■急性肾损伤(AKI)患者的草酸钙(CaOx)晶体沉积尚未得到认可,但会影响肾脏结局。本研究调查了其决定因素和影响。
■从2011年到2020年,我们研究了814例AKI患者的天然肾脏活检,确定了CaOx晶体沉积的严重程度(轻度:<5,中度:5-10,重度:>每节10个晶体)。我们评估了尿草酸盐等因素,柠檬酸盐urate,电解质,pH值,肾小管钙化指数,和SLC26A6表达式,将其与肌酐匹配的AKI对照组进行比较,而无草藻病。我们分析了这些因素与CaOx严重程度及其对肾脏恢复的影响(3个月随访时eGFR<15mL/min/1.73m2)。
■在AKI队列(32例)的3.9%中发现CaOx晶体沉积,72%是由于肾毒性药物引起的肾小管间质性肾炎。使用利尿剂,低血尿引起的尿草酸盐与柠檬酸盐的比例较高,和肾小管钙化指数是中度和/或重度CaOx沉积的重要因素。基线肾功能差,低尿氯化物,高尿酸和尿素氮,管状SLC26A6过表达,肾小球硬化也与中重度CaOx沉积相关。肾脏恢复延迟,43.8%,31.2%,18.8%的患者在损伤后4、12和24周eGFR<15mL/min/1.73m2。不良结局与高尿α1-微球蛋白与肌酐(α1-MG/C)比率和活动性肾小管损伤评分有关。单变量分析显示,这一比率与不良肾脏结局之间有很强的联系,与草中毒的严重程度无关。
■在AKI中,尽管GFR下降,CaOx沉积是常见的。肾小管损伤恶化的因素,不仅仅是草酸盐与柠檬酸盐的比例,是了解肾脏恢复受损的关键。
UNASSIGNED: Calcium oxalate (CaOx) crystal deposition in acute kidney injury (AKI) patients is under recognized but impacts renal outcomes. This study investigates its determinants and effects.
UNASSIGNED: We studied 814 AKI patients with native kidney biopsies from 2011 to 2020, identifying CaOx crystal deposition severity (mild: <5, moderate: 5-10, severe: >10 crystals per section). We assessed factors like urinary oxalate, citrate, urate, electrolytes, pH, tubular calcification index, and SLC26A6 expression, comparing them with creatinine-matched AKI controls without oxalosis. We analyzed how these factors relate to CaOx severity and their impact on renal recovery (eGFR < 15 mL/min/1.73 m2 at 3-month follow-up).
UNASSIGNED: CaOx crystal deposition was found in 3.9% of the AKI cohort (32 cases), with 72% due to nephrotoxic medication-induced tubulointerstitial nephritis. Diuretic use, higher urinary oxalate-to-citrate ratio induced by hypocitraturia, and tubular calcification index were significant contributors to moderate and/or severe CaOx deposition. Poor baseline renal function, low urinary chloride, high uric acid and urea nitrogen, tubular SLC26A6 overexpression, and glomerular sclerosis were also associated with moderate-to-severe CaOx deposition. Kidney recovery was delayed, with 43.8%, 31.2%, and 18.8% of patients having eGFR < 15 mL/min/1.73 m2 at 4, 12, and 24-week post-injury. Poor outcomes were linked to high urinary α1-microglobulin-to-creatinine (α1-MG/C) ratios and active tubular injury scores. Univariate analysis showed a strong link between this ratio and poor renal outcomes, independent of oxalosis severity.
UNASSIGNED: In AKI, CaOx deposition is common despite declining GFR. Factors worsening tubular injury, not just oxalate-to-citrate ratios, are key to understanding impaired renal recovery.