Analysis Of Clinical Characteristics,Incidence And Risk Factors Of Renal Insufficiency In Patients With Solitary Kidney

Objectives:The purpose of this study is to analyze the clinical characteristics of patients with isolated kidney in Gansu Province,and to explore the incidence and risk factors of renal dysfunction in patients with isolated kidney.Therefore,targeted early intervention can delay renal development as much as possible,and provide basis for management and clinical diagnosis and treatment of patients with solitary kidney.Research and Methods:Retrospectively,448 adult patients with isolated kidney who were admitted to the Second Hospital of Lanzhou University from January 2012 to June 2019 were selected.All patients were diagnosed with unilateral renal deficiency by imaging tests such as renal ultrasound or urological CT.Analyze the clinical data of patients including clinical manifestations,renal function,complications,etc.,and than calculate the incidence of renal insufficiency in isolated kidney patients,analyze the relation between of hypertension,proteinuria and renal function,and to compare the isolated kidney patients with or without hypertension/proteinuria,further divide them into eGFR<60ml/min/1.73m~2group and eGFR≥60ml/min/1.73m~2 group to analyze their clinical characteristics,and use logistic regression models to screen out the risk factors for renal function decline in those patients.Results:Among the 448 patients with solitary kidney,the average age of was(52.5±15.4)years,the median duration of 4.0 years.There are 268 m ales(59.8%)and 180 females(40.2%);92 congenital solitary kidneys(20.5%),356 cases of acquired solitary kidney(79.5%),of which the rate of ne phrectomy caused by urinary malignant tumors was 44.4%(199/448).193 pat ients(43.1%)had hypertension,189(42.2%)had proteinuria,143(31.9%)h ad renal insufficiency,and 19(4.2%)had advanced end-stage renal disease.Nephrology consultation rate was 11.8%.Parametric analysis of patients with hypertension and/or proteinuria in isolated kidney found that the incidence of hypertension gradually increased with the increase of CKD 1-5 stages,w hich were 28.3%,45.5%,49.5%,57.9%,and 78.9%,respectively;The incide nce of proteinuria generally increased with the increase of CKD 1-5 stages,which were 39.9%,35.9%,46.7%,63.2%,and 68.4%,respectively.Compare d with the patients without hypertension,the age,serum uric acid level and the proportion of acquired/congenital isolated kidney were higher in hyperte nsion group,the glomerular filtration rate was lower,and the incidence of r enal dysfunction was significantly higher in hypertension group than that in non hypertension group(P<0.05).Compared with the patients without albumi nuria,the incidence of renal dysfunction in the group with albuminuria was significantly higher,and the patients were younger(P<0.05).Compared with the eGFR≥60ml/min/1.73m~2,the eGFR<60ml/min/1.73m~2 group was older an d had a longer course of disease,and hypertension,arterial systolic blood pr essure,Serum creatinine,blood uric acid,fasting blood glucose levels,and t he incidence of proteinuria were higher,and the proportion of congenital sol itary kidneys,hemoglobin,estimated glomerular filtration rate,and plasma al bumin levels were lower.Finally,multivariate logistic regression analysis sho wed that the increase in age(for each 10-year increase,OR=1.845,95%CI1.549-2.198,P<0.001),anemia(OR=2.627,95%CI 1.599-4.315,P<0.001),H yperuricemia(OR=6.645,95%CI 3.825-11.544,P<0.001)and high urinary pr otein levels(for each 1+increase in qualitative urinary protein,OR=1.528,95%CI 1.225-1.905,P<0.001)are independent risk factors for renal insufficien cy in solitary kidney patients.Conclusions:This study showed that the incidence of renal insufficiency in solitary kidney patients was 31.9%(143/448).And 193 patients(43.1%)had hypertension,189(42.2%)had proteinuria,and 19(4.2%)had advanced to end-stage renal disease.Patients with solitary kidney have no specific clinical manifestations,and the rate of consultation of specialists in the kidney is low,which is only 11.8%(53/448).With the progress of renal function,the incidence of hypertension and proteinuria increased significantly.Patients with hypertension and/or proteinuria had a lower glomerular filtration rate and a significantly higher incidence of renal insufficiency.Follow-up of patients with proteinuria revealed that there is currently no unified intervention timing and treatment plan,and the residual renal function prognosis of a large number of proteinuria patients may be worse,and it is not possible to exclude nephritis.Influencing factors of renal insufficiency in patients with solitary kidney in this study include increasing age,anemia,hyperuricemia,and high urine protein levels.