Risk factors for minimal change nephrotic syndrome complicated by acute kidney injury in adults and their impact on prognosis
Objective To investigate the clinical features of adults with primary minimal change nephrotic syndrome (MCNS) complicated by acute kidney injury (AKI), as well as the risk factors for AKI in primary MCNS and their impact on prognosis. Methods A total of 315 adult patients who were diagnosed with pr...
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| Format: | Article |
| Language: | zho |
| Published: |
Editorial Office of Journal of Precision Medicine
2025-08-01
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| Series: | 精准医学杂志 |
| Subjects: | |
| Online Access: | https://jpmed.qdu.edu.cn/fileup/2096-529X/PDF/1754471578229-592365854.pdf |
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| Summary: | Objective To investigate the clinical features of adults with primary minimal change nephrotic syndrome (MCNS) complicated by acute kidney injury (AKI), as well as the risk factors for AKI in primary MCNS and their impact on prognosis. Methods A total of 315 adult patients who were diagnosed with primary MCNS by renal biopsy in The Affiliated Hospital of Qingdao University from October 2013 to March 2024 were enrolled, and according to the presence or absence of AKI at initial diagnosis, they were divided into MCNS group and MCNS+AKI group. The clinical features of adult patients with MCNS complicated by AKI were analyzed, and the logistic regression model was used to identify the risk factors for AKI in adult patients with primary MCNS. The impact of AKI on the prognosis of adult patients with primary MCNS was further analyzed. Results When compared with the MCNS group, the MCNS+AKI group had a significantly older age (Z=3.989,P<0.05), a significantly higher proportion of male patients (χ2=7.623,P<0.05), significantly lower levels of complement C3, lymphocyte count, and hemoglobin (t=2.248-5.619,P<0.05), and significantly higher levels of lactate dehydrogenase, blood uric acid, urinary erythrocyte count, urinary leukocyte count, D-dimer, C-reactive protein, and cystatin C (t=-3.292,-4.261,Z=2.492-5.973,P<0.05). As for renal histopathological changes, compared with the MCNS group, the MCNS+AKI group had a significantly higher proportion of patients with IgA deposition, interstitial renal lesions, or protein casts (χ2=4.567-12.013,P<0.05). The logistic regression analysis showed that age ≥60 years (OR=2.56,95%CI=1.10-5.95,P<0.05), male sex (OR=2.88,95%CI=1.36-6.11,P<0.05), a high level of lactate dehydrogenase (OR=1.00,95%CI=1.00-1.01,P<0.05), blood uric acid >385.04 μmol/L (OR=1.98,95%CI=1.03-3.78,P<0.05), and protein casts (OR=2.73,95%CI=1.20-6.22,P<0.05) were independent risk factors for AKI in adult patients with primary MCNS, while hemoglobin >139.26 g/L (OR=0.40,95%CI=0.20-0.80,P<0.05) was a protective factor against AKI. Compared with the MCNS group, the MCNS+AKI group had a significantly longer time to achieve complete remission of urinary protein (t=2.318,P<0.05), and the patients with MCNS and stage Ⅱ/Ⅲ AKI had a significantly longer time to achieve complete remission of urinary protein than those with MCNS and stage I AKI (F=3.287,t=2.080、2.048,P<0.05). Conclusion There is an increased risk of AKI in adult patients with primary MCNS who are elderly, male, have a high level of lactate dehydrogenase in blood, hyperuricemia, and the presence of protein casts found by renal pathological examination, and the clinical monitoring of renal function should be enhanced for these patients. The time to achieve complete remission of urinary protein increases with the increase in the severity of AKI, and early identification, prevention, and treatment of AKI are crucial for the prognosis of adult patients with primary MCNS. |
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| ISSN: | 2096-529X |