Acute kidney injury in patients with primary nephrotic syndrome: influencing factors and coping strategies

Honghua Lu, Liping Xiao, Mengqi Song, Xiaolan Liu, Fang Wang, Honghua Lu, Liping Xiao, Mengqi Song, Xiaolan Liu, Fang Wang

Abstract

Background: Acute kidney injury (AKI) is a frequent and serious complication in patients with primary nephrotic syndrome (PNS). We aimed to evaluate the influencing factors of AKI in patients with PNS, to provide implications for the clinical management and nursing care of patients with PNS.

Methods: PNS patients who were treated in the Department of Nephrology in our hospital from January 1, 2020 to July 31, 2021 were included. The clinical characteristics and pathological type of PNS patients were evaluated. Pearson correlation and Logistic regression analysis were performed to analyze the related risk factors of AKI in patients with PNS.

Results: A total of 328 patients with PNS were included, the incidence of AKI in PNS patients was 28.05%. Pearson correlation analysis showed that diabetes(r = 0.688), pulmonary infection (r = 0.614), albumin (r = 0.779), serum creatinine (r = 0.617), uric acid (r = 0.522), blood urea nitrogen (r = 0.616), renal tubular casts (r = 0.707) were correlated with AKI in PNS patients (all P < 0.05). Logistic regression analysis indicated that diabetes (OR2.908, 95%CI1.844 ~ 4.231), pulmonary infection(OR3.755, 95%CI2.831 ~ 4.987), albumin ≤ 24 g/L (OR1.923, 95%CI1.214 ~ 2.355), serum creatinine ≥ 90 μmol/L (OR2.517, 95%CI2.074 ~ 3.182), blood urea nitrogen ≥ 6.5 mmol/L (OR1.686, 95%CI1.208 ~ 2.123), uric acid ≥ 390 μmol/L (OR2.755, 95%CI2.131 ~ 3.371), renal tubular casts(OR1.796, 95%CI1.216 ~ 2.208) were the independently influencing factors of AKI in PNS patients (all P < 0.05).

Conclusions: AKI is common in PNS patients. Actively controlling diabetes and pulmonary infection, strengthening nutrition support and renal function monitoring are essential to reduce the occurrence of AKI in PNS patients.

Keywords: Acute kidney injury; Care; Factors; Nursing; Primary nephrotic syndrome; Treatment.

Conflict of interest statement

The authors declare that they have no competing interests.

© 2022. The Author(s).

