Acute raum Injury nyob rau hauv Pediatric Inflammatory Multisystem Syndrome Temporally Associated With SARS- CoV- 2 (PIMS-TS) Is Not Associated With Progression To Chronic Kidney Disease
Mar 13, 2022
CISTANCHE yuav txhim kho rau lub raum/ raum mob
Taw qhia
Ib qho mob tshiab cuam tshuam rau cov menyuam yaus thiab cov tub ntxhais hluas (CYP) uas muaj kev soj ntsuam sib tshooj nrog tus kab mob Kawa-saki, toxic shock syndrome, thiab macrophage activation syndrome yog thawj zaug qhia los ntawm South Thames Retrieval Service hauv London, UK, thaum lub Plaub Hlis 2020 hauv cov ntsiab lus ntawm the evolving SARS-CoV- 2 pandemics. 1 Hauv tebchaws Askiv, tus mob no tau muaj npe hu ua pediatric inflammatory multisystem syndrome ib ntus cuam tshuam nrog SARS- CoV- 2 (PIMS-TS) thiab Royal College of Paediatrics and Child Health (RCPCH) yog thawj zaug tshaj tawm cov ntaub ntawv txhais. 2 Lub Chaw Tiv Thaiv Kab Mob thiab Tiv Thaiv thiab WHO tom qab tau tshaj tawm lawv tus kheej cov ntsiab lus rau tus mob no, hu ua multisystem inflammatory syndrome hauv cov menyuam yaus (MISC). 3 4 Thaum Lub Rau Hli 2020, peb tau tshaj tawm txog qhov xwm txheej mob hnyavmob raum(AKI) hauv tsev kho mob CYP nrog SARS- CoV- 2 kab mob ntawm Great Ormond Street Hospital (London, UK). 5 Peb pom tias AKI feem ntau tshwm sim hauv CYP nrog SARS-CoV- 2 uas tau ntsib cov txheej txheem kuaj mob rau PIMS-TS, nrog 73 feem pua ntawm AKI tshwm sim hauv pawg no. Cov kev tshawb pom no.
Ntsiab lus:mob raum; lub raum ua haujlwm; lub raum tsis ua haujlwm; raum; lub raum
Txoj kev Txoj kev tsim qauv thiab cov neeg koom Peb tau ua ib qho kev soj ntsuam hauv ib lub hauv paus los ntawm kev txheeb xyuas cov ntaub ntawv tus neeg mob hauv Great Ormond Street Hospital. Tag nrho cov neeg mob tau<18 years="" at="" time="" of="" hospitalisation="" and="" met="" the="" rcpch="" case="" definition="" for="" pims-="" ts="" including="" persistent="" fever="" with="" evidence="" of="" systemic="" inflammation="" and="" organ="" dysfunction.="" 2="" patients="" were="" admitted="" between="" 4="" april="" 2020="" and="" 7="" march="" 2021,="" and="" were="" retrieved="" from="" a="" primary="" site="" to="" our="" centre="" which="" acts="" as="" a="" regional="" tertiary/quaternary="" referral="">
AKI txhaisRaws li cov neeg mob tau nthuav tawm qhov mob hnyav, yav dhau los cov ntshav creatinine (sCr) qhov tseem ceeb tsis muaj los tsim cov hauv paus.lub raum ua haujlwm. AKI tau txhais raws li qhov siab tshaj sCr qhov tseem ceeb tau txais thaum tus neeg mob tau txais kev lees paub tiv thaiv lub hnub nyoog tshwj xeeb ntawm kev siv lub sijhawm (ULRI) qhov tseem ceeb luam tawm los ntawm British Association of Pediatric Nephrology. 10 Txolub raum ua haujlwm was assumed to be reversible as part of the criteria for defining AKI. AKI stage 1 was defined as sCr >1.5–2×ULRI, stage 2 as >2–3×ULRI and stage 3 as >3 × ULRI. Kwv yees glomerular filtration rate (eGFR) yog raws li kev hloov kho Schwartz equation 11 : eGFR creat =36.5 × (qhov siab (cm)/sCr (μmol/L)). 11
