Value of renal biopsy in the diagnosis and treatment of adult patients with acute kidney disease
吕梦茹 1邬步云 1卞奥 1张波 1吴琳 1朱敬凤 1孙彬 1邢昌赢 1毛慧娟 1孙玉玲
扫码查看
点击上方二维码区域，可以放大扫码查看
作者信息
1. 南京医科大学第一附属医院（江苏省人民医院）肾内科，南京 210029
折叠
摘要
目的 分析成人急性肾脏病（acute kidney disease，AKD）患者接受肾活检前后诊断和治疗方案的变化，探讨肾活检在AKD患者诊断和治疗中的价值。 方法 该研究为单中心回顾性观察性研究，纳入2017年1月1日至2021年12月31日在南京医科大学第一附属医院肾内科接受肾活检的成人AKD患者，收集患者人口学、一般临床、实验室检查、肾活检前后诊断和治疗资料，分析肾活检前临床诊断与肾活检后病理诊断的诊断一致率、肾活检后治疗方案的改变及出血并发症情况。 结果 该研究纳入575例经肾活检诊断的AKD患者，年龄51（36，63）岁，男性359例（62.4%）。其中，急性肾损伤293例（51.0%），合并高血压348例（60.5%），合并糖尿病124例（21.6%）。峰值血肌酐272（190，477）μmol/L，血红蛋白106（86，126）g/L，24 h尿蛋白量2.15（0.79，4.82）g。575例AKD患者中，急性肾小球疾病347例（60.3%），急性间质性肾炎136例（23.7%），血栓性微血管病47例（8.2%），急性肾小管坏死45例（7.8%）。急性肾小球疾病中最常见的是IgA肾病（22.3%，128/575）和抗中性粒细胞胞质抗体相关性肾小球肾炎（12.2%，70/575）。454例（79.0%）患者肾活检前的临床诊断与肾活检后病理诊断相符。肾活检后394例（68.5%）患者调整了激素或免疫抑制剂治疗方案。15例（2.6%）患者发生显著的肾活检后出血，其中12例需输血治疗，1例需手术干预。 结论 21.0%的成人AKD患者的临床诊断与病理诊断不符，68.5%的患者肾活检后改变了治疗方案，2.6%的患者肾活检后出现显著的出血并发症。临床需充分权衡肾活检利弊，作出个体化的决策。 Objective To analyze the changes of diagnosis and treatment before and after renal biopsy in adult patients with acute kidney disease (AKD), and to explore the value of renal biopsy in the diagnosis and treatment of AKD. Methods It was a single-center retrospective observational study. The adult patients with AKD who underwent renal biopsy in the Department of Nephrology of the First Affiliated Hospital of Nanjing Medical University from January 1, 2017 to December 31, 2021 were enrolled. Demographic data, general clinical data, laboratory tests, and diagnosis and treatment data before and after renal biopsy were collected to analyze the concordance rate between clinical and pathological diagnoses, changes in treatment after renal biopsy, and bleeding complication. Results A total of 575 patients diagnosed with AKD by renal biopsy were included in this study, with age of 51 (36, 63) years old and 359 males (62.4%). Among them, there were 293 patients (51.0%) of acute kidney injury, 348 patients (60.5%) of hypertension and 124 patients (21.6%) of diabetes. The peak serum creatinine was 272 (190, 477) μmol/L. The hemoglobin was 106 (86, 126) g/L. The 24-hour urine protein was 2.15 (0.79, 4.82) g. There were 347 patients (60.3%) of acute glomerular diseases, 136 patients (23.7%) of acute interstitial nephritis, 47 patients (8.2%) of thrombotic microangiopathy, and 45 patients (7.8%) of acute tubular necrosis. The most common types of acute glomerular diseases were IgA nephropathy and anti-neutrophil cytoplasmic antibody-associated glomerulonephritis, accounting for 22.3% (128/575) and 12.2% (70/575), respectively. The clinical diagnoses before renal biopsy were consistent with the renal histopathological diagnoses in 454 patients, with an accuracy rate of 79.0%. Following the renal biopsy, the treatment plan involving glucocorticoids or immunosuppressants was adjusted in 394 patients (68.5%). Significant post-biopsy bleeding occurred in 15 patients (2.6%), with 12 patients requiring blood transfusion and 1 patient requiring surgical intervention. Conclusions Twenty-one clinical diagnoses do not match the pathological diagnoses in adult AKD patients, 68.5% of patients have changes in their treatment plans, and 2.6% of patients have significant hemorrhagic complications after renal biopsy. Clinicians need to carefully consider the benefits and risks and make individualized decisions about renal biopsy.
Abstract
Objective To analyze the changes of diagnosis and treatment before and after renal biopsy in adult patients with acute kidney disease (AKD), and to explore the value of renal biopsy in the diagnosis and treatment of AKD. Methods It was a single-center retrospective observational study. The adult patients with AKD who underwent renal biopsy in the Department of Nephrology of the First Affiliated Hospital of Nanjing Medical University from January 1, 2017 to December 31, 2021 were enrolled. Demographic data, general clinical data, laboratory tests, and diagnosis and treatment data before and after renal biopsy were collected to analyze the concordance rate between clinical and pathological diagnoses, changes in treatment after renal biopsy, and bleeding complication. Results A total of 575 patients diagnosed with AKD by renal biopsy were included in this study, with age of 51 (36, 63) years old and 359 males (62.4%). Among them, there were 293 patients (51.0%) of acute kidney injury, 348 patients (60.5%) of hypertension and 124 patients (21.6%) of diabetes. The peak serum creatinine was 272 (190, 477) μmol/L. The hemoglobin was 106 (86, 126) g/L. The 24-hour urine protein was 2.15 (0.79, 4.82) g. There were 347 patients (60.3%) of acute glomerular diseases, 136 patients (23.7%) of acute interstitial nephritis, 47 patients (8.2%) of thrombotic microangiopathy, and 45 patients (7.8%) of acute tubular necrosis. The most common types of acute glomerular diseases were IgA nephropathy and anti-neutrophil cytoplasmic antibody-associated glomerulonephritis, accounting for 22.3% (128/575) and 12.2% (70/575), respectively. The clinical diagnoses before renal biopsy were consistent with the renal histopathological diagnoses in 454 patients, with an accuracy rate of 79.0%. Following the renal biopsy, the treatment plan involving glucocorticoids or immunosuppressants was adjusted in 394 patients (68.5%). Significant post-biopsy bleeding occurred in 15 patients (2.6%), with 12 patients requiring blood transfusion and 1 patient requiring surgical intervention. Conclusions Twenty-one clinical diagnoses do not match the pathological diagnoses in adult AKD patients, 68.5% of patients have changes in their treatment plans, and 2.6% of patients have significant hemorrhagic complications after renal biopsy. Clinicians need to carefully consider the benefits and risks and make individualized decisions about renal biopsy.
万方数据