References

    1. Zhou YL, Du XG. Risk factors of acute kidney injury complicating adult primary nephrotic syndrome. Zhongguo Yi Xue Ke Xue Yuan Xue Bao. 2020;42(4):436–443.
    1. Guan N, Yao Y, Xiao H, Ding J, Zhong X, Wang F, Liu X, Zhang H, Su B. Factors predicting the recovery from acute kidney injury in children with primary nephrotic syndrome. Clin Exp Nephrol. 2021;25(9):1011–1017. doi: 10.1007/s10157-021-02074-z.
    1. Rovin BH, Caster DJ, Cattran DC, Gibson KL, Hogan JJ, Moeller MJ, Roccatello D, Cheung M, Wheeler DC, Winkelmayer WC, et al. Management and treatment of glomerular diseases (part 2): conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference. Kidney Int. 2019;95(2):281–295. doi: 10.1016/j.kint.2018.11.008.
    1. Larpparisuth N, Chanchairujira T, Chawanasuntorapoj R, Choensuchon B, Vareesangthip K, Vasuvattakul S, Teerapornlertratt T. Acute kidney injury in primary nephrotic syndrome: report of nine cases in Siriraj Hospital. J Med Assoc Thai. 2011;94(Suppl 1):S125–133.
    1. Lionaki S, Liapis G, Boletis JN. Pathogenesis and management of acute kidney injury in patients with nephrotic syndrome due to primary glomerulopathies. Medicina (Kaunas) 2019;55(7):365. doi: 10.3390/medicina55070365.
    1. de Melo CVB, Tavares MB, Fernandes PN, Dos Santos Silva CA, Couto RD, Oliveira MB, Dos-Santos WLC. Urinary cytology: a potential tool for differential diagnosis of acute kidney injury in patients with nephrotic syndrome. BMC Res Notes. 2020;13(1):401. doi: 10.1186/s13104-020-05244-6.
    1. Chen T, Zhou Y, Chen X, Chen B, Pan J. Acute kidney injury in idiopathic membranous nephropathy with nephrotic syndrome. Ren Fail. 2021;43(1):1004–1011. doi: 10.1080/0886022X.2021.1942913.
    1. Konigsfeld HP, Viana TG, Pereira SC, Santos T, Kirsztajn GM, Tavares A, de Souza Durao Junior M. Acute kidney injury in hospitalized patients who underwent percutaneous kidney biopsy for histological diagnosis of their renal disease. BMC Nephrol. 2019;20(1):315. doi: 10.1186/s12882-019-1514-8.
    1. Group AKIEC Acute kidney injury diagnosis and expert consensus. China J Nephrol. 2006;22(11):661–663.
    1. Kodner C. Diagnosis and management of nephrotic syndrome in adults. Am Fam Physician. 2016;93(6):479–485.
    1. Yajun P, Quanying L, Huayou L. Analysis of risk factors for primary nephrotic syndrome complicated by acute kidney injury. China Pract Med. 2013;8(17):21–24.
    1. Infectology Group RDBoCMA Guidelines for the diagnosis and treatment of hospital-acquired pneumonia and ventilator-associated pneumonia in Chinese adult hospitals. Chinese J Tuberc Respir. 2018;41(4):255–280.
    1. Stefan G, Busuioc R, Stancu S, Hoinoiu M, Zugravu A, Petre N, Mircescu G. Adult-onset minimal change disease: the significance of histological chronic changes for clinical presentation and outcome. Clin Exp Nephrol. 2021;25(3):240–250. doi: 10.1007/s10157-020-01985-7.
    1. Covic A, Vlad CE, Caruntu ID, Voroneanu L, Hogas S, Cusai S, Florea L, Covic A. Epidemiology of biopsy-proven glomerulonephritis in the past 25 years in the North-Eastern area of Romania. Int Urol Nephrol. 2021;8:10–16.
    1. Ronsin C, Georges M, Chapelet-Debout A, Augusto JF, Audard V, Lebourg L, Rubin S, Quemeneur T, Bataille P, Karras A, et al. ANCA-Negative Pauci-immune Necrotizing Glomerulonephritis: a case series and a new clinical classification. Am J Kidney Dis. 2021;24:1–4.
    1. AlYousef A, AlSahow A, AlHelal B, Alqallaf A, Abdallah E, Abdellatif M, Nawar H, Elmahalawy R. Glomerulonephritis histopathological pattern change. BMC Nephrol. 2020;21(1):186. doi: 10.1186/s12882-020-01836-3.
    1. Shi C, Li C, Ye W, Ye WL, Li MX. Nephrotic-range proteinuria and central nervous involvement in typical hemolytic uremic syndrome: a case report. BMC Nephrol. 2020;21(1):319. doi: 10.1186/s12882-020-01979-3.
    1. Togashi H, Shimosato Y, Saida K, Miyake N, Nakamura T, Ito S. Childhood nephrotic syndrome complicated by catastrophic multiple arterial thrombosis requiring bilateral above-knee amputation. Front Pediatr. 2020;8:107. doi: 10.3389/fped.2020.00107.
    1. Meyrier A, Niaudet P. Acute kidney injury complicating nephrotic syndrome of minimal change disease. Kidney Int. 2018;94(5):861–869. doi: 10.1016/j.kint.2018.04.024.
    1. Guo QY, Zhu QJ, Liu YF, Zhang HJ, Ding Y, Zhai WS, Ren XQ, Zhang J, Zhang X, Yang M. Steroids combined with levothyroxine to treat children with idiopathic nephrotic syndrome: a retrospective single-center study. Pediatr Nephrol. 2014;29(6):1033–1038. doi: 10.1007/s00467-013-2727-x.
