| Objective:Kidney disease is a common and frequently occurring clinical disease in China,with a variety of pathogenic factors and atypical early symptoms,which are often easy to be ignored.If appropriate medical intervention is not taken,renal function will deteriorate progressively and eventually enter uremia.A needle biopsy of the kidney can obtain renal tissue,and we can reach the pathological diagnosis by looking at the specially treated renal tissue microscopically,which is the "gold standard" of diagnosis.Accurate diagnosis means accurate medicine.The clinical data of the patients who underwent kidney biopsy on August 1,2019 solstice and December 31,2020 in our department are summarized and analyzed,and the risk factors of their complicated acute kidney injury are explored.Methods:Patients who underwent kidney biopsy on August 1,2019 solstice and December 31,2020 in the Department of Nephrology of the First Affiliated Hospital of Kunming Medical University were screened,and those with incomplete data and missing visitors were excluded.146 cases were included and 2 cases were excluded due to incomplete information.Its demographic and medical characteristics were obtained through statistical analysis.Thirty-three patients with membranous nephropathy were screened by pathological manifestations,and divided into 23 cases of idiopathic membranous nephropathy and 10 cases of secondary membranous nephropathy according to clinical manifestations.To explore the value of phospholipase A2 receptor and type 1 thrombospondin 7A domain in the diagnosis and prognosis of patients with idiopathic membranous nephropathy.According to the clinical data,acute kidney injury was determined.The patients were divided into two groups on the basis of this:the combined group(40 cases)and the uncombined group(106 cases).The clinical manifestations of patients in the two groups were analyzed to explore whether pathological manifestations would affect the occurrence of acute kidney injury and the risk factors of these cases combined with acute kidney injury.Results:1.In this statistical study,57 cases(39.00%)of IgA nephropathy,33 cases(22.60%)of membranous nephropathy,19 cases(13.00%)of minor change nephropathy.The majority of patients with IgA nephropathy and minor change nephropathy were young and middle-aged,with 56 cases(98.24%)and 18 cases(94.73%),respectively.The incidence of membranous nephropathy was concentrated in the middle-aged(25 cases,75.76%).2.The combination of phospholipase A2 receptor antibody and type 1 thromboplastin 7A domain antibody had a high sensitivity(91.30%)in the diagnosis of idiopathic membranous nephropathy.The phospholipase A2 receptor antibody had a high Youden index(0.48)and type 1 thromboplastin 7A domain antibody had a high specificity(90.00%).It has been pointed out that the cases of co-positive or co-negative of the two antibodies are rare but of great prognostic value.In this analysis,there was 1 case of co-positive of the two antibodies,indicating rapid progression of the disease and poor prognosis.One case of co-negative antibody had a good prognosis.3.Among different pathological types of glomerular diseases,minor degenerative nephropathy and membranous nephropathy were closely associated with acute kidney injury,and their constituent ratios were significantly higher than those of non-such nephropathy types,the difference being statistically significant(P<0.05).4.Regression analysis showed that total cholesterol(OR=1.409,95%CI:0.015-1.068,P<0.05),serum creatinine(OR=1.009,95%CI:1.002-1.016,P<0.05),albumin(OR=0.928,95%CI:0.043-0.863,P<0.05)significantly affected the incidence of acute kidney injury.In other words,the incidence of that increased by 40.9%when total cholesterol increased by 1 unit.The incidence of that increased by 0.9%for each 1 unit increase in serum creatinine.The incidence of that increased by 8.2%for each 1 unit reduction in albumin.Conclusions:1.IgA nephropathy,membranous nephropathy and minor change nephropathy are the top three glomerular diseases in this area.The majority of patients with IgA nephropathy and minor change nephropathy were young and middle-aged,while the majority of patients with membranous nephropathy were middle-aged.2.Phospholipase A2 receptor and type 1 thrombospondin 7A domain may assist in the diagnosis of idiopathic membranous nephropathy.Thromboplastin type 1 7A domain has good specificity,and the combination of the two can significantly improve the diagnostic sensitivity.3.Among the different pathological types of nephropathy,membranous nephropathy and minor disease nephropathy can increase the probability of acute kidney injury.4.Hypoproteinemia,hypercholesterolemia and pre-onset renal function level are risk factors for acute kidney injury. |
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