National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China.
National Clinical Research Center of Kidney Diseases, Jinling Hospital, The First School of Clinical Medicine, Southern Medical University, Nanjing, China.
Nephron. 2023;147(9):541-549. doi: 10.1159/000530615. Epub 2023 Apr 24.
Acute kidney injury (AKI) is a group of highly heterogeneous, complicated clinical syndromes. Although kidney biopsy plays an irreplaceable role in evaluating complex AKI, a few studies have focused on the clinicopathology of AKI biopsies. This study analyzed the pathological disease spectrum, causes, and renal outcomes of biopsied AKI patients.
We retrospectively included 2,027 AKI patients who underwent kidney biopsies at a national clinical research center of kidney diseases from 2013 through 2018. To compare the biopsied AKI cases without and with coexisting glomerulopathy, patients were classified into acute tubular/tubulointerstitial nephropathy-associated AKI (ATIN-AKI) and glomerular disease-associated AKI (GD-AKI) groups.
Of 2,027 biopsied AKI patients, 65.1% were male, with a median age of 43 years. A total of 1,590 (78.4%) patients had coexisting GD, while only 437 (21.6%) patients had ATIN alone. The AKI patients with GD mainly (53.5%) manifested as stage 1 AKI, while most ATIN-AKI patients (74.8%) had stage 3 AKI. In the ATIN-AKI group, 256 (58.6%) patients had acute interstitial nephritis (AIN), and 77 (17.6%) had acute tubular injury (ATI). ATIN-AKI was mainly caused by drugs in 85.5% of AIN and 63.6% of ATI cases, respectively. In AKI patients with coexisting GD, the leading pathological diagnoses in over 80% of patients were IgA nephropathy (IgAN, 22.5%), minimal change disease (MCD, 17.5%), focal segmental glomerulosclerosis (FSGS, 15.3%), lupus nephritis (LN, 11.9%), membranous nephropathy (MN, 10.2%), and ANCA-associated vasculitis (AAV, 4.7%). A total of 775 patients were followed up within 3 months after renal biopsy; ATIN-AKI patients achieved statistically higher complete renal recovery than the GD-AKI patients (83.5% vs. 70.5%, p < 0.001).
Most biopsied AKI patients have coexisting GD, while ATIN alone is seen less frequently. ATIN-AKI is mainly caused by drugs. In GD-AKI patients, IgAN, MCD, FSGS, LN, MN, and AAV are the leading diagnoses. Compared to AKI patients without GD, patients with GD suffer from worse renal function recovery.
急性肾损伤（AKI）是一组高度异质的复杂临床综合征。尽管肾活检在评估复杂 AKI 方面具有不可替代的作用，但很少有研究关注 AKI 活检的临床病理。本研究分析了活检 AKI 患者的病理疾病谱、病因和肾脏结局。
我们回顾性纳入了 2013 年至 2018 年期间在国家肾脏疾病临床研究中心接受肾活检的 2027 例 AKI 患者。为了比较无并存肾小球疾病和并存肾小球疾病的 AKI 活检病例，将患者分为急性肾小管/间质性肾病相关性 AKI（ATIN-AKI）和肾小球疾病相关性 AKI（GD-AKI）组。
在 2027 例接受肾活检的 AKI 患者中，65.1%为男性，中位年龄为 43 岁。共有 1590 例（78.4%）患者同时存在 GD，而仅有 437 例（21.6%）患者单纯存在 ATIN。伴有 GD 的 AKI 患者主要（53.5%）表现为 1 期 AKI，而大多数 ATIN-AKI 患者（74.8%）表现为 3 期 AKI。在 ATIN-AKI 组中，256 例（58.6%）患者为急性间质性肾炎（AIN），77 例（17.6%）为急性肾小管损伤（ATI）。AIN 中 85.5%和 ATI 中 63.6%的病例分别由药物引起。在伴有 GD 的 AKI 患者中，80%以上患者的主要病理诊断为 IgA 肾病（IgAN，22.5%）、微小病变病（MCD，17.5%）、局灶节段性肾小球硬化（FSGS，15.3%）、狼疮性肾炎（LN，11.9%）、膜性肾病（MN，10.2%）和抗中性粒细胞胞质抗体相关性血管炎（AAV，4.7%）。共有 775 例患者在肾活检后 3 个月内进行了随访；ATIN-AKI 患者的完全肾功能恢复明显高于 GD-AKI 患者（83.5% vs. 70.5%，p < 0.001）。
大多数接受肾活检的 AKI 患者同时存在 GD，而单纯 ATIN 则较为少见。ATIN-AKI 主要由药物引起。在 GD-AKI 患者中，IgAN、MCD、FSGS、LN、MN 和 AAV 是主要的诊断。与无 GD 的 AKI 患者相比，GD 患者的肾功能恢复较差。
