急性肾梗死的临床特征:单中心52例临床分析

doi:10.19723/j.issn.1671-167X.2019.05.012

Abstract

Abstract:

Objective:To investigate the clinical characteristics of patients with acute renal infarction (ARI) and explore the possible clinical and/or laboratory parameters relative to hematuria. Methods: Medical records of 52 patients hospitalized with radiologic proven ARI were retrospectively reviewed. Clinical characteristics, including demographic data, risk factors for thromboembolism, initial clinical presentations, laboratory data, diagnosis, treatment programs and outcomes were evaluated and compared between hematuria(+) and hematuria(-) patients. Results: The mean age of the patients (34 men and 18 women) was (56.3±14.8) years. The left, right, and bilateral kidneys were involved in 44.2%, 34.6% and 21.2% of the patients, respectively. Focal, multiple and massive infarctions were involved in 36.5%, 50.0% and 13.5% of the patients. The prevalence of concurrent thromboembolic events was 38.5%. Atrial fibrillation was complicated in 44.2% of the patients. ARI often presented with non-specific symptoms, including abdominal/flank pain (71.2%), nausea (55.8%), lumbar pain (53.9%), vomiting (48.1%), fever (48.1%), and diarrhea (21.2%). Percussion tenderness over kidney region was the most common sign (40.4%). The levels of serum lactate dehydrogenase, white blood cell count and C-reactive protein were elevated in 86.5%, 67.3%, and 54.5% of cases, respectively. Hematuria was detected in only 38.5% of the cases on admission. Elevation of serum D-dimer was only noted in 56.5% of the patients. The median duration from hospital presentation to diagnosis was 41.5 h (range: 2-552 h). Contrast-enhanced computed tomography was diagnostic in 47 (90.4%) cases. Angiography was positive in the other 5 (9.6%) cases. Anticoagulation was the most common therapy. During a mean follow-up of (39.4±35.8) months, renal functions of most patients were stable. Four patients needed permanent dialysis and one patient died of heart failure. There was no statistical significance between hematuria(+) group and hematuria(-) group for all the parameters except the level of serum lactate dehydrogenase, which was higher in hematuria(+) group [773.5 IU/L (range: 153.0-3 159.0 IU/L) vs. 488.0 IU/L (range: 137.0-3 370.0 IU/L), P=0.041]. Conclusion: Thromboembolism due to heart disease is the main etiology of ARI. Early contrast-enhanced computed tomography scan should be considered for high-risk patients with persisting abdominal or lumbar pain and elevated serum level of lactate dehydrogenase. Hematuria is not a sensitive clue for diagnosis and is not relative to prognosis. Whether it is present may be determined by the severity of infarction.

Key words: Acute renal infarction, Thromboembolism, Hematuria, Contrast-enhanced computed tomography, Lactate dehydrogenase

CLC Number:

R692.2

Zhi-gang ZHANG,Xin-min LIU. Clinical characteristics of patients with acute renal infarction: an analysis of 52 patients in a single center[J].Journal of Peking University(Health Sciences), 2019, 51(5): 863-869.

Figures/Tables 3

Table 1

Clinical characteristics of patients with acute renal infarction"

