Tenzi Jordán, Hurtado Javier, Nin Nicolás, Rodriguez Fernando, Molina Claudia, Aunchayna Maria
Unidad de Medicina Intensiva Hospital Español, ASSE, Montevideo, Uruguay.
Unidad de Medicina Intensiva Hospital Español, ASSE, Montevideo, Uruguay.
J Crit Care. 2022 Apr;68:38-41. doi: 10.1016/j.jcrc.2021.11.013. Epub 2021 Dec 3.
To describe the kidney histopathology of patients with S-AKI and correlate the histological findings with AKI severity, presence of septic shock, and the degree of multiple organic dysfunction (MOD) using the SOFA score.
This was a prospective, observational, and analytical study of a cohort of critically ill patients with S-AKI who died from sepsis at the "Hospital Español" intensive care unit (ICU). Kidney necropsies were performed within 2 h after death.
We considered twenty (20) patients, with all of them exhibiting S-AKI stage 3 at the same time. In renal histopathology analysis, nonspecific tubulointerstitial (TI) lesions were found in almost all patients (95%). The more frequently found nonspecific TI lesions involved leukocyte infiltration (85%). Necrotic TI lesions were found in 6 patients (30%), and necrotic tubular cell casts were the most frequent lesions (50% of patients). It was not possible to demonstrate an association between the presence of necrotic TI lesions and factors such as the APACHE II score, the global SOFA score, ICU stays, AKI length and renal replacement therapy (RRT).
The main histopathological findings in kidney necropsies in patients with S-AKI KDIGO 3, showed nonspecific TI lesions, and TI necrosis was only observed in 30% of the cases; therefore, S-AKI cannot be considered to be synonymous with acute tubular necrosis (ATN).
描述脓毒症相关性急性肾损伤（S-AKI）患者的肾脏组织病理学特征，并使用序贯器官衰竭评估（SOFA）评分将组织学结果与急性肾损伤（AKI）严重程度、感染性休克的存在以及多器官功能障碍（MOD）程度相关联。
这是一项对在“西班牙医院”重症监护病房（ICU）因脓毒症死亡的重症S-AKI患者队列进行的前瞻性、观察性和分析性研究。在死亡后2小时内进行肾脏尸检。
我们纳入了20例患者，所有患者同时处于S-AKI 3期。在肾脏组织病理学分析中，几乎所有患者（95%）均发现非特异性肾小管间质（TI）病变。最常见的非特异性TI病变为白细胞浸润（85%）。6例患者（30%）发现坏死性TI病变，坏死性肾小管细胞管型是最常见的病变（50%的患者）。无法证明坏死性TI病变的存在与急性生理与慢性健康状况评分系统II（APACHE II）评分、整体SOFA评分、ICU住院时间、AKI持续时间及肾脏替代治疗（RRT）等因素之间存在关联。
S-AKI KDIGO 3患者肾脏尸检的主要组织病理学发现为非特异性TI病变，仅30%的病例观察到TI坏死；因此，不能认为S-AKI等同于急性肾小管坏死（ATN）。
