Nephrology and Renal Transplantation Department and Institut Francilien de Recherche en Nephrologie et Transplantation (IFRNT), Henri Mondor Hospital, 51 Avenue du Marechal de Lattre de Tassigny Creteil, France.
Nephrol Dial Transplant. 2010 Aug;25(8):2524-9. doi: 10.1093/ndt/gfq083. Epub 2010 Feb 22.
The association between chronic kidney involvement and sickle cell disease (SCD) has been well characterized, but our knowledge on acute kidney injury (AKI) in relation to SCD remains limited.
We retrospectively assessed 254 episodes of vaso-occlusive complication in 161 SCD patients who were admitted to our hospital: these included 174 episodes of painful crisis (PC), 58 episodes of moderate acute chest syndrome (ACS) and 22 episodes of severe ACS.
The overall incidence of AKI [defined according to Acute Kidney Injury Network (AKIN) criteria] during vaso-occlusive complications was low (4.3%) but seemed to be related to its severity: 2.3% for PC vs 6.9% for moderate ACS and 13.6% for severe ACS (P = 0.03). This finding led us prospectively to look at specific risk factors for AKI occurrence in SCD patients admitted to our intensive care unit for severe ACS and, in particular, the possible link between AKI and haemodynamic status (transthoracic echocardiography). Among patients with severe ACS, those with AKI displayed significantly greater aminotransferases, bilirubin and lactate dehydrogenase levels than patients without AKI. Echocardiography identified higher systolic pulmonary artery pressure in patients with AKI than in those without, whereas the cardiac index was similar between groups.
AKI incidence during vaso-occlusive complications of SCD is relatively low (<5%) and appears to be confined to patients with ACS and pulmonary hypertension. These findings suggest a pathophysiological process involving right ventricular dysfunction and venous congestion.
慢性肾脏受累与镰状细胞病（SCD）之间的关联已得到充分描述，但我们对 SCD 相关急性肾损伤（AKI）的认识仍然有限。
我们回顾性评估了 161 例 SCD 患者因血管阻塞性并发症住院的 254 例病例：其中 174 例为疼痛危象（PC），58 例为中度急性胸部综合征（ACS），22 例为严重 ACS。
血管阻塞性并发症中 AKI 的总发生率（根据急性肾损伤网络（AKIN）标准定义）较低（4.3%），但似乎与并发症的严重程度有关：PC 为 2.3%，中度 ACS 为 6.9%，严重 ACS 为 13.6%（P = 0.03）。这一发现促使我们前瞻性地研究 SCD 患者因严重 ACS 住院时 AKI 发生的特定危险因素，特别是 AKI 与血液动力学状态（经胸超声心动图）之间的可能联系。在严重 ACS 患者中，发生 AKI 的患者的氨基转移酶、胆红素和乳酸脱氢酶水平明显高于未发生 AKI 的患者。超声心动图显示，发生 AKI 的患者的收缩肺动脉压明显高于未发生 AKI 的患者，而心指数在两组之间相似。
SCD 血管阻塞性并发症期间 AKI 的发生率相对较低（<5%），似乎仅限于 ACS 和肺动脉高压患者。这些发现提示涉及右心室功能障碍和静脉充血的病理生理过程。
