获得性孤立肾患者的临床特征及危险因素分析

Analysis of clinical characteristics and risk factors of patients with acquired solitary kidney

目的分析获得性孤立肾(ASK)患者的临床特征及危险因素。方法回顾性收集2011年1月至2022年11月武汉大学人民医院收治的336例ASK患者的临床资料,采用Kaplan-Meier生存曲线比较不同分组ASK患者术后终末期肾病累积发生率。采用单因素和多因素Logistic回归分析ASK患者术后肾功能损伤进展的危险因素。结果术后患者高血压病147例(43.8%),冠状动脉疾病34例(10.1%),心脑血管事件37例(11.0%),糖尿病53例(15.7%),肝硬化8例(2.4%),高脂血症105例(31.3%),贫血137例(40.8%),高尿酸血症127例(37.8%),血尿239例(71.1%),对侧泌尿系手术史68例(20.2%),蛋白尿149例(44.3%)。单因素Logistic回归分析结果显示肾切除时长、肾切除年龄、术前高血压病、糖尿病、高尿酸血症、蛋白尿、对侧泌尿系手术史、贫血、非腹腔镜切除与术后估算肾小球滤过率<60 ml/(min·1.73 m^(2))相关(均P<0.05)。多因素Logistic回归分析结果显示肾切除时长≥5年、肾切除年龄≥45岁、术前高血压病、高尿酸血症、蛋白尿微量及以上、对侧泌尿系手术史、贫血是患者术后估算肾小球滤过率<60 ml/(min·1.73 m^(2))的独立危险因素(均P<0.05)。结论以临床病因为主的ASK患者合并高血压病、糖尿病等比例较高,其中存在肾切除时长≥5年、肾切除年龄≥45岁、术前高血压病、高尿酸血症、蛋白尿微量及以上、对侧泌尿系手术史、贫血的患者术后更容易出现肾功能损伤进展。

Objective To analyze the clinical characteristics and risk factors of patients with acquired solitary kidney(ASK).Methods The clinical data of 336 ASK patients admitted to Renmin Hospital of Wuhan University from January 2011 to November 2022 were retrospectively collected.Kaplan-Meier survival curve was used to compare the cumulative incidence of postoperative end-stage renal disease in different groups of ASK patients.Univariate and multivariate Logistic regression were used to analyze the risk factors for the progression of postoperative renal dysfunction in patients with ASK.Results There were 147 cases(43.8%)of hypertension,34 cases(10.1%)of coronary artery disease,37 cases(11.0%)of cardiovascular and cerebrovascular events,53 cases(15.7%)of diabetes,8 cases(2.4%)of liver cirrhosis,105 cases(31.3%)of hyperlipidemia,137 cases(40.8%)of anemia,127 cases(37.8%)with hyperuricemia,239 cases(71.1%)with hematuria,68 cases(20.2%)with contralateral urinary tract surgery history and 149 cases(44.3%)with proteinuria.Univariate Logistic regression analysis showed that the duration of nephrectomy,age of nephrectomy,preoperative hypertension,hyperuricemia,proteinuria,history of contralateral urinary tract surgery,anemia,and non-laparoscopic were associated with postoperative estimated glomerular filtration rate<60 ml/(min·1.73 m^(2))(all P<0.05).Multivariate Logistic regression analysis showed that the duration of nephrectomy≥5 years,age of nephrectomy≥45 years,hypertension,hyperuricemia,urinary protein trace or above,history of contralateral urinary tract surgery and anemia were independent risk factors for postoperative estimated glomerular filtration rate<60 ml/(min·1.73 m^(2)).Conclusion The proportion of ASK patients with clinical etiology is high,such as hypertension and diabetes.Among them,patients with kidney resection time≥5 years,kidney resection age≥45 years,hypertension,hyperuricemia,urinary protein trace or above,history of contralateral urinary tract surgery,and anemia are more likely to have postoperative renal function progression.