Kim Hyun W, Yu Mi H, Lee Jang H, Chang Jai W, Yang Won S, Kim Soon B, Lee Sang K, Park Jung S, Park Su-Kil
Division of Nephrology, Department of Internal Medicine, University of Ulsan College of Medicine, Asan Medical Centre, Seoul, Korea.
Nephrology (Carlton). 2008 Dec;13(6):451-8. doi: 10.1111/j.1440-1797.2008.00974.x. Epub 2008 Jun 1.
To describe the clinical features and to identify factors related to development of acute kidney injury in acute hepatitis A patients.
The study and control groups consisted of 21 and 425 patients who did or did not develop acute kidney injury, respectively, after acute hepatitis A from January 1997 to May 2007.
There were 13 men and eight women; their mean age at diagnosis was 28.8 +/- 8.2 years in the study group. Peak values for renal and liver function impairment consisted of a median serum creatinine of 4.6 mg/dL (range, 1.5-15.3 mg/dL) on day 6 (range, days 1-20) and a median total bilirubin of 10.7 mg/dL (range, 2.6-57.5 mg/dL) on day 8 (range, day 1-19). Serum creatinine concentrations returned to baseline level by a median of 16 days and total bilirubin levels returned to normal by a median of 62 days. Six of 21 (29%) patient underwent haemodialysis. Renal biopsies performed in two patients showed acute tubular necrosis and interstitial nephritis, respectively. Logistic regression analysis showed that a lower haematocrit, the presence of coagulopathy and high C-reactive protein concentration on admission, and higher peak bilirubin value during the illness were associated with development of acute kidney injury.
Acute hepatitis A should be considered in the differential diagnosis of patients with acute kidney injury, even without fulminant hepatic failure. A lower haematocrit, the presence of coagulopathy and high C-reactive protein level at presentation, and higher peak bilirubin level during the illness were associated with development of acute kidney injury in acute hepatitis A patients.
描述急性甲型肝炎患者的临床特征，并确定与急性肾损伤发生相关的因素。
研究组和对照组分别由1997年1月至2007年5月急性甲型肝炎后发生或未发生急性肾损伤的21例和425例患者组成。
研究组有13名男性和8名女性；诊断时的平均年龄为28.8±8.2岁。肾功能和肝功能损害的峰值分别为第6天（范围为1 - 20天）血清肌酐中位数4.6mg/dL（范围为1.5 - 15.3mg/dL）和第8天（范围为1 - 19天）总胆红素中位数10.7mg/dL（范围为2.6 - 57.5mg/dL）。血清肌酐浓度中位数16天恢复至基线水平，总胆红素水平中位数62天恢复正常。21例患者中有6例（29%）接受了血液透析。两名患者进行的肾活检分别显示急性肾小管坏死和间质性肾炎。逻辑回归分析表明，入院时血细胞比容较低、存在凝血病和高C反应蛋白浓度以及疾病期间胆红素峰值较高与急性肾损伤的发生有关。
即使没有暴发性肝衰竭，急性肾损伤患者的鉴别诊断中也应考虑急性甲型肝炎。入院时血细胞比容较低、存在凝血病和高C反应蛋白水平以及疾病期间较高的胆红素峰值与急性甲型肝炎患者急性肾损伤的发生有关。