Items		Total (n=52)		Hematuria(+) (n=20)		Hematuria(-) (n=32)		Statistics	P
Age/years		56.3±14.8		55.9±14.7		56.6±15.1		0.18	0.86
Male		34 (65.4)		13 (65.0)		21 (65.6)		0	0.96
BMI/(kg/m²)		24.1±3.8		23.7±4.1		24.2±3.8		0.34	0.74
Time from symptom presentation to urinanalysis/h		24 (1, 360)		24 (1, 360)		24 (2, 288)		1.12	0.27
Symptoms/signs
Abdominal/flank pain		37 (71.2)		14 (70.0)		23 (71.9)		0.02	0.89
Lumbar pain		28 (53.9)		10 (50.0)		18 (56.3)		0.19	0.66
No pain		4 (7.7)		3 (15.0)		1 (3.1)		-	0.29^*
Nausea		29 (55.8)		11 (55.0)		18 (56.3)		0.01	0.93
Vomiting		25 (48.1)		11 (55.0)		14 (43.8)		0.62	0.43
Fever		25 (48.1)		13 (65.0)		12 (37.5)		3.73	0.05
Diarrhea		11 (21.2)		3 (15.0)		8 (25.0)		-	0.50^*
Oliguria		9 (17.3)		2 (10.0)		7 (21.9)		-	0.45^*
Fatigue		6 (11.5)		2 (10.0)		4 (12.5)		-	1.00^*
Percussion tenderness over kidney region		21 (40.4)		9 (45.0)		12 (37.5)		0.29	0.59
Laboratory data
ALT/(IU/L)		42.0 (3.0, 201.0)		52.5 (13.0, 201.0)		39.5 (3.0, 127.0)		-1.76	0.08
AST/(IU/L)		38.5 (12.0, 308.0)		40.5 (14.0, 308.0)		35.0 (12.0, 118.0)		0.55	0.14
LDH/(IU/L)		511.0 (137, 3 370)		773.5 (153.0, 3 159.0)		488.0 (137.0, 3 370.0)		-2.13	0.04
Creatinine/(μmol/L)		118.0 (63.5, 824.8)		123.5 (77.0, 526.0)		114.5 (63.5, 824.8)		-0.56	0.57
eGFR/[mL/(min·1.73 m²)]		56.8±27.2		53.1±29.5		59.0±26.0		0.74	0.46
UA/(μmol/L)		355.8±116.3		351.6±105.5		358.1±123.7		0.18	0.86
TG/(mmol/L)		1.06 (0.20, 4.08)		1.05 (0.40, 4.08)		1.08 (0.20, 2.56)		-0.01	0.99
TCHO/(mmol/L)		4.15±1.05		4.15±1.23		4.15±0.94		-0.03	0.98
LDL-C/(mmol/L)		2.62±0.88		2.54±0.93		2.67±0.86		0.48	0.63
WBC/(×10³/μL)		11.9 (2.7, 32.2)		12.3 (6.5, 25.6)		10.8 (2.7, 32.2)		-1.60	0.12
Plt/(×10⁴/μL)		20.5 (7.4, 49.7)		20.9 (10.1, 32.0)		20.1 (7.4, 49.7)		0.70	0.49
CRP/(mg/dL)		30.3 (0.5, 249.0)		69.0 (1.8, 249.0)		5.7 (0.5, 189.4)		-1.84	0.07
Fibrinogen/(g/L)		4.6±1.8		4.3±1.8		4.7±1.8		0.63	0.54
D-dimer > normal upper limit		26/46 (56.5)		12/17 (70.6)		14/29 (48.3)		2.17	0.14
Left		23 (44.2)		9 (45.0)		14 (43.8)
Right		18 (34.6)		5 (25.0)		13 (40.6)			0.35
Bilateral		11 (21.2)		6 (30.0)		5 (15.6)
Focal infarction		19 (36.5)		5 (25.0)		14 (43.8)
Multiple infarction		26 (50.0)		12 (60.0)		14 (43.8)			0.39
Global ARI		7 (13.5)		3 (15.0)		4 (12.5)
Items	Total (n=52)		Hematuria(+) (n=20)		Hematuria(-) (n=32)		Statistics		P
Concurrent thromboembolism	20 (38.5)		7 (35.0)		13 (40.6)		0.16		0.69
Splenic infarction	11 (21.2)		4 (20.0)		7 (21.9)		-		1.00^*
Lower extremity arterial embolism	5 (9.6)		0 (0)		5 (15.6)		-		0.14^*
Mesenteric arterial embolism	4 (7.7)		2 (10.0)		2 (6.3)		-		0.63^*
Iliaic artery embolism	1 (1.9)		1 (5.0)		0 (0)		-		0.39^*
Cerebral infarction	5 (9.6)		3 (15.0)		2 (6.3)		-		0.36^*
Liver infarction	1 (1.9)		1 (5.0)		0 (0)		-		0.39^*
Pulmonary thromboembolism	1 (1.9)		1 (5.0)		0 (0)		-		0.39^*
Pancreatic infarction	1 (1.9)		1 (5.0)		0 (0)		-		0.39^*

