关键词:

肾病综合征, 急性肾损伤, 危险因素, 预后, 儿童

Abstract:

Objective　To analyze the clinical characteristics, prognosis, and risk factors of nephrotic syndrome (NS) complicated with acute kidney injury (AKI). Methods　Children with NS were retrospectively enrolled from Shenzhen Children's Hospital from January 2016 to December 2019. Of these, 50 children with AKI were defined as the NS-AKI group, and 50 children without AKI matched by both gender and age as the control group. There were 36 males (72.0%) and 14 females (28.0%) in both NS-AKI group and control group, aged 5.5 (2.0, 8.0) years. The clinical characteristics and laboratory examination indexes of the two groups were compared, and the risk factors and prognosis of NS complicated with AKI were analyzed. χ² test, rank sum test, and multiple logistic regression analysis were used. Results　In the NS-AKI group, the length of hospital stay [16 (9.0, 21.3) d], proportions of hematuria [28.0% (14/50)], hypertension [32.0% (16/50)], infection [72.0% (36/50)], and tacrolimus use [48.0% (24/50)], and levels of urea [17.0 (10.0, 24.7) mmol/L], uric acid [616.8 (476.8, 764.0) μmol/L], cystatin C [1.7 (1.4, 2.4) mg/L], fibrinogen [5.7 (4.7, 7.2) g/L], and triacylglycerol [2.9 (2.0, 4.8) mmol/L] were higher than those in the control group [8 (5.0, 10.0) d, 6.0% (3/50), 4.0% (2/50), 50.0% (25/50), 24.0% (12/50), 4.3 (3.4, 6.0) mmol/L, 329.9 (273.7, 435.8) μmol/L, 0.9 (0.8, 1.0) mg/L, 4.7 (3.5, 5.9) g/L, and 2.0 (1.5, 3.8) mmol/L], and the levels of serum albumin [14.2 (12.5, 16.9) g/L] and serum sodium [131.8 (129.0, 134.2) mmol/L] were lower than those in the control group [17.8 (12.7, 23.6) g/L and 135.3 (133.1, 137.8) mmol/L], with statistically significant differences (all P<0.05). Multivariate logistic regression analysis indicated that urea nitrogen, cystatin C, and fibrinogen were independent risk factors for NS complicated with AKI (OR=1.516, 48.087, and 1.569; all P<0.05). At the discharge of children with NS-AKI, the renal function in 43 cases returned to normal, which was improved in 5 cases and remained unchanged in 2 cases. During the follow-up, except for 1 case developed stage 5 chronic kidney disease, the renal function in other 49 cases was normalized. Conclusions　Independent risk factors for NS complicated with AKI include increased urea nitrogen, cystatin C, and fibrinogen. Renal function can return to normal in most NS-AKI children.

Key words:

Nephrotic syndrome, Acute kidney injury, Risk factors, Prognosis, Children