PDF(Pubmed)
Abstract：
BACKGROUND: A percutaneous kidney biopsy (PKB) allows nephrologists to make informed decisions for treating various kidney diseases; however, the risk of bleeding complications should be considered, given the vascularity of the kidney. Many studies have reported risk factors for bleeding events after a PKB. However, while urinary N-acetyl-β-D-glucosaminidase (NAG) is a useful biomarker of kidney disease severity, little is known about whether or not urinary NAG is related to the bleeding risk.
METHODS: Medical records of patients who underwent a PKB at the National Defense Medical College Hospital between October 2018 and October 2023 were retrospectively studied. Hemoglobin (Hb) loss ≥ 1 g/dL was defined as a bleeding event.
RESULTS: Of the 213 patients, 110 (51.6%) were men, and the median age was 56 years old (interquartile range 40-71). The most frequent diagnosis on a PKB was IgA nephropathy (N = 72; 34.0%). Fifty-four patients (25.3%) experienced Hb loss ≥ 1 g/dL after a PKB, and urinary NAG/Cr levels before the biopsy were able to predict a bleeding event, with an area under the receiver operating characteristic curve of 0.65 (p = 0.005). Using the optimal cutoff value of 35 U/gCr, urinary NAG/Cr was found to be an independent risk factor by multiple logistic regression analysis (odds ratio 3.21, 95% confidence interval 1.42-7.27, p = 0.005). Even after adjusting for previously-reported risk factors, the elevated urinary NAG/Cr ratio remained a statistically significant variable. Compared with the pathological findings, only the severity of multilayered elastic laminae of the small muscular artery was associated with both urinary NAG/Cr levels (p = 0.008) and bleeding events (p = 0.03).
CONCLUSIONS: Urinary NAG successfully predicted not only the severity of kidney disorders but also bleeding events after a PKB. Arteriosclerosis in the kidneys may be the mechanism underlying these increased bleeding events.
METHODS: Medical records of patients who underwent a PKB at the National Defense Medical College Hospital between October 2018 and October 2023 were retrospectively studied. Hemoglobin (Hb) loss ≥ 1 g/dL was defined as a bleeding event.
RESULTS: Of the 213 patients, 110 (51.6%) were men, and the median age was 56 years old (interquartile range 40-71). The most frequent diagnosis on a PKB was IgA nephropathy (N = 72; 34.0%). Fifty-four patients (25.3%) experienced Hb loss ≥ 1 g/dL after a PKB, and urinary NAG/Cr levels before the biopsy were able to predict a bleeding event, with an area under the receiver operating characteristic curve of 0.65 (p = 0.005). Using the optimal cutoff value of 35 U/gCr, urinary NAG/Cr was found to be an independent risk factor by multiple logistic regression analysis (odds ratio 3.21, 95% confidence interval 1.42-7.27, p = 0.005). Even after adjusting for previously-reported risk factors, the elevated urinary NAG/Cr ratio remained a statistically significant variable. Compared with the pathological findings, only the severity of multilayered elastic laminae of the small muscular artery was associated with both urinary NAG/Cr levels (p = 0.008) and bleeding events (p = 0.03).
CONCLUSIONS: Urinary NAG successfully predicted not only the severity of kidney disorders but also bleeding events after a PKB. Arteriosclerosis in the kidneys may be the mechanism underlying these increased bleeding events.
摘要：
背景：经皮肾活检（PKB）使肾脏病学家能够做出治疗各种肾脏疾病的明智决定；然而，应考虑出血并发症的风险，考虑到肾脏的血管。许多研究报道了PKB后出血事件的危险因素。然而,而尿N-乙酰-β-D-氨基葡萄糖苷酶（NAG）是肾脏疾病严重程度的有用生物标志物，关于尿NAG是否与出血风险相关的问题知之甚少.
方法：回顾性研究了2018年10月至2023年10月在国防科技大学医院接受PKB的患者的病历。血红蛋白（Hb）丢失≥1g/dL定义为出血事件。
结果：在213名患者中，110（51.6％）是男性，中位年龄为56岁（四分位距40-71）。PKB最常见的诊断是IgA肾病（N=72；34.0％）。54例患者（25.3％）在PKB后出现Hb损失≥1g/dL，活检前的尿NAG/Cr水平能够预测出血事件，接收器工作特性曲线下的面积为0.65(p=0.005)。使用35U/gCr的最佳截止值，通过多元logistic回归分析发现尿NAG/Cr是独立的危险因素(比值比3.21,95%置信区间1.42-7.27,p=0.005).即使在调整了以前报告的风险因素后，尿NAG/Cr比值升高仍然是一个有统计学意义的变量.与病理结果相比，只有肌肉小动脉多层弹性层的严重程度与尿NAG/Cr水平(p=0.008)和出血事件(p=0.03)相关.
结论：尿NAG不仅成功预测了肾脏疾病的严重程度，而且还预测了PKB后的出血事件。肾脏中的动脉硬化可能是这些出血事件增加的潜在机制。
方法：回顾性研究了2018年10月至2023年10月在国防科技大学医院接受PKB的患者的病历。血红蛋白（Hb）丢失≥1g/dL定义为出血事件。
结果：在213名患者中，110（51.6％）是男性，中位年龄为56岁（四分位距40-71）。PKB最常见的诊断是IgA肾病（N=72；34.0％）。54例患者（25.3％）在PKB后出现Hb损失≥1g/dL，活检前的尿NAG/Cr水平能够预测出血事件，接收器工作特性曲线下的面积为0.65(p=0.005)。使用35U/gCr的最佳截止值，通过多元logistic回归分析发现尿NAG/Cr是独立的危险因素(比值比3.21,95%置信区间1.42-7.27,p=0.005).即使在调整了以前报告的风险因素后，尿NAG/Cr比值升高仍然是一个有统计学意义的变量.与病理结果相比，只有肌肉小动脉多层弹性层的严重程度与尿NAG/Cr水平(p=0.008)和出血事件(p=0.03)相关.
结论：尿NAG不仅成功预测了肾脏疾病的严重程度，而且还预测了PKB后的出血事件。肾脏中的动脉硬化可能是这些出血事件增加的潜在机制。
