2.5±1.0	t＝1.091	0.276
CO₂CP(mmol/L)	26.0±3.0	22.0±5.0	Z＝－12.294	<0.001
白蛋白(g/L)	42.0±5.0	41.0±5.0	Z＝－3.237	0.001
血红蛋白(g/L)	133.3±16.7	128.3±18.9	t＝5.138	<0.001
尿pH值	7.0±3.0	7.0±3.0	Z＝－0.240	0.810
尿红细胞(个/HPF)	211.1±1101.1	188.2±971.5	t＝0.373	0.709
尿蛋白(mg/L)	0	0	Z＝－2.026	0.043

变量	非梗阻性肾病(n＝1786)	梗阻性肾病(n＝373)	统计量	P值
性别[例(%)]			χ²＝3.733	0.053
女	869(48.7)	202(54.2)
男	917(51.3)	171(45.8)
年龄(岁)	49.9±12.0	57.1±11.5	t＝10.758	<0.001
高血压[例(%)]	537(30.1)	176(47.2)	χ²＝40.877	<0.001
糖尿病[例(%)]	271(15.2)	106(28.4)	χ²＝37.556	<0.001
血清肌酐(μmol/L)	75.0±22.0	123.0±36.0	Z＝－28.137	<0.001
尿酸(μmol/L)	371.7±101.2	433.5±116.9	t＝－10.424	<0.001
总胆固醇(mmol/L)	4.8±1.1	4.66±1.0	t＝1.458	0.145
甘油三酯(mmol/L)	2.2±1.5	2.3±1.3	t＝－0.419	0.675
LDL(mmol/L)	2.6±1.4	2.5±1.0	t＝1.091	0.276
CO₂CP(mmol/L)	26.0±3.0	22.0±5.0	Z＝－12.294	<0.001
白蛋白(g/L)	42.0±5.0	41.0±5.0	Z＝－3.237	0.001
血红蛋白(g/L)	133.3±16.7	128.3±18.9	t＝5.138	<0.001
尿pH值	7.0±3.0	7.0±3.0	Z＝－0.240	0.810
尿红细胞(个/HPF)	211.1±1101.1	188.2±971.5	t＝0.373	0.709
尿蛋白(mg/L)	0	0	Z＝－2.026	0.043

变量	Wald卡方	P值	OR值(95%CI)
年龄(岁)	81.160	<0.001	1.054(1.042～1.066)
高血压	2.013	0.156	0.826(0.635～1.076)
糖尿病	0.512	0.474	0.894(0.657～1.216)
尿酸(μmol/L)	44.308	<0.001	1.004(1.003～1.005)
CO₂CP(mmol/L)	70.259	<0.001	0.820(0.783～0.859)
白蛋白(g/L)	1.432	0.231	0.980(0.948～1.013)
血红蛋白(g/L)	6.078	0.014	0.991(0.983～0.998)
尿蛋白(mg/L)	0.002	0.968	1.005(0.774～1.305)

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