From the Department of Medicine, Albany Medical Center, Albany, NY.
Department of Pulmonary and Critical Care Medicine, Froedtert and the Medical College of Wisconsin, Milwaukee, WI.
J Clin Rheumatol. 2024 Sep 1;30(6):219-222. doi: 10.1097/RHU.0000000000002108. Epub 2024 Jul 9.
Renal involvement in systemic sclerosis remains a significant concern with the focus often centered on scleroderma renal crisis (SRC). However, the broader spectrum of renal manifestations, beyond SRC, remains underrecognized. In our case-control analysis, we describe other causes, risk factors, and renal outcomes of acute kidney injury (AKI) in systemic sclerosis other than SRC.
Patients diagnosed with SSC, with and without AKI, between 2017 and 2023 at Albany Medical Center, were included in the case-control study using International Classification of Diseases , 10th Revision codes and electronic medical records. Patients with SRC were carefully excluded. Data were collected and compared between AKI and non-AKI groups for patients' demographics, clinical characteristics, and baseline treatment. Additionally, data were collected for baseline, peak, and follow-up creatinine, etiology of AKI, treatment, and outcomes. Statistical analysis was performed using R (version 4.3.0) and Minitab (V19). Categorical variables were presented as frequencies/percentages, and continuous variables as means/standard deviations. Associations between categorical variables were assessed by χ 2 test and Fisher exact test. Odds ratios and 95% confidence intervals were calculated using binary logistic regression to separately assess the effect of each independent variable on the odds of AKI. Statistical significance was set at p < 0.05.
A total of 74 cases were identified. Out of these 74 cases, 27 had AKI and 47 did not have AKI. Out of the 27 AKI cases, 4 with SRC were excluded. Advanced age, chronic kidney disease, and heart failure were identified as risk factors for AKI development. The predominant cause of AKI was prerenal etiology, accounting for 47.8% (n = 11) of cases. This was followed by cardiorenal syndrome and acute tubular necrosis, accounting for 21.7% and 17.3% of the cases, respectively. Most of the cases with AKI had complete renal recovery 78% (n = 18), whereas 17% (n = 4) had progression of the underlying chronic kidney disease. One patient progressed to end-stage renal disease requiring hemodialysis.
This analysis highlights the risk factors and variable clinicopathological courses of renal involvement in patients with scleroderma. This may range from mild AKI with good prognosis to life-threatening SRC.
系统性硬化症（SSc）患者的肾脏受累仍然是一个重大问题，其重点通常集中在硬皮病肾危象（SRC）上。然而，除 SRC 之外，更广泛的肾脏表现仍然认识不足。在我们的病例对照分析中，我们描述了其他原因、风险因素和 SSc 患者急性肾损伤（AKI）的肾脏预后，而不仅仅是 SRC。
2017 年至 2023 年期间，在奥尔巴尼医学中心根据国际疾病分类第 10 版代码和电子病历，对诊断为 SSc 并伴有或不伴有 AKI 的患者进行了病例对照研究。仔细排除了 SRC 患者。收集 AKI 组和非 AKI 组患者的人口统计学、临床特征和基线治疗数据，并进行比较。此外，还收集了 AKI 患者的基线、峰值和随访肌酐、AKI 病因、治疗和结局的数据。使用 R（版本 4.3.0）和 Minitab（V19）进行统计分析。分类变量以频率/百分比表示，连续变量以平均值/标准差表示。采用 χ 2 检验和 Fisher 精确检验评估分类变量之间的关联。使用二元逻辑回归分别评估每个独立变量对 AKI 发生几率的影响，计算比值比和 95%置信区间。设定统计学显著性水平为 p < 0.05。
共确定了 74 例患者，其中 27 例有 AKI，47 例没有 AKI。在 27 例 AKI 患者中，排除了 4 例伴有 SRC 的患者。高龄、慢性肾脏病和心力衰竭被确定为 AKI 发生的危险因素。AKI 的主要病因是肾前性病因，占 47.8%（n = 11）。其次是心肾综合征和急性肾小管坏死，分别占 21.7%和 17.3%。大多数 AKI 患者的肾功能完全恢复（78%，n = 18），而 17%（n = 4）的患者慢性肾脏病进展。1 例患者进展为终末期肾病，需要血液透析。
本分析强调了 SSc 患者肾脏受累的风险因素和可变的临床病理过程，其范围可从预后良好的轻度 AKI 到危及生命的 SRC。