Cov txheej txheemTxhua tus neeg mob tau txais SARS- CoV- 2 kev sim los ntawm kev thim rov qab PCR los ntawm nasopharyngeal swabs, thiab kev kuaj serology siv IgG antibodies rau SARS- CoV- 2 nucleocapsid protein lossis spike protein txij Lub Rau Hli 2020 mus rau (Epitope Diagnostics; San Diego , California, USA). Sab laug ventricular ejection fraction (LVEF) ntawm echocardiography tau siv los txheeb xyuas sab laug ventricular dysfunction: tsis muaj ntau tshaj lossis sib npaug li 50 feem pua, mob me 40 feem pua -49 feem pua, nruab nrab 30 feem pua -39 feem pua thiab hnyav.<>Lub raumKev tshawb pom ultrasound tau tshaj tawm tias tsis ua, ib txwm lossis txawv txav. Cov kev tshawb pom txawv txav suav nrog kev poob ntawm kev sib txawv ntawm corticomedullary thiab / lossis nce echogenicity uas tuaj yeem qhia txog AKI. Qhov tseem ceeb comorbidities tsim cov uas yuav tsum muaj kev tswj xyuas hauv tsev kho mob. Kev rog rog tsis suav nrog comorbidity li cov ntaub ntawv hais txog qhov no tau sau los ntawm lub cev qhov ntsuas qhov ntsuas (BMI) suav. Tom qab tawm hauv tsev kho mob, cov neeg mob tau ua raws li ntawm 6-8 lub lis piam thiab 6 lub hlis hauv ib lub chaw kho mob ntau tus kws tshaj lij PIMS-TS. Kev nthuav qhia ua ntej lub Cuaj Hlis 2020 raug faib ua 'thawjyoj', thiab cov tom qab ntawd ua 'thib ob'. Vim tias qhov kis tau sai ntawm Alpha hloov pauv txij lub Kaum Hli 2020 mus rau hauv UK, feem ntau nthwv dej thib ob PIMS-TS tau raug tshaj tawm los cuam tshuam nrog qhov no. Genotype sequencing tau cuam tshuam los ntawm cov kev txwv ntawm PCR yam tsawg kawg nkaus lub voj voog pib tshawb pom raws li cov neeg mob feem ntau tau nthuav tawm qee lub lis piam tom qab SARS- CoV- 2 raug.
CISTANCHE yuav txhim kho lub raum / raum mob ntshav qab zib
Kev txheeb caisQhov kev ntsuas tseem ceeb yog qhov muaj AKI thaum mus pw hauv tsev kho mob. Lub hauv paus biochemical, kev kho mob thiab pej xeem cov yam ntxwv tau raug soj ntsuam los txheeb xyuas cov koom haum nrog AKI. Univariable logistic regression qauv ntsuas qhov txawv ntawm ib qho kev sib txawv ntawm qhov sib txawv nrog AKI theem 1-3. Multivariable modelling, siv tsuas yog peb qhov kev txwv kom tsis txhob overfitting, soj ntsuam lub koom haum ywj pheej nrog AKI hnyav (theem 2–3). ORs tau nthuav tawm nrog 95 feem pua CI ntau yam. χ² test piv categorical variables thiab Student's t-test piv txwv tsis tu ncua. Cov txiaj ntsig tau nthuav tawm raws li tus lej thiab feem pua (feem pua) rau categorical variables, thiab nruab nrab thiab IQRs rau qhov sib txawv tsis tu ncua. Kev soj ntsuam tau ua tiav siv Microsoft Excel V.2019 (Microsoft, Redmond, Washington, USA) thiab R programming language (R Core Team).
TSEEM CEEB Cov yam ntxwvCov ntaub ntawv muaj rau 110 tus neeg mob nrog PIMS-TS. Cov yam ntxwv tseem ceeb tau muab sau tseg hauv cov lus 1. Lub hnub nyoog nruab nrab ntawm kev nthuav qhia yog 10.2 xyoo (IQR 7.6–12.6), 63 (57 feem pua) yog txiv neej, 98 (88 feem pua) yog haiv neeg dawb thiab nruab nrab BMI centile yog 88 (IQR 47–97). SARS- CoV- 2 seropositivity muaj nyob rau hauv 105 (95 feem pua) thiab PCR positivity nyob rau hauv 33 (30 feem pua). Ua npaws tshwm sim hauv txhua qhov. Mob raws plab thiab ntuav muaj nyob rau hauv 65 (59 feem pua) thiab 66 (60 feem pua), feem. Comorbidities muaj nyob rau hauv 6 (5 feem pua). Lub sijhawm nruab nrab ntawm kev nyob hauv tsev kho mob yog 8 hnub (IQR 6–11) nrog 98 (89 feem pua) tau txais ncaj qha mus rau lub tsev kho mob hnyav (PICU) rau qhov nruab nrab ntawm 3 hnub (IQR 2–5). Kev txhawb nqa Inotropic yog xav tau hauv 84 (76 feem pua) rau qhov nruab nrab ntev ntawm 1.7 hnub (IQR 1–2). Nees nkaum ob (20 feem pua) tau txais cov tshuab ua pa rau qhov nruab nrab ntawm 2 hnub (IQR 1–3). Myocardial dysfunction muaj nyob rau hauv 47 (43 feem pua). Plaub (4 feem pua) muaj hauv pausraumabnormalities ntawm ultrasound raws li congenital abnormalities ntawm lubraumthiab tso zis ntau dua li AKI.
