伴肾皮质坏死急性肾损伤患者的临床特点及预后

Clinical and prognostic features of acute kidney injury with renal cortical necrosis

目的:总结肾皮质坏死(RCN)患者的临床特点和预后。方法:回顾性分析2000年1月至2021年7月就诊于国家肾脏疾病临床医学研究中心,并经肾脏MRI或肾穿刺活检确诊RCN患者的临床表现、实验室检查及预后转归。结果:20例患者均以急性肾损伤起病,其中妊娠相关RCN 13例(8例患者合并血栓性微血管病,1例合并抗磷脂抗体综合征,3例合并HELLP综合征);非妊娠相关RCN7例(2例合并脓毒症,其中1例同时伴冷球蛋白血症,2例伴动脉血管疾病,3例系统性红斑狼疮伴抗磷脂抗体综合征)。与非妊娠相关RCN组相比,妊娠相关RCN组肾功能损害进展速度快,更快进入无尿期,且急性心力衰竭发生率更高。妊娠相关RCN患者中9例进入终末期肾病(ESRD),而非妊娠相关患者均未进入ESRD。结论:妊娠相关RCN肾脏预后差,肾功能恶化进展快,预后更差,临床须高度重视。

Objective:To summarize the characteristics and prognosis of renal cortical necrosis(RCN)associated acure kidney injury(AKI).Methodology:Retrospectively analysis of clinical manifestations,laboratory examinations and prognosis of AKI patients who were diagnosed with RCN from January 2000 to July 2021.Results:Twenty AKI with RCN patients were included.Among 13 pregnancy-related RCN,8 cases were accompanied by thrombotic microangiopathy(TMA),1 case by antiphospholipid antibody syndrome,and 3 by HELLP syndrome.In 7 non-pregnancy-related RCN group,2 cases were secondary to sepsis,3 cases were due to vascular disease,and 3 cases were secondary to systemic lupus erythematosus with antiphospholipid antibody syndrome.Renal function impairment progressesd rapidly in pregnancy-related RCN patients,and had more severe acute heart failure than the non-pregnant group.In terms of prognosis,9 patients with pregnancy-related RCN deteriorated to end stage kidney disease(ESRD),while all non-pregnancy-related patients were free of dialysis.Conclusion:Pregnancy-related RCN patients had poor prognosis,rapid deterioration of renal function and pay more attention in clinic.