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首页> 美国卫生研究院文献>Journal of Clinical and Translational Hepatology >Bile Cast Nephropathy in Patients with Acute Kidney Injury Due to Hepatorenal Syndrome: A Postmortem Kidney Biopsy Study
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Bile Cast Nephropathy in Patients with Acute Kidney Injury Due to Hepatorenal Syndrome: A Postmortem Kidney Biopsy Study

机译：肝肾综合征导致的急性肾脏损伤患者的胆汁铸型肾病：死后肾脏活检研究

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>Background and Aims: The role of bile cast nephropathy (BCN) in pathogenesis of hepatorenal syndrome (HRS) in decompensated cirrhosis and acute on chronic liver failure (ACLF) is unknown. This study aimed to determine the frequency of BCN detected on postmortem renal biopsy among patients with decompensated cirrhosis and ACLF who had been admitted with acute kidney injury due to HRS (HRA-AKI) and expired during that hospitalization.>Methods: One-hundred-twenty-seven postmortem renal biopsies with adequate size (>1 cm in length) were included for analysis. These were obtained from 84 patients with decompensated cirrhosis and 43 patients with ACLF.>Results: BCN was detected in 57 of the total 127 (44.8%) renal biopsy specimens. Patients with BCN had significantly higher levels of serum total bilirubin, total leukocyte count and model for end-stage liver disease score, as compared to those without BCN. BCN was detected in 32/43 (74.4%) of the patients with ACLF, as compared to 25/84 (29.7%) of the patients with decompensated cirrhosis (p < 0.001). On multivariate analysis, direct bilirubin (OR (95% CI): 1.27 (1121–1.698); p < 0.001) and presence of ACLF (OR (95% CI): 2.603 (1.054–7.111); p = 0.041) were found to be significant predictors of BCN on postmortem renal biopsy.>Conclusion: BCN was found in 72.1% of patients with ACLF and 27.4% patients with decompensated cirrhosis who had been hospitalized with an admitting diagnosis of HRS-AKI and who expired during that hospitalization and underwent postmortem renal biopsy. Direct serum bilirubin and presence of ACLF were found to be significant predictors of BCN on postmortem renal biopsy.
机译：>背景和目的：胆管性肾病（BCN）在失代偿性肝硬化和急性肝衰竭（ACLF）急性肝肾综合征（HRS）发病机理中的作用尚不清楚。这项研究的目的是确定在失代偿性肝硬化和ACLF中因HRS（HRA-AKI）急性肾损伤入院并在住院期间死亡的患者，在死后肾活检中检测到BCN的频率。>方法：包括一百二十七份尸体尸体，其大小合适（长度> 1厘米）以进行分析。这些是从84例失代偿性肝硬化患者和43例ACLF患者中获得的。>结果：在总共127例（44.8％）肾活检标本中检测到BCN。与没有BCN的患者相比，具有BCN的患者的血清总胆红素，总白细胞计数和终末期肝病评分模型的水平明显更高。 ACLF患者中32/43（74.4％）检测到BCN，而代偿性肝硬化患者中25/84（29.7％）被检测到（p <0.001）。在多变量分析中，发现直接胆红素（OR（95％CI）：1.27（1121-1.698）; p <0.001）和存在ACLF（OR（95％CI）：2.603（1.054-7.111）; p = 0.041） >结论：BCN在72.1％的ACLF患者和27.4％的失代偿性肝硬化患者中入院，这些患者被确诊为HRS-AKI和在该住院期间死亡并进行了死后肾活检的患者。发现直接血清胆红素和ACLF的存在是死后肾活检中BCN的重要预测指标。

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