    1. Kim MY, Cho MH, Kim JH, Ahn YH, Choi HJ, Ha IS, Il Cheong H, Kang HG. Acute kidney injury in childhood-onset nephrotic syndrome: incidence and risk factors in hospitalized patients. Kidney Res Clin Pract. 2018;37(4):347–355. doi: 10.23876/j.krcp.18.0098.
    1. Koomans HA. Pathophysiology of acute renal failure in idiopatic nephrotic syndrome. Nephrol Dial Transplant. 2001;16(2):221–224. doi: 10.1093/ndt/16.2.221.
    1. Kimura T, Yasuda K, Obi Y, Satoh T, Namba T, Sasaki K, Muramoto N, Wada A, Rakugi H, Isaka Y, et al. Case of HIV-associated nephropathy accompanied by nephrotic syndrome and acute worsening of kidney function. Nihon Jinzo Gakkai Shi. 2012;54(2):94–98.
    1. Jun L, Xiangmei C. The mechanism of proteinuria accelerating renal tubular injury. Chinese J Nephrol Res. 2014;3(2):99–102.
    1. Meijuan Z, Bin Z, Caifeng Z. A case-control study on the risk factors analysis of primary nephrotic syndrome complicated by acute kidney injury. Chinese J Integr Tradit Chinese Western Med Nephro. 2018;19(11):24–28.
    1. Weiwei F, Beiyan B. Analysis of related factors of primary nephrotic syndrome complicated by acute kidney injury. Chinese Mod Med. 2013;51(12):34–35,38.
    1. Xiuyuan L, Jinxia G, Zenglei Z. Nested case-control study on risk factors of acute kidney injury in critically ill patients. China Hospital Statistics. 2019;14(2):11–15.
    1. Lin SP, Zhu FG, Meng JL, Sun XW, Cui J, Liang S, Yin Z, Sun XF, Cai GY. Clinical features of acute kidney injury in patients with nephrotic syndrome and minimal change disease: a retrospective, cross-sectional study. Chin Med J (Engl) 2020;134(2):206–211. doi: 10.1097/CM9.0000000000001218.
    1. Muhlbacher T, Amann K, Mahling M, Nadalin S, Heyne N, Guthoff M. Successful long-term management of recurrent focal segmental glomerulosclerosis after kidney transplantation with costimulation blockade. Clin Kidney J. 2021;14(6):1691–1693. doi: 10.1093/ckj/sfaa267.
    1. Zhong XH, Ding J, Liu XY, Xiao HJ, Yao Y, Huang JP. Clinical analysis of acute kidney injury in children with renal diseases. Zhonghua Er Ke Za Zhi. 2011;49(1):60–65.
    1. Mahanta PJ, Agarawalla B, Sharma M. Clinicopathological features and risk factors analysis of IgA nephropathy associated with acute kidney injury: a single-center retrospective study. Saudi J Kidney Dis Transpl. 2019;30(2):445–450. doi: 10.4103/1319-2442.256851.
    1. Xu X, Hu J, Song N, Chen R, Zhang T, Ding X. Hyperuricemia increases the risk of acute kidney injury: a systematic review and meta-analysis. BMC Nephrol. 2017;18(1):27. doi: 10.1186/s12882-016-0433-1.
    1. Otomo K, Horino T, Miki T, Kataoka H, Hatakeyama Y, Matsumoto T, Hamada-Ode K, Shimamura Y, Ogata K, Inoue K, et al. Serum uric acid level as a risk factor for acute kidney injury in hospitalized patients: a retrospective database analysis using the integrated medical information system at Kochi Medical School hospital. Clin Exp Nephrol. 2016;20(2):235–243. doi: 10.1007/s10157-015-1156-5.
    1. Lapsia V, Johnson RJ, Dass B, Shimada M, Kambhampati G, Ejaz NI, Arif AA, Ejaz AA. Elevated uric acid increases the risk for acute kidney injury. Am J Med. 2012;125(3):302 e309–317. doi: 10.1016/j.amjmed.2011.06.021.
    1. Kanbay M, Solak Y, Afsar B, Nistor I, Aslan G, Caglayan OH, Aykanat A, Donciu MD, Lanaspa MA, Ejaz AA, et al. Serum uric acid and risk for acute kidney injury following contrast. Angiology. 2017;68(2):132–144. doi: 10.1177/0003319716644395.
    1. Chen X, Xu J, Li Y, Xu X, Shen B, Zou Z, Ding X, Teng J, Jiang W. Risk scoring systems including electrolyte disorders for predicting the incidence of acute kidney injury in hospitalized patients. Clin Epidemiol. 2021;13:383–396. doi: 10.2147/CLEP.S311364.
    1. Popa O, Stefan G, Capusa C, Mandache E, Stancu S, Petre N, Mircescu G. Non-diabetic glomerular lesions in diabetic kidney disease: clinical predictors and outcome in an Eastern European cohort. Int Urol Nephrol. 2021;53(4):739–747. doi: 10.1007/s11255-020-02681-x.
    1. Jia SL, Ni FF, Ma YJ, Wu YH, Ma WK, Gao XJ. Clinical analysis of primary nephrotic syndrome complicated by plastic bronchitis in children. Klin Padiatr. 2021;233(2):63–68. doi: 10.1055/a-1288-3670.
    1. Go AS, Tan TC, Chertow GM, Ordonez JD, Fan D, Law D, Yankulin L, Wojcicki JM, Zheng S, Chen KK, et al. Primary nephrotic syndrome and risks of ESKD, cardiovascular events, and death: the Kaiser Permanente nephrotic syndrome study. J Am Soc Nephrol. 2021;12:22–27.
    1. Mohd R, Mohammad Kazmin NE, Abdul Cader R, AbdShukor N, Wong YP, Shah SA, Alfian N. Long term outcome of immunoglobulin A (IgA) nephropathy: a single center experience. PLoS One. 2021;16(4):e0249592. doi: 10.1371/journal.pone.0249592.

Source: PubMed

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