肾静脉血栓形成患者肾脏结局和死亡率的预测因素：一项回顾性多中心研究。
Predictors of renal outcomes and mortality in patients with renal vein thrombosis: a retrospective multicenter study.
作者信息
Mohamed Osama Nady, Ibrahim Sharehan Abdelrahman, Elsaghir Shereen Mohammed Mohammed, Mohamed Marwa Ibrahim, Fathy Basma, Dardeer Ahmed M, Shehata Sayed, Mohammed Hassan M H, Setouhi Amr, Ahmed Ayat Mostafa Mohamed, Kamel Asmaa Khalf, Ismail Doaa Elzaeem, Abbas Nehal I, Ziady Ahmed Fathy Kamel, Esmaeel Tamer El Zaeem, Issa Ahmed S, Yassin Ahmed M, Hussein Mostafa Mahmoud, Abdelghany Mostafa M, Nagy Momen Mostafa, Ayad Michael Samuel, Kamel Shaimaa F
机构信息
Nephrology Unit, Department of Internal Medicine, Faculty of Medicine, Minia University, Taha Hussein Street, Minia, Egypt.
Department of Cardiology, Faculty of Medicine, Minia University, Minia, Egypt.
出版信息
J Nephrol. 2025 Mar;38(2):551-561. doi: 10.1007/s40620-024-02166-5. Epub 2024 Dec 31.
BACKGROUND
Studies on renal vein thrombosis have been conducted as case reports or case series. The renal outcomes and mortality risk of renal vein thrombosis have not been fully established. We aimed to investigate the clinical characteristics, treatment modalities, and predictors of renal outcomes and mortality in patients with renal vein thrombosis in a large multicenter cohort.
METHODS
We retrospectively assessed 182 patients with renal vein thrombosis diagnosed between January 2011 and May 2023 using either Doppler ultrasonography or computed tomography venography. The main outcomes analyzed were all-cause mortality, and worsening kidney function.
RESULTS
We evaluated 182 patients comprising 76 males (41.8%) and 106 females (58.2%). Nephrotic syndrome was the most common cause (51.6%) followed by malignancy (33%) and post-trauma or surgery (11%). Kidney function worsened in 126 patients (69.2%). Acute kidney injury (AKI) was identified in 72 patients (39.6%), whereas 54 patients (29.7%) developed chronic kidney disease (CKD). Multivariate logistic regression showed that declining kidney function was reliably predicted by nephrotic syndrome (Odds ratio (OR): 6.41, P = 0.004), serum albumin (OR: 0.31, P = 0.003), and diabetes mellitus (OR: 14.04, P < 0.001). Eighty-two patients (45.1%) died while being monitored. Sepsis accounted for the majority of deaths (25.3%). Bilateral renal vein thrombosis (Hazard Ratio (HR): 5.61, P < 0.001), malignancy (HR: 6.15, P = 0.004), serum albumin (HR: 0.12, P < 0.001), hemoglobin (Hb) level (HR: 0.102, P < 0.001) and diabetes mellitus (HR: 2.42, P = 0.007) were all reliable predictors of all-cause mortality using multivariate Cox regression.
CONCLUSION
Renal vein thrombosis is associated with a higher risk of mortality and worsening kidney function. It is essential to promptly identify high risk patients and start early treatment to prevent unfavorable outcomes.
背景
关于肾静脉血栓形成的研究多为病例报告或病例系列。肾静脉血栓形成的肾脏预后及死亡风险尚未完全明确。我们旨在调查一个大型多中心队列中肾静脉血栓形成患者的临床特征、治疗方式以及肾脏预后和死亡的预测因素。
方法
我们回顾性评估了2011年1月至2023年5月期间通过多普勒超声或计算机断层扫描静脉造影诊断为肾静脉血栓形成的182例患者。分析的主要结局为全因死亡率和肾功能恶化。
结果
我们评估了182例患者，其中男性76例（41.8%），女性106例（58.2%）。肾病综合征是最常见的病因（51.6%），其次是恶性肿瘤（33%）和创伤或手术后（11%）。126例患者（69.2%）肾功能恶化。72例患者（39.6%）被诊断为急性肾损伤（AKI），而54例患者（29.7%）发展为慢性肾脏病（CKD）。多因素logistic回归显示，肾病综合征（比值比（OR）：6.41，P = 0.004）、血清白蛋白（OR：0.31，P = 0.003）和糖尿病（OR：14.04，P < 0.001）可可靠预测肾功能下降。82例患者（45.1%）在监测期间死亡。脓毒症是死亡的主要原因（25.3%）。多因素Cox回归分析显示，双侧肾静脉血栓形成（风险比（HR）：5.61，P < 0.001）、恶性肿瘤（HR：6.15，P = 0.004）、血清白蛋白（HR：0.12，P < 0.001）、血红蛋白（Hb）水平（HR：0.102，P < 0.001）和糖尿病（HR：2.42，P = 0.007）均为全因死亡率的可靠预测因素。
结论
肾静脉血栓形成与更高的死亡风险和肾功能恶化相关。及时识别高危患者并尽早开始治疗以预防不良结局至关重要。
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