儿童肾病综合征合并急性肾损伤的临床特点及危险因素分析

Clinical characteristics and risk factors of acute kidney injury in children with nephrotic syndrome

目的分析肾病综合征(nephrotic syndrome,NS)患儿合并急性肾损伤(acute kidney injury,AKI)的临床特征、预后及危险因素。方法回顾性分析2016年1月至2019年12月深圳市儿童医院住院的NS患儿,将合并AKI患儿50例定义为NS-AKI组,收集同期性别、年龄相匹配的NS非AKI患儿50例为对照组。NS-AKI组与对照组均为男36例(72.0%),女14例(28.0%);年龄5.5(2.0,8.0)岁。比较两组患儿临床特征、实验室检查指标,分析NS患儿合并AKI的危险因素及预后情况。采用χ^(2)检验、秩和检验、多因素logistic回归分析。结果NS-AKI组的住院天数[16(9.0,21.3)d]、血尿[28.0%(14/50)]、高血压[32.0%(16/50)]、感染[72.0%(36/50)]、使用他克莫司[48.0%(24/50)]、尿素[17.0(10.0,24.7)mmol/L]、尿酸[616.8(476.8,764.0)μmol/L]、胱抑素C[1.7(1.4,2.4)mg/L]、纤维蛋白原[5.7(4.7,7.2)g/L]、三酰甘油[2.9(2.0,4.8)mmol/L]均高于对照组[8(5.0,10.0)d、6.0%(3/50)、4.0%(2/50)、50.0%(25/50)、24.0%(12/50)、4.3(3.4,6.0)mmol/L、329.9(273.7,435.8)μmol/L、0.9(0.8,1.0)mg/L、4.7(3.5,5.9)g/L、2.0(1.5,3.8)mmol/L],血清白蛋白[14.2(12.5,16.9)g/L]、血钠[131.8(129.0,134.2)mmol/L]均低于对照组[17.8(12.7,23.6)g/L、135.3(133.1,137.8)mmol/L],差异均有统计学意义(均P<0.05)。多因素logistic回归分析提示,尿素氮、胱抑素C、纤维蛋白原升高是NS合并AKI的独立危险因素(OR=1.516、48.087、1.569,均P<0.05)。NS-AKI组患儿出院时肾功能恢复43例、好转5例、未好转2例;随访时肾功能恢复49例、慢性肾脏病5期1例。结论尿素氮、胱抑素C以及纤维蛋白原升高是NS合并AKI的独立危险因素;同时大多数NS合并AKI患儿肾功能可以完全恢复。

Objective To analyze the clinical characteristics,prognosis,and risk factors of nephrotic syndrome(NS)complicated with acute kidney injury(AKI).Methods Children with NS were retrospectively enrolled from Shenzhen Children's Hospital from January 2016 to December 2019.Of these,50 children with AKI were defined as the NS-AKI group,and 50 children without AKI matched by both gender and age as the control group.There were 36 males(72.0%)and 14 females(28.0%)in both NS-AKI group and control group,aged 5.5(2.0,8.0)years.The clinical characteristics and laboratory examination indexes of the two groups were compared,and the risk factors and prognosis of NS complicated with AKI were analyzed.χ^(2) test,rank sum test,and multiple logistic regression analysis were used.Results In the NS-AKI group,the length of hospital stay[16(9.0,21.3)d],proportions of hematuria[28.0%(14/50)],hypertension[32.0%(16/50)],infection[72.0%(36/50)],and tacrolimus use[48.0%(24/50)],and levels of urea[17.0(10.0,24.7)mmol/L],uric acid[616.8(476.8,764.0)μmol/L],cystatin C[1.7(1.4,2.4)mg/L],fibrinogen[5.7(4.7,7.2)g/L],and triacylglycerol[2.9(2.0,4.8)mmol/L]were higher than those in the control group[8(5.0,10.0)d,6.0%(3/50),4.0%(2/50),50.0%(25/50),24.0%(12/50),4.3(3.4,6.0)mmol/L,329.9(273.7,435.8)μmol/L,0.9(0.8,1.0)mg/L,4.7(3.5,5.9)g/L,and 2.0(1.5,3.8)mmol/L],and the levels of serum albumin[14.2(12.5,16.9)g/L]and serum sodium[131.8(129.0,134.2)mmol/L]were lower than those in the control group[17.8(12.7,23.6)g/L and 135.3(133.1,137.8)mmol/L],with statistically significant differences(all P<0.05).Multivariate logistic regression analysis indicated that urea nitrogen,cystatin C,and fibrinogen were independent risk factors for NS complicated with AKI(OR=1.516,48.087,and 1.569;all P<0.05).At the discharge of children with NS-AKI,the renal function in 43 cases returned to normal,which was improved in 5 cases and remained unchanged in 2 cases.During the follow-up,except for 1 case developed stage 5 chronic kidney disease,the renal function in other 49 cases was normalized.Conclusions Independent risk factors for NS complicated with AKI include increased urea nitrogen,cystatin C,and fibrinogen.Renal function can return to normal in most NS-AKI children.