Sumbal Wajid, Lee Shapiro, Larabe Farrukh, Kurt Hu, Paul J Feustel, Krishnakumar Hongalgi, Swati Mehta
{"title":"超越硬皮病肾危象的系统性硬化症急性肾损伤:病例对照研究","authors":"Sumbal Wajid, Lee Shapiro, Larabe Farrukh, Kurt Hu, Paul J Feustel, Krishnakumar Hongalgi, Swati Mehta","doi":"10.1097/RHU.0000000000002108","DOIUrl":null,"url":null,"abstract":"<p><strong>Background and objectives: </strong>Renal involvement in systemic sclerosis remains a significant concern with the focus often centered on scleroderma renal crisis (SRC). However, the broader spectrum of renal manifestations, beyond SRC, remains underrecognized. In our case-control analysis, we describe other causes, risk factors, and renal outcomes of acute kidney injury (AKI) in systemic sclerosis other than SRC.</p><p><strong>Methods: </strong>Patients diagnosed with SSC, with and without AKI, between 2017 and 2023 at Albany Medical Center, were included in the case-control study using International Classification of Diseases , 10th Revision codes and electronic medical records. Patients with SRC were carefully excluded. Data were collected and compared between AKI and non-AKI groups for patients' demographics, clinical characteristics, and baseline treatment. Additionally, data were collected for baseline, peak, and follow-up creatinine, etiology of AKI, treatment, and outcomes. Statistical analysis was performed using R (version 4.3.0) and Minitab (V19). Categorical variables were presented as frequencies/percentages, and continuous variables as means/standard deviations. Associations between categorical variables were assessed by χ 2 test and Fisher exact test. Odds ratios and 95% confidence intervals were calculated using binary logistic regression to separately assess the effect of each independent variable on the odds of AKI. Statistical significance was set at p < 0.05.</p><p><strong>Results: </strong>A total of 74 cases were identified. Out of these 74 cases, 27 had AKI and 47 did not have AKI. Out of the 27 AKI cases, 4 with SRC were excluded. Advanced age, chronic kidney disease, and heart failure were identified as risk factors for AKI development. The predominant cause of AKI was prerenal etiology, accounting for 47.8% (n = 11) of cases. This was followed by cardiorenal syndrome and acute tubular necrosis, accounting for 21.7% and 17.3% of the cases, respectively. Most of the cases with AKI had complete renal recovery 78% (n = 18), whereas 17% (n = 4) had progression of the underlying chronic kidney disease. One patient progressed to end-stage renal disease requiring hemodialysis.</p><p><strong>Conclusions: </strong>This analysis highlights the risk factors and variable clinicopathological courses of renal involvement in patients with scleroderma. This may range from mild AKI with good prognosis to life-threatening SRC.</p>","PeriodicalId":14745,"journal":{"name":"JCR: Journal of Clinical Rheumatology","volume":" ","pages":"219-222"},"PeriodicalIF":2.4000,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Acute Kidney Injury in Systemic Sclerosis Beyond Scleroderma Renal Crisis: A Case-Control Study.\",\"authors\":\"Sumbal Wajid, Lee Shapiro, Larabe Farrukh, Kurt Hu, Paul J Feustel, Krishnakumar Hongalgi, Swati Mehta\",\"doi\":\"10.1097/RHU.0000000000002108\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background and objectives: </strong>Renal involvement in systemic sclerosis remains a significant concern with the focus often centered on scleroderma renal crisis (SRC). However, the broader spectrum of renal manifestations, beyond SRC, remains underrecognized. In our case-control analysis, we describe other causes, risk factors, and renal outcomes of acute kidney injury (AKI) in systemic sclerosis other than SRC.</p><p><strong>Methods: </strong>Patients diagnosed with SSC, with and without AKI, between 2017 and 2023 at Albany Medical Center, were included in the case-control study using International Classification of Diseases , 10th Revision codes and electronic medical records. Patients with SRC were carefully excluded. Data were collected and compared between AKI and non-AKI groups for patients' demographics, clinical characteristics, and baseline treatment. Additionally, data were collected for baseline, peak, and follow-up creatinine, etiology of AKI, treatment, and outcomes. Statistical analysis was performed using R (version 4.3.0) and Minitab (V19). Categorical variables were presented as frequencies/percentages, and continuous variables as means/standard deviations. Associations between categorical variables were assessed by χ 2 test and Fisher exact test. Odds ratios and 95% confidence intervals were calculated using binary logistic regression to separately assess the effect of each independent variable on the odds of AKI. Statistical significance was set at p < 0.05.</p><p><strong>Results: </strong>A total of 74 cases were identified. Out of these 74 cases, 27 had AKI and 47 did not have AKI. Out of the 27 AKI cases, 4 with SRC were excluded. Advanced age, chronic kidney disease, and heart failure were identified as risk factors for AKI development. The predominant cause of AKI was prerenal etiology, accounting for 47.8% (n = 11) of cases. This was followed by cardiorenal syndrome and acute tubular necrosis, accounting for 21.7% and 17.3% of the cases, respectively. Most of the cases with AKI had complete renal recovery 78% (n = 18), whereas 17% (n = 4) had progression of the underlying chronic kidney disease. One patient progressed to end-stage renal disease requiring hemodialysis.