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IF 4.3 3区医学 Q1 UROLOGY & NEPHROLOGY

American Journal of Nephrology Pub Date : 2025-01-27 DOI:10.1159/000543789

Shun Wu, Mengling Guo, Yudan Wang, Yilun Zhou, Liyuan Zhang, Yun Zhou, Yuanyuan Xing, Dong Sun, Xueqing Hu, Zhenmin Ruan, John Cijiang He, Hongqi Ren

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引用次数: 0

摘要

简介荚膜损伤已被证实是急性肾损伤（AKI）后肾功能不佳的主要原因。然而，临床试验数据仍然有限。本研究旨在探讨住院 AKI 患者荚膜损伤与肾脏预后之间的临床相关性：这项回顾性研究分析了 2012 年 1 月至 2023 年 6 月期间全国 6 个中心的 52 例 AKI 患者的数据，这些患者经组织学诊断为急性肾小管坏死（ATN）或急性间质性肾炎（AIN）。根据足突融合程度将患者分为两组：≤50%（轻度荚膜损伤组）和＞50%（重度荚膜损伤组）。结果为 AKI 后新发蛋白尿和慢性肾脏病：在 52 名 AKI 患者中（男性 14 人；中位年龄 49 [30, 56] 岁），28 人（53.8%）有轻度荚膜细胞损伤，24 人（46.2%）有重度荚膜细胞损伤。随访 12 个月后，轻度荚膜损伤组中有 16 人（57.1%）在 AKI 后出现蛋白尿，5 人（17.9%）在 AKI 后出现 CKD。重度荚膜细胞损伤组中，20 例（83.3%）患者在 AKI 后出现新发蛋白尿，14 例（58.3%）患者在 AKI 后出现 CKD。足突融合程度更严重的患者在 AKI 后 12 个月时，AKI 后新发蛋白尿（83.3% 对 57.1%，P = 0.041）和偶发 CKD（58.3% 对 17.9%，P = 0.003）的发生率明显更高。足突融合程度（95%CI 1.013～3.88，P=0.048）和 3 个月时的蛋白尿（95%CI 1.309～5.443，P=0.015）被确定为 AKI 后 12 个月时新发蛋白尿的独立风险因素。足突融合程度（95%CI 1.026～14.196，P=0.048）和部分肾脏病理特征的存在，包括肾小管萎缩（95%CI 1.012～5.958，P=0.030）、肾间质炎症（95%CI 1.005～6.846，P=0.039）、肾间质纤维化（95%CI 1.110～6.075，P=0.043）是AKI后12个月时发生CKD的独立危险因素。Kaplan-Meier分析显示，严重荚膜损伤组的肾脏存活率最差，包括AKI后新发蛋白尿（P=0.0066）和事件性CKD（P=0.0455）：结论：荚膜损伤程度是 AKI 后新发蛋白尿和 CKD 患者的独立危险因素，荚膜损伤更严重的患者 AKI 后新发蛋白尿和 CKD 的发生率更高。

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Relationship Between Podocyte Injury and Renal Outcomes in Patients with Acute Kidney Injury: A Report From a Retrospective Study in China.

Introduction: Podocyte injury has been proven to be a major cause for poor renal outcomes after acute kidney injury (AKI). However, clinical trial data are still limited. This study aimed to explore the clinical correlations between podocyte injury and renal outcomes in hospitalized AKI patients.

Method: This retrospective study analyzed data on 52 AKI patients who were histologically diagnosed with acute tubular necrosis (ATN) or acute interstitial nephritis (AIN) from six centers throughout China between January 2012 and June 2023. Patients were classified into two groups based on the degree of foot process fusion: ≤50% (mild podocyte injury group), and ＞50% (severe podocyte injury group). The outcomes were post-AKI new-onset proteinuria and incident CKD.

Results: Among 52 AKI patients (14 male; median age, 49 [30, 56] years), 28 (53.8%) had mild podocyte injury, 24 (46.2%) had severe podocyte injury. After 12-month follow-up, 16(57.1%) had post-AKI proteinuria, and 5(17.9%) had post-AKI incident CKD in mild podocyte injury group. 20 (83.3%) had post-AKI new-onset proteinuria, and 14 (58.3%) had post-AKI incident CKD in severe podocyte injury group. Patients with more severe foot process fusion exhibited significantly higher incidences of post-AKI new-onset proteinuria (83.3% vs. 57.1%, P = 0.041) and incident CKD (58.3% vs. 17.9%, P = 0.003) at 12 months following AKI. The degree of foot process fusion (95%CI 1.013～3.88, P=0.048) and proteinuria at 3 months (95%CI 1.309～5.443, P=0.015) were identified as independent risk factors for post-AKI new-onset proteinuria at 12 months. The degree of foot process fusion (95%CI 1.026～14.196, P=0.048), and the presence of partial renal pathological features, including tubular atrophy (95%CI 1.012～5.958, P=0.030), interstitial inflammation (95%CI 1.005～6.846, P=0.039), interstitial fibrosis (95%CI 1.110～6.075, P=0.043) were independent risk factors for post-AKI incident CKD at 12month. Kaplan-Meier analysis shows severe podocyte injury group had worst renal survival, including post-AKI new-onset proteinuria (P=0.0066) and incident CKD (P=0.0455).

Conclusion: The degree of podocyte injury is an independent risk factor for post-AKI new-onset proteinuria and incident CKD in patients, and patients with more severe podocyte injury exhibit a higher incidence of post-AKI new-onset proteinuria and incident CKD.

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来源期刊

American Journal of Nephrology 医学-泌尿学与肾脏学

CiteScore

7.50

自引率

2.40%

发文量

审稿时长

4-8 weeks

期刊介绍： The ''American Journal of Nephrology'' is a peer-reviewed journal that focuses on timely topics in both basic science and clinical research. Papers are divided into several sections, including: