Abstract: FR-PO010
Pathological Characteristics and Prognosis of Community-Acquired AKI: Risk Factors of AKI to CKD Transition
Session Information
- AKI: Epidemiology, Risk Factors, Prevention - II
November 08, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Acute Kidney Injury
- 101 AKI: Epidemiology, Risk Factors, and Prevention
Authors
- Ruan, Mengna, Changzheng Hospital, Second Military Medical Universisy, Shanghai, China
- Xu, Jing, Shanghai Changzheng Hospital, Shanghai, China
- Mao, Zhiguo, Changzheng Hospital, Shanghai, SHanghai, China
Background
Community-acquired acute kidney injury(CA-AKI) wins more attentions from society. Underlying pathological damages are regraded as major determinants to AKI to CKD transition. In this study, we clarified the pathological characteristics of CA-AKI and evaluated the influence of morphologic changes in the renal biopsy on the rapid loss of renal function and AKI-CKD transition.
Methods
This single-centered cohort study enrolled CA-AKI patients with renal biopsy examination from January 1, 2010 to September 30, 2017 admitted to Shanghai Changzheng Hospital. All patients were followed up for 90 days after diagnosis.The demographic characteristics, pathological lesions and outcomes were recorded and analyzed. Cox proportional hazard models were used to evaluate the risk factors for all-cause mortality and renal replacement therapy requirement after diagnosis. Logistics regression analyses were used to identify the risk factors associated with progression to CKD or maintained dialysis, and renal recovery as well.
Results
A total of 251 eligible CA-AKI patients were recruited into the cohort, of whom 144(57.4%) were male and age ranged from 18 to 85 years old(median 53). Our results showed that pathological lesions played critical role in AKI-CKD progression and renal recovery. With regard to progression on 90th day, segmental glomerulosclerosis(Relative Ratio(RR) 6.44; 95%CI, 2.03 to 20.38, p=0.002), severe vascular lesion(RR 14.92; 95% CI, 2.35 to 94.80, p=0.004) , and crescent index (RR 3.50; 95% CI, 2.07 to 5.91, p=0.037) were significantly associated with progression to maintained dialysis.Over 50% area of Interstitial inflammation(RR 8.09; 95%CI 2.54 to 25.77, p＜0.001) and crescent index(RR 3.30; 95%CI 1.78 to 6.12, p＜0.001) were risk factors for progression to CKD. Moreover, interstitial fibrosis and crescent were risk factors for partial renal recovery. While, renal morphologic changes showed little impact on in-hospital all-cause mortality and RRT requirement by Cox proportional hazard modeling analysis.
Conclusion
Pathological damages played a part in the rapid loss of renal function and AKI-CKD transition of CA-AKI patients in a short term，affected renal recovery as well. Whereas, it did not interfere with severity of AKI: all-cause mortality and RRT requirement.
Funding
- Government Support - Non-U.S.