急性肾损伤患者尿沉渣评分与肾损伤严重程度的关系

The association of urinary sediment with severity in patients with acute kidney injury

目的探讨以肾小管上皮细胞及颗粒管型为基础建立的尿沉渣评分系统与急性肾损伤(AKI)病变严重程度的关系。方法 60例AKI患者,取晨尿由专人双盲用相差显微镜计数肾小管上皮细胞及颗粒管型,依据尿沉渣评分系统予以评分,依据RIFLE[危险(risk)、损伤(injury)、衰竭(loss)、丧失(failur)、终末期肾脏病(end-stage kidney disease)]标准修改方案进行AKI分期,以AKI的分期加重、需要透析治疗或者院内死亡为恶化标准,研究尿沉渣评分与AKI恶化的关系,Logistic回归分析AKI恶化的危险因素。结果 AKI 1期患者的尿沉渣评分明显低于AKI 3期的患者(0.72±0.64 vs.1.36±0.97,P<0.05);40%的AKI患者病情恶化,恶化的患者尿沉渣评分明显高于未恶化者(1.88±0.74 vs.0.52±0.56,P<0.05);多元逐步Logistic回归分析显示,尿沉渣评分及肌酐是AKI恶化的独立危险因素。结论尿沉渣评分可以作为AKI患者病情严重程度及病情恶化的预测指标。

ObjectiveTo investigate the association of urinary sediment scoring system created on the basis of the number of renal tubular epithelial cells and granular casts with the severity of acute kidney injury. Methods Of 60 patients consulted for AKI, fresh morning urine was examined by two experts with phase-contrast microscopy, who did not know clinical information, counting the number of renal tubular epithelial cells and granular casts, scored on the basis of urinary sediment grading system, staged AKI on the base of the RIFLE standard, the worsening of AKI was progressing to higher AKI network stage, dialysis, or death. The association of score of urinary sediment with worsening of AKI was investigated, then the difference between worsening group with not worsening group was compared, the relationship of score of urinary sediment and the risk factors of worsening in AKI were analyzed by Logistic regression analysis. ResultsThe urinary sediment scores were lowest in those with stage 1 and highest in stage 3 of AKI （0.72±0.64vs. 1.36±0.97,P〈0.05）. 40% patients experienced worsening of AKI, the urinary sediment scores of worsening group were significantly higher than that of not worsening group （1.88±0.74vs.0.52±0.56,P〈0.05）. Multivariate stepwise Logistic regression analysis showed that the urinary sediment scores and serum creatinine were the independent risk factors of AKI worsening. ConclusionThe urinary sediment score may be a useful tool to predict worsening of AKI.