草酸性肾病的临床病理特点及预后分析

Clinico-pathological characteristics and outcome of patients with biopsy-proven oxalate nephropathy

目的:探讨草酸性肾病的病因、临床病理特点、治疗及预后。方法:回顾性分析2013年1月至2018年4月期间经肾活检确诊为草酸性肾病患者,分析其病因、临床病理特点、治疗及预后。结果:共收集52例草酸性肾病患者男性39例、女性13例,平均年龄49. 4±12. 3岁。49例自体肾,3例移植肾; 2例为原发性高草酸尿症,余50例继发性草酸性肾病,病因包括药物(静脉维生素C最为常见)、摄入富含草酸食物或化学中毒等。最常见的临床表现为少尿/无尿(50. 0%),自体肾表现为急性肾损伤(AKI) 1期、AKI 2期、AKI 3期、慢性肾功能不全基础上出现AKI(ACKD)分别占4. 1%、8. 2%、67. 3%、20. 4%。病程中最高血清肌酐为783. 2±425. 2μmol/L,突出表现为肾小管损伤指标异常,9例行24h草酸定量检测均升高(90. 35±35. 14 mg/24h)。肾脏病理均表现为草酸钙结晶沉积伴急性肾小管间质性损伤。51. 9%的患者接受肾脏替代治疗,以及泼尼松、维生素B6等药物治疗。随访时间12. 1±15. 6月,2例患者进入终末期肾病,33例肾功能恢复正常,恢复时间为56±39d。结论:草酸性肾病的病因多样,继发性草酸性肾病主要病因为药物、高草酸食物和中毒,临床表现为AKI或ACKD,肾活检见草酸钙沉积及肾小管间质急性损伤,半数患者需要肾脏替代治疗,去除诱因并积极治疗后,多数患者肾功能恢复正常。

Objective: To investigate the etiology,clinicopathological features,treatment and prognosis of oxalate nephropathy(OxN). Methodology: A retrospective analysis of patients diagnosed as OxN by renal biopsy from January 2013 to April 2018 in Jinling Hospital was performed.The etiology and clinicopathological characteristics of the patients were analyzed. Results: A total of 52 cases of OxN were collected,including 39 males and 13 females. The average age was49. 4±12. 3 years.Two cases were primary hyperoxaluria and 50 cases were secondary OxN. The most common cause was medication,following by ingestion of foods rich in oxalate and poisoning. The most frequent chief complains were oliguria/anuria( 50. 0%).In native kidney,AKI stage 1,2,3 and AKI on CKD( ACKD) accounted for 4. 1%,8. 2%,67. 3%,and20. 4%,respectively.The highest serum creatinine( SCr) during hospitalization was( 783. 2 ± 425. 2) μmol/L. Urinary oxalate excretion increased in all 9 cases detection with average of( 90. 35 ± 35. 14) mg/24 h. Kidney biopsy showed extensive calcium oxalate crystal deposition with acute tubulointerstitial nephritis.Twenty-seven patients( 51. 9%) received continuous renal replacement therapy.At the end of follow-up of( 12. 1±15. 6) months,2 patients reached ESRD. In 33 of41( 80. 5%) patients who followed up for >3 months,renal function returned to normal in 56±39 days. Conclusion: OxN is associated with a cluster of etiologies and manifestations as AKI or ACKD.Half of the patients required renal replacement therapy.Most of the patients had renal function recovery.