</p><p><strong>Conclusions: </strong>This analysis highlights the risk factors and variable clinicopathological courses of renal involvement in patients with scleroderma. This may range from mild AKI with good prognosis to life-threatening SRC.</p>\",\"PeriodicalId\":14745,\"journal\":{\"name\":\"JCR: Journal of Clinical Rheumatology\",\"volume\":\" \",\"pages\":\"219-222\"},\"PeriodicalIF\":2.4000,\"publicationDate\":\"2024-09-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"JCR: Journal of Clinical Rheumatology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1097/RHU.0000000000002108\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2024/7/9 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q2\",\"JCRName\":\"RHEUMATOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"JCR: Journal of Clinical Rheumatology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1097/RHU.0000000000002108","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/7/9 0:00:00","PubModel":"Epub","JCR":"Q2","JCRName":"RHEUMATOLOGY","Score":null,"Total":0}
引用次数: 0
摘要
背景和目的:系统性硬化症的肾脏受累仍是一个重大问题,其焦点通常集中在硬皮病肾危象(SRC)上。然而,除SRC外,更广泛的肾脏表现仍未得到充分认识。在我们的病例对照分析中,我们描述了系统性硬化症急性肾损伤(AKI)除SRC以外的其他病因、风险因素和肾脏结局:病例对照研究采用《国际疾病分类》第十版代码和电子病历,纳入了2017年至2023年期间在奥尔巴尼医疗中心确诊为SSC、伴有或不伴有AKI的患者。SRC患者被仔细排除在外。研究人员收集了 AKI 组和非 AKI 组患者的人口统计学、临床特征和基线治疗数据,并进行了比较。此外,还收集了基线血肌酐、峰值血肌酐、随访血肌酐、AKI 病因、治疗和结果等数据。统计分析使用 R(4.3.0 版)和 Minitab(V19)进行。分类变量以频率/百分比表示,连续变量以平均值/标准差表示。分类变量之间的关联通过χ2检验和费舍尔精确检验进行评估。使用二元逻辑回归法分别计算各自变量对 AKI 发生几率的影响,并计算出比率和 95% 的置信区间。统计显著性以 p < 0.05 为标准:共发现 74 个病例。在这 74 个病例中,27 例发生了 AKI,47 例未发生 AKI。在 27 例 AKI 病例中,有 4 例患有 SRC,被排除在外。高龄、慢性肾病和心力衰竭被认为是发生 AKI 的风险因素。肾前性 AKI 的主要病因是肾前性疾病,占 47.8%(11 例)。其次是心肾综合征和急性肾小管坏死,分别占 21.7% 和 17.3%。大多数急性肾功能衰竭病例的肾功能完全恢复率为 78%(18 人),而 17%(4 人)的慢性肾脏疾病病情恶化。一名患者发展为终末期肾病,需要进行血液透析:这项分析强调了硬皮病患者肾脏受累的风险因素和不同的临床病理过程。从预后良好的轻度 AKI 到危及生命的 SRC 都有可能。
Acute Kidney Injury in Systemic Sclerosis Beyond Scleroderma Renal Crisis: A Case-Control Study.
Background and objectives: Renal involvement in systemic sclerosis remains a significant concern with the focus often centered on scleroderma renal crisis (SRC). However, the broader spectrum of renal manifestations, beyond SRC, remains underrecognized. In our case-control analysis, we describe other causes, risk factors, and renal outcomes of acute kidney injury (AKI) in systemic sclerosis other than SRC.
Methods: Patients diagnosed with SSC, with and without AKI, between 2017 and 2023 at Albany Medical Center, were included in the case-control study using International Classification of Diseases , 10th Revision codes and electronic medical records. Patients with SRC were carefully excluded. Data were collected and compared between AKI and non-AKI groups for patients' demographics, clinical characteristics, and baseline treatment. Additionally, data were collected for baseline, peak, and follow-up creatinine, etiology of AKI, treatment, and outcomes. Statistical analysis was performed using R (version 4.3.0) and Minitab (V19). Categorical variables were presented as frequencies/percentages, and continuous variables as means/standard deviations. Associations between categorical variables were assessed by χ 2 test and Fisher exact test. Odds ratios and 95% confidence intervals were calculated using binary logistic regression to separately assess the effect of each independent variable on the odds of AKI. Statistical significance was set at p < 0.05.
Results: A total of 74 cases were identified. Out of these 74 cases, 27 had AKI and 47 did not have AKI. Out of the 27 AKI cases, 4 with SRC were excluded. Advanced age, chronic kidney disease, and heart failure were identified as risk factors for AKI development. The predominant cause of AKI was prerenal etiology, accounting for 47.8% (n = 11) of cases. This was followed by cardiorenal syndrome and acute tubular necrosis, accounting for 21.7% and 17.3% of the cases, respectively. Most of the cases with AKI had complete renal recovery 78% (n = 18), whereas 17% (n = 4) had progression of the underlying chronic kidney disease. One patient progressed to end-stage renal disease requiring hemodialysis.
Conclusions: This analysis highlights the risk factors and variable clinicopathological courses of renal involvement in patients with scleroderma. This may range from mild AKI with good prognosis to life-threatening SRC.
期刊介绍:
JCR: Journal of Clinical Rheumatology the peer-reviewed, bimonthly journal that rheumatologists asked for. Each issue contains practical information on patient care in a clinically oriented, easy-to-read format. Our commitment is to timely, relevant coverage of the topics and issues shaping current practice. We pack each issue with original articles, case reports, reviews, brief reports, expert commentary, letters to the editor, and more. This is where you''ll find the answers to tough patient management issues as well as the latest information about technological advances affecting your practice.