Department of Medicine, University of California San Diego, San Diego, CA, USA.
East Bay Nephrology Medical Group, Berkeley, CA, USA.
BMC Nephrol. 2023 Jun 15;24(1):176. doi: 10.1186/s12882-023-03209-y.
Acute Kidney Injury (AKI) incidence has continued to rise and is recognized as a major risk factor for kidney disease progression and cardiovascular complications. Early recognition of factors associated with post-AKI complications is fundamental to stratifying patients that could benefit from closer follow-up and management after an episode of AKI. Recent studies have shown that proteinuria is a prevalent sequela after AKI and a strong predictor of complications post-AKI. This study aims to evaluate the frequency and timing of the development of de-novo proteinuria after an AKI episode in patients with known kidney function and no prior history of proteinuria.
We retrospectively analyzed data from adult AKI patients with pre- and post-kidney function information between Jan 2014 and March 2019. The presence of proteinuria determined before and after index AKI encounter was based on ICD-10 code and/or urine dipstick and UPCR during the follow-up period.
Of 9697 admissions with AKI diagnoses between Jan 2014 and March 2019, 2120 eligible patients with at least one assessment of Scr and proteinuria before AKI index admission were included in the analysis. The median age was 64 (IQR 54-75) years, and 57% were male. 58% (n-1712) patients had stage 1 AKI, 19% (n = 567) stage 2 AKI, and 22% (n = 650) developed stage 3 AKI. De novo proteinúria was found in 62% (n = 472) of patients and was already present by 90 days post-AKI in 59% (209/354). After adjusting for age and comorbidities, severe AKI (stage 2/3 AKI) and diabetes, were independently associated with increased risk for De novo proteinuria.
Severe AKI is an independent risk factor for subsequent de novo proteinuria post-hospitalization. Further prospective studies are needed to determine whether strategies to detect AKI patients at risk of proteinuria and early therapeutics to modify proteinuria can delay the progression of kidney disease.
急性肾损伤（AKI）的发病率持续上升，已被认为是肾脏疾病进展和心血管并发症的主要危险因素。早期识别与 AKI 后并发症相关的因素对于分层患者至关重要，这些患者在 AKI 发作后可能需要更密切的随访和管理。最近的研究表明，蛋白尿是 AKI 后的常见后遗症，也是 AKI 后并发症的强预测因子。本研究旨在评估已知肾功能且无蛋白尿既往史的 AKI 患者在 AKI 发作后新发蛋白尿的发生频率和时间。
我们回顾性分析了 2014 年 1 月至 2019 年 3 月间 AKI 患者的临床资料，这些患者在 AKI 发作前后均有肾功能信息。根据 ICD-10 编码和/或尿液干化学和 UPCR 在随访期间确定 AKI 指数就诊前后蛋白尿的存在。
在 2014 年 1 月至 2019 年 3 月间 AKI 诊断的 9697 例住院患者中，纳入了 2120 例至少有一次 AKI 指数入院前 Scr 和蛋白尿评估的合格患者进行分析。中位年龄为 64（IQR 54-75）岁，57%为男性。58%（n-1712）患者为 1 期 AKI，19%（n=567）为 2 期 AKI，22%（n=650）发展为 3 期 AKI。62%（n=472）的患者出现新发蛋白尿，59%（209/354）的患者在 AKI 后 90 天内出现蛋白尿。在校正年龄和合并症后，严重 AKI（2/3 期 AKI）和糖尿病与新发蛋白尿的风险增加独立相关。
严重 AKI 是住院后新发蛋白尿的独立危险因素。需要进一步的前瞻性研究来确定是否可以通过检测 AKI 患者发生蛋白尿的风险并早期进行治疗来改变蛋白尿，从而延缓肾脏病的进展。
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