{"title":"轻、中度热相关疾病急性肾损伤的机制。","authors":"Kenta Kondo, Naoyuki Hashiguchi, Shin Watanabe, Hirofumi Nishio, Yuji Takazawa, Toshiaki Iba","doi":"10.14789/ejmj.JMJ24-0013-OA","DOIUrl":null,"url":null,"abstract":"<p><strong>Objectives: </strong>This study focuses on mild-to-moderate severity cases to examine the triggers initiating kidney injury.</p><p><strong>Materials: </strong>Patients aged ≥18 years with suspected heat-related illnesses at the Juntendo University Hospital Emergency and Primary Care Center between July and September 2020 and June and August 2022 were included.</p><p><strong>Methods: </strong>Blood samples were obtained during their visit, and the patients were categorized into two groups based on their cystatin-based estimated GFR (eGFRcys) values: a kidney injury group (eGFRcys < 60 mL/min/1.73 m<sup>2</sup>) and a non-kidney injury group (eGFRcys ≥ 60 mL/min/1.73 m<sup>2</sup>). Inflammation, coagulation, and skeletal muscle damage markers were compared between the groups, and markers related to the early development of kidney injury were examined.</p><p><strong>Results: </strong>Thirty-five patients were diagnosed with heat-related illnesses, and 10 were diagnosed with kidney injury. White blood cell count was higher in the kidney injury group (<i>P</i> < 0.01), whereas the levels of CRP and Interleukin-6 showed no significant difference between the groups. No statistically significant differences in coagulation markers were observed. In contrast, myoglobin, a marker of skeletal muscle damage, showed elevated levels in the kidney injury group (<i>r</i> = -0.80, <i>P</i> < 0.01) and demonstrated a stronger association with early kidney injury than creatine kinase (<i>r</i> = -0.38, <i>P</i> < 0.05).</p><p><strong>Conclusions: </strong>The predominant mechanism of acute kidney injury in mild to moderate heat-related illnesses appears to be tubular damage caused by myoglobin. Measuring myoglobin levels is essential to identify and exclude patients at risk of acute kidney injury due to heat-related illnesses.</p>","PeriodicalId":52660,"journal":{"name":"Juntendo Iji Zasshi","volume":"70 6","pages":"420-428"},"PeriodicalIF":0.0000,"publicationDate":"2024-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Mechanism of Acute Kidney Injury in Mild to Moderate Heat-related Illness.\",\"authors\":\"Kenta Kondo, Naoyuki Hashiguchi, Shin Watanabe, Hirofumi Nishio, Yuji Takazawa, Toshiaki Iba\",\"doi\":\"10.14789/ejmj.JMJ24-0013-OA\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objectives: </strong>This study focuses on mild-to-moderate severity cases to examine the triggers initiating kidney injury.</p><p><strong>Materials: </strong>Patients aged ≥18 years with suspected heat-related illnesses at the Juntendo University Hospital Emergency and Primary Care Center between July and September 2020 and June and August 2022 were included.</p><p><strong>Methods: </strong>Blood samples were obtained during their visit, and the patients were categorized into two groups based on their cystatin-based estimated GFR (eGFRcys) values: a kidney injury group (eGFRcys < 60 mL/min/1.73 m<sup>2</sup>) and a non-kidney injury group (eGFRcys ≥ 60 mL/min/1.73 m<sup>2</sup>). Inflammation, coagulation, and skeletal muscle damage markers were compared between the groups, and markers related to the early development of kidney injury were examined.</p><p><strong>Results: </strong>Thirty-five patients were diagnosed with heat-related illnesses, and 10 were diagnosed with kidney injury. White blood cell count was higher in the kidney injury group (<i>P</i> < 0.01), whereas the levels of CRP and Interleukin-6 showed no significant difference between the groups. No statistically significant differences in coagulation markers were observed. In contrast, myoglobin, a marker of skeletal muscle damage, showed elevated levels in the kidney injury group (<i>r</i> = -0.80, <i>P</i> < 0.01) and demonstrated a stronger association with early kidney injury than creatine kinase (<i>r</i> = -0.38, <i>P</i> < 0.05).</p><p><strong>Conclusions: </strong>The predominant mechanism of acute kidney injury in mild to moderate heat-related illnesses appears to be tubular damage caused by myoglobin. Measuring myoglobin levels is essential to identify and exclude patients at risk of acute kidney injury due to heat-related illnesses.</p>\",\"PeriodicalId\":52660,\"journal\":{\"name\":\"Juntendo Iji Zasshi\",\"volume\":\"70 6\",\"pages\":\"420-428\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2024-12-31\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Juntendo Iji Zasshi\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.14789/ejmj.JMJ24-0013-OA\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2024/1/1 0:00:00\",\"PubModel\":\"eCollection\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Juntendo Iji Zasshi","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.14789/ejmj.JMJ24-0013-OA","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/1/1 0:00:00","PubModel":"eCollection","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 0
摘要
目的:本研究的重点是轻至中度严重的病例,以检查触发肾损伤。材料:纳入2020年7月至9月和2022年6月至8月在Juntendo大学医院急诊和初级保健中心就诊的年龄≥18岁疑似热相关疾病的患者。方法:在访视过程中采集血样,根据患者基于胱他汀的GFR (eGFRcys)估计值将患者分为肾损伤组(eGFRcys 2)和非肾损伤组(eGFRcys≥60 mL/min/1.73 m2)。比较各组间炎症、凝血和骨骼肌损伤标志物,并检测与肾损伤早期发展相关的标志物。结果:35例患者诊断为热相关疾病,10例诊断为肾损伤。肾损伤组白细胞计数较高(P r = -0.80, P r = -0.38, P)。结论:轻至中度热相关疾病急性肾损伤的主要机制可能是肌红蛋白引起的肾小管损伤。测量肌红蛋白水平对于识别和排除因热相关疾病而有急性肾损伤风险的患者至关重要。
Mechanism of Acute Kidney Injury in Mild to Moderate Heat-related Illness.
Objectives: This study focuses on mild-to-moderate severity cases to examine the triggers initiating kidney injury.
Materials: Patients aged ≥18 years with suspected heat-related illnesses at the Juntendo University Hospital Emergency and Primary Care Center between July and September 2020 and June and August 2022 were included.
Methods: Blood samples were obtained during their visit, and the patients were categorized into two groups based on their cystatin-based estimated GFR (eGFRcys) values: a kidney injury group (eGFRcys < 60 mL/min/1.73 m2) and a non-kidney injury group (eGFRcys ≥ 60 mL/min/1.73 m2). Inflammation, coagulation, and skeletal muscle damage markers were compared between the groups, and markers related to the early development of kidney injury were examined.
Results: Thirty-five patients were diagnosed with heat-related illnesses, and 10 were diagnosed with kidney injury. White blood cell count was higher in the kidney injury group (P < 0.01), whereas the levels of CRP and Interleukin-6 showed no significant difference between the groups. No statistically significant differences in coagulation markers were observed. In contrast, myoglobin, a marker of skeletal muscle damage, showed elevated levels in the kidney injury group (r = -0.80, P < 0.01) and demonstrated a stronger association with early kidney injury than creatine kinase (r = -0.38, P < 0.05).
Conclusions: The predominant mechanism of acute kidney injury in mild to moderate heat-related illnesses appears to be tubular damage caused by myoglobin. Measuring myoglobin levels is essential to identify and exclude patients at risk of acute kidney injury due to heat-related illnesses.