钩端螺旋体病所致急性肾损伤的长期预后？斯里兰卡的一项纵向研究。
Long term outcome of acute kidney injury due to leptospirosis? A longitudinal study in Sri Lanka.
作者信息
Herath Nalaka J, Kularatne Senanayake A M, Weerakoon Kosala G A D, Wazil Abdul, Subasinghe Nilakshi, Ratnatunga Neelakanthi V I
机构信息
Department of Medicine, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka.
出版信息
BMC Res Notes. 2014 Jun 25;7:398. doi: 10.1186/1756-0500-7-398.
BACKGROUND
Leptospirosis is an important zoonotic disease of variable severity and is a common cause of acute kidney injury (AKI) in tropics. However the knowledge on long term renal outcome in leptospirosis is scarce. This study aims to assess the long-term renal outcome of AKI caused by leptospirosis.
FINDINGS
Hospital records of patients who had developed AKI following leptospirosis (Serologically confirmed) presented to two Teaching Hospitals in Kandy district over 3 years from 2007 were studied. A total of 44 patients were included and they had been followed up at least for one year in out patient clinics with regular assessment including renal status. Renal histology was studied in two patients. The primary outcome measure was normalization of renal function at one year. Of the 44 patients, 31 were in the risk and injury stage (Group 1), and the rest of them were in the failure stage (Group 2) under RIFLE criteria. Of group 2 patients, 11 had abnormal renal functions on discharge. Their mean serum creatinine and GFR values on discharge were 392 mmol/l and 20 ml/min/1.73 m2. Other two patients had full renal recovery whilst in the hospital. Nine in the group 2 required renal replacement therapy by means of peritoneal dialysis, intermittent haemodialysis or haemofiltration. Seventeen out of the total had persistently abnormal renal functions on discharge. Of them 13 recovered their renal functions to normal. Four patients (9%) who belonged to group 2, had persistently abnormal renal functions after first year compatible with stage 3 chronic kidney disease (CKD). Renal histology of two patients showed tubulointerstitial lymphocyte infiltrate, tubular atrophy and interstitial fibrosis.
CONCLUSION
The long term renal outcome of AKI following leptospirosis is satisfactory as only 9% of patients had abnormal renal functions compatible with early stage of CKD. Even among them, advanced CKD or dialysis dependency had not been observed.
背景
钩端螺旋体病是一种严重程度不一的重要人畜共患病，是热带地区急性肾损伤（AKI）的常见病因。然而，关于钩端螺旋体病长期肾脏转归的知识却很匮乏。本研究旨在评估由钩端螺旋体病引起的急性肾损伤的长期肾脏转归。
研究结果
对2007年起3年期间在康提地区两家教学医院就诊的、因钩端螺旋体病（血清学确诊）后发生急性肾损伤的患者的医院记录进行了研究。共纳入44例患者，他们在门诊至少随访了一年，进行包括肾脏状况在内的定期评估。对两名患者进行了肾脏组织学研究。主要结局指标是一年时肾功能恢复正常。根据RIFLE标准，44例患者中，31例处于风险和损伤期（第1组），其余患者处于衰竭期（第2组）。第2组患者中，11例出院时肾功能异常。他们出院时的平均血清肌酐和肾小球滤过率分别为392 mmol/l和20 ml/min/1.73 m²。另外两名患者在住院期间肾功能完全恢复。第2组中有9例需要通过腹膜透析、间歇性血液透析或血液滤过进行肾脏替代治疗。总共有17例出院时肾功能持续异常。其中13例肾功能恢复正常。属于第2组的4例患者（9%）在第一年之后肾功能持续异常，符合3期慢性肾脏病（CKD）。两名患者的肾脏组织学显示肾小管间质淋巴细胞浸润、肾小管萎缩和间质纤维化。
结论
钩端螺旋体病后急性肾损伤的长期肾脏转归令人满意，因为只有9%的患者肾功能异常符合早期CKD。即使在这些患者中，也未观察到晚期CKD或透析依赖。
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