Correlation of Red Blood Cell Casts With Renal Dysfunction in Patients With Infection-Related Glomerulonephritis.

IF 3.7 3区 医学 Q2 MEDICAL LABORATORY TECHNOLOGY
Mineaki Kitamura, Laura Biederman, Dalia Ibrahim, Tibor Nadasdy, Sergey V Brodsky, Anjali A Satoskar
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引用次数: 0

Abstract

Context: Infection-related glomerulonephritis (IRGN) usually manifests as a proliferative immune-complex glomerulonephritis. The degree of renal dysfunction at presentation can vary. Association with histologic features on kidney biopsy remains unknown.

Objective: To study the correlation between renal function in IRGN at the time of biopsy and the severity of histologic features.

Design: Culture-proven IRGN cases at our facility were included and divided based on estimated glomerular filtration rate (eGFR) 15 ml/min/1.73 m2. Patients' demographic and pathologic findings were obtained from electronic medical records and kidney biopsy reports.

Results: In total, 104 cases were diagnosed with IRGN on biopsy (mean age, 55.6 ± 15.6 years; male, n = 79 [76%]; median eGFR, 14.5 mL/min/1.73 m2), and 51 of 104 showed eGFR <15 mL/min/1.73 m2. Among all the histologic features assessed, only percent tubules with red blood cell (RBC) casts showed statistical difference, being significantly higher in the lower-eGFR group (P = .004). Multivariable logistic regression analysis also showed that %tubules with RBC casts were associated with lower eGFR (odds ratio, 1.12; 95% CI, 1.01-1.24; P = .01). Patients with 5% or more RBC casts (n = 31) showed a lower eGFR (P = .02) and a higher %cellular crescent (P < .001) compared with those with less than 5% RBC casts. Patients with concomitant anticoagulant therapy (n = 11) showed higher percentages of RBC casts than those without anticoagulants (P = .02).

Conclusions: Particular attention to the extent of RBC casts on kidney biopsy is recommended in patients with IRGN because these portend worse renal dysfunction, more so in patients requiring anticoagulation (including for hemodialysis) because they are especially vulnerable to developing anticoagulant-related nephropathy.

感染性肾小球肾炎患者红细胞铸型与肾功能障碍的相关性
背景:感染相关性肾小球肾炎(IRGN)通常表现为增殖性免疫复合物性肾小球肾炎。发病时肾功能不全的程度各不相同。其与肾活检组织学特征的关系尚不清楚:研究IRGN活检时肾功能与组织学特征严重程度之间的相关性:设计:纳入我院经培养证实的 IRGN 病例,并根据估计肾小球滤过率(eGFR)15 ml/min/1.73 m2 进行划分。从电子病历和肾活检报告中获取患者的人口统计学和病理学结果:结果:共有 104 例经活检确诊为 IRGN(平均年龄为 55.6 ± 15.6 岁;男性,n = 79 [76%];eGFR 中位数为 14.5 mL/min/1.73 m2),104 例中有 51 例得出了 eGFR 结论:建议IRGN患者特别注意肾活检中红细胞铸型的程度,因为这些铸型预示着更严重的肾功能障碍,尤其是需要抗凝治疗(包括血液透析)的患者,因为他们特别容易发生与抗凝剂相关的肾病。
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来源期刊
CiteScore
9.20
自引率
2.20%
发文量
369
审稿时长
3-8 weeks
期刊介绍: Welcome to the website of the Archives of Pathology & Laboratory Medicine (APLM). This monthly, peer-reviewed journal of the College of American Pathologists offers global reach and highest measured readership among pathology journals. Published since 1926, ARCHIVES was voted in 2009 the only pathology journal among the top 100 most influential journals of the past 100 years by the BioMedical and Life Sciences Division of the Special Libraries Association. Online access to the full-text and PDF files of APLM articles is free.
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