잠시만 기다려 주세요. 로딩중입니다.

Long-term Renal Outcome of Biopsy-proven Acute Tubular Necrosis and Acute Interstitial Nephritis

Journal of Korean Medical Science 2020년 35권 26호 p.206 ~ 206
김현서, 조상경, 안신영, 권영주, 이하정, 오지은, 진호준, 임기준, 이준영, 양지현, 김명규, 조원용, 오세원,
소속 상세정보
김현서 ( Kim Hyun-Seo ) - Korea University College of Medicine Korea University Anam Hospital Department of Internal Medicine
조상경 ( Jo Sang-Kyung ) - Korea University College of Medicine Korea University Anam Hospital Department of Internal Medicine
안신영 ( Ahn Shin-Young ) - Korea University College of Medicine Korea University Guro Hospital Department of Internal Medicine
권영주 ( Kwon Young-Joo ) - Korea University College of Medicine Korea University Guro Hospital Department of Internal Medicine
이하정 ( Lee Ha-Jeong ) - Seoul National University College of Medicine Seoul National University Hospital Department of Internal Medicine
오지은 ( Oh Ji-Eun ) - Hallym University College of Medicine Hallym University Kangdong Sacred Heart Hospital Department of Internal Medicine
진호준 ( Chin Ho-Jun ) - Seoul National University College of Medicine Seoul National University Bundang Hospital Department of Internal Medicine
임기준 ( Lim Ki-Joon ) - Korea University College of Medicine Korea University Anam Hospital Department of Internal Medicine
이준영 ( Lee Jun-Yong ) - Korea University College of Medicine Korea University Anam Hospital Department of Internal Medicine
양지현 ( Yang Ji-Hyun ) - Korea University College of Medicine Korea University Anam Hospital Department of Internal Medicine
김명규 ( Kim Myung-Gyu ) - Korea University College of Medicine Korea University Anam Hospital Department of Internal Medicine
조원용 ( Cho Won-Yong ) - Korea University College of Medicine Korea University Anam Hospital Department of Internal Medicine
오세원 ( Oh Se-Won ) - Korea University College of Medicine Korea University Anam Hospital Department of Internal Medicine

Abstract


Background: Although emerging evidence suggest acute kidney injury (AKI) progress to chronic kidney disease (CKD), long-term renal outcome of AKI still remains unclear. Acute tubular necrosis (ATN) is the most common cause of AKI due to ischemia, toxin or sepsis. Acute interstitial nephritis (AIN), caused by drugs or autoimmune diseases is also increasingly recognized as an important cause of AKI. Unlike glomerular diseases, AKI is usually diagnosed in the clinical context without kidney biopsies, and lack of histology might contribute to this uncertainty.

Methods: Among 8,769 biopsy series, 253 adults who were histologically diagnosed with ATN and AIN from 1982 to 2018 at five university hospitals were included. Demographic and pathological features that are associated with the development of end stage renal disease (ESRD) were also examined.

Results: Rate of non-recovery of renal function at 6 month was significantly higher in the AIN (ATN vs AIN 49.3 vs 69.4%, P = 0.007) with a 2.71-fold higher risk of non- recovery compared to ATN (95% confidence interval [CI], 1.20?6.47). During the mean follow up of 76.5 ± 91.9 months, ESRD developed in 39.4% of patients with AIN, and 21.5% patients of ATN. The risk of ESRD was significantly higher in AIN (23.05; 95% CI, 2.42?219.53) and also in ATN (12.14; 95% CI, 1.19?24.24) compared to control with non-specific pathology. Older age, female gender, renal function at the time of biopsy and at 6 months, proteinuria and pathological features including interstitial inflammation and fibrosis, tubulitis, vascular lesion were significantly associated with progression to ESRD.

Conclusion: Our study demonstrated that patients with biopsy proven ATN and AIN are at high risk of developing ESRD. AIN showed higher rate of non-renal recovery at 6 month than ATN.

키워드

Acute Interstitial Nephritis; Acute Tubular Necrosis; Inflammation; Fibrosis

원문 및 링크아웃 정보

  

등재저널 정보