Table 1

Table 2

Table 3

References 17

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[2]	. [J]. Journal of Peking University(Health Sciences), 2009, 41(2): 125 -128 .
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Items	Total (n=52)	Hematuria(+) (n=20)	Hematuria(-) (n=32)	Statistics	P
Time from hospital presentation to diagnosis/h	41.5 (2.0, 552.0)	24.0 (2.0, 552.0)	48.0 (2.0, 408.0)	0.39	0.70
Diagnostic methods
Contrast-enhanced CT	47 (90.4)	19 (95.0)	28 (87.5)	-	0.64^*
Ultrasound	0 (0)	0 (0)	0 (0)	-	-
MRI	0 (0)	0 (0)	0 (0)	-	-
Angiography	5 (9.6)	1 (5.0)	4 (12.5)	-	0.64^*
Treatment
Anticoagulation	25 (48.1)	10 (50.0)	15 (46.9)	0.05	0.83
Antiplatelet	2 (3.8)	0 (0)	2 (6.3)	-	0.52^*
Systemic thrombolysis+anticoagulation	9 (17.3)	6 (30.0)	3 (9.4)	-	0.07^*
Catheter-directed thrombolysis+anticoagulation	7 (13.5)	2 (10.0)	5 (15.6)	-	0.69^*
Interventional therapy+anticoagulation	1 (1.9)	0 (0)	1 (3.1)	-	1.00^*
Interventional therapy+antiplatelet	4 (7.7)	1 (5.0)	3 (9.4)	-	1.00^*
Surgery+anticoagulation	0 (0)	0 (0)	0 (0)	-	-
No	4 (7.7)	1 (5.0)	3 (9.4)	-	1.00^*
Prognosis
Duration of symptom after treatment/d	3 (1, 12)	4 (1, 12)	3 (1, 9)	-0.81	0.43
Median time of hospital stay/d	13 (2, 64)	18 (3, 64)	11 (2, 42)	-1.35	0.18
Inhospital mortality	0 (0)	0 (0)	0 (0)	-	-
Creatinine/(μmol/L), discharge	102.0 (60.0, 1 043.0)	111.0 (66.0, 896.0)	99.0 (60.0, 1 043.0)	-1.46	0.15
eGFR/[mL/(min·1.73 m²)], discharge	64.6±29.3	57.4±30.6	68.8±28.2	1.25	0.22
Dialysis-dependent, follow-up	4 (7.7)	2 (10.0)	2 (6.3)	-	0.63^*
Creatinine/(μmol/L), follow-up	116.6±20.9	118.8±23.4	113.7±18.5	0.47	0.65
eGFR/[mL/(min·1.73 m²)], follow-up	52.8±15.3	52.3±14.7	53.4±17.2	-0.14	0.90

Clinical characteristics of patients with acute renal infarction: an analysis of 52 patients in a single center

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Items	Total (n=52)	Hematuria(+) (n=20)	Hematuria(-) (n=32)	Statistics	P
Risk factors for ARI
Atrial fibrillation	23 (44.2)	9 (45.0)	14 (43.8)	0.01	0.93
Malignancy	2 (3.8)	2 (10.0)	0 (0)	-	0.14^*
Hyperlipidemia	15 (28.8)	5 (25.0)	10 (31.3)	0.23	0.63
Homocysteinemia	5/6 (83.3)	3/3 (100.0)	2/3 (66.7)	-	1.00^*
Diabetes mellitus	4 (7.7)	1 (5.0)	3 (9.4)	-	1.00^*
Hypertension	26 (50.0)	13 (65.0)	13 (40.6)	2.92	0.09
Valvular heart disease	30 (57.7)	12 (60.0)	18 (56.3)	0.07	0.79
Aortic mural thrombus	6 (11.5)	2 (10.0)	4 (12.5)	-	1.00^*
Aortic dissection	2 (3.8)	1 (5.0)	1 (3.1)	-	1.00^*
Congestive heart failure	5 (9.6)	2 (10.0)	3 (9.4)	-	1.00^*
Coronary artery disease	12 (23.1)	5 (25.0)	7 (21.9)	0.07	0.8
Antiphospholipid syndrome	1 (1.9)	1 (5.0)	0 (0)	-	0.39^*
Smoking (current/exsmoker)	20 (38.5)	9 (45.0)	11 (34.4)	0.59	0.44
Renal artery stenosis	17 (32.7)	4 (20.0)	13 (40.6)	2.38	0.12
Cerebrovascular disease	3 (5.8)	2 (10.0)	1 (3.1)	-	0.55^*
Obesity	6/35 (17.1)	1/11(9.1)	5/24 (20.8)	-	0.64^*
Cardiomyopathy	3 (5.8)	1 (5.0)	2 (6.3)	-	1.00^*
Etiologies of ARI
Thromboembolism	30 (57.7)	10 (50.0)	20 (62.5)	0.79	0.38
In situ thrombosis	5 (9.6)	2 (10.0)	3 (9.4)	-	1.00^*
Coagulation dysfunction	6 (11.5)	4 (20.0)	2 (6.3)	-	0.19^*
Idiopathic	0 (0)	0 (0)	0 (0)	-	-
Unknown	11 (21.2)	4 (20.0)	7 (21.9)	-	1.00^*

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