Kev kuaj mob thiab theem ntawm AKIOf 110 patients, AKI was diagnosed in 33 (30%): stage 1 in 13 (12%), stage 2 in 8 (7%) and stage 3 in 12 (11%). A further 35 (45%) had peak sCr >ULRI tab sis tsis dhau ntawm AKI kuaj qhov pib. Tsis muaj CYP tau paub tias muaj keeb kwmmob raumua ntej nkag. Tsis tas yuav tsum tau txuas ntxivlub raumhloov kho. Ntawm pawg AKI, ob tus neeg mob tsis tau ntsib kev ua haujlwm ntawm sCr rau
Kev sib piv ntawm pawg tsis-AKI thiab AKICov yam ntxwv hauv paus ntsiab lus hla-tabulated nrog lub xub ntiag ntawm AKI tau sau tseg hauv cov lus 2. AKI qhov xwm txheej tau siab dua hauv cov haiv neeg uas tsis yog neeg dawb (p=0.004), cov neeg mob ua pa nyuaj (p=0 .04), cov uas tau txais mus rau PICU (p=0.016), thiab nyob rau hauv cov uas xav tau cov tshuab cua tshuab (p=0.005) thiab inotropic kev them nyiaj yug (p=0.001). Lub sijhawm nruab nrab ntawm kev txhawb nqa inotropic tau ntev dua hauv AKI pawg (p=0.04). Cov pab pawg AKI tau ntsib qhov siab tshaj ntawm triglycerides (p=0.04), ferritin (p{17}}.03), C reactive protein (CRP) (<0.001), d-="" dimers="" (p="0.04)" and="" n-="" terminal="" pro="" b-="" type="" natriuretic="" peptide="" (nt-="" probnp)="" (p="0.03)." additional="" data="" are="" summarised="" in="" online="" supplemental="" appendix="">
Kev ua qauv tsis txawv thiab ntau yam sib txawv rau AKIHauv kev tshuaj ntsuam xyuas tsis sib xws (table 3), cov neeg mob AKI tau pom zoo rau qib siab ntawm triglycerides (OR, 1.27 (95 feem pua CI, 1.05 txog 1.6) ib 1 mmol / L nce), CRP (OR, 1.06 (95 feem pua CI, 1.02 txog 1.12) rau 10 mg/L nce), D- dimers (OR, 1.07 (95 feem pua CI, 1.03 txog 1.14) rau 1000 ng/mL nce) thiab NT-proBNP (OR, 1.03 (95 feem pua CI, 1.004 rau 1.07) rau 1000 pg / mL nce). Lawv feem ntau yuav xav tau cov tshuab ua pa (OR, 3.8 (95 feem pua CI, 1.46 txog 10.4)) thiab inotropic txhawb (OR, 15.4 (95 feem pua CI, 3.02 txog 281)). Tus qauv sib txawv (Table 4), siv- haiv neeg dawb, triglycerides (ib 1 mmol / L nce) thiab raws plab raws li cov tsos mob tshwm sim, pom tsuas yog triglycerides los ntawm nws tus kheej cuam tshuam nrog AKI hnyav (theem 2-3) (hloov OR, 1.26). (95% CI, 1.04 txog 1.6)).
Kev sib piv ntawm AKI kev nthuav qhia raws li lub sij hawm taw tes Plaub caug-peb(39 feem pua) cov neeg mob tau nthuav tawm ua ntej lub Cuaj Hlis 2020, tsis muaj leej twg nthuav tawm rau lub Cuaj Hli thiab 67 (61 feem pua) tau nthuav tawm hauv qab no (daim duab 2). AKI qhov xwm txheej tsis sib txawv ntawm cov pab pawg ua ntej thiab tom qab lub Cuaj Hli 2020 (33 feem pua vs 28.4 feem pua , p=0.85).
Cov ntaub ntawv rov qabThaum lub sijhawm tshuaj xyuas cov ntaub ntawv, 50 tus neeg mob (46 feem pua) tau txais kev tshuaj xyuas tom qab 6-8 lub lis piam, thiab 39 (36 feem pua) ntawm 6 lub hlis. Plaub caug-rau tau suav nrog hauv kev tshawb fawb PIMS-TS uas nyuam qhuav luam tawm los ntawm Penner thiab cov npoj yaig tab sis tsis muaj kev tsom mus raulub raum parameters or subanalysis of AKI cases. 12 Of those reviewed at 6–8 weeks (n=50), 15 were from the AKI group (45%). None had macro- albuminuria (urine albumin/creatinine ratio (ACR) >30 mg/ mmol) or haematuria on urinalysis. Median urine ACR was 1.1 mg/mmol (IQR 0.7–1.8), retinol-binding protein (RBP)/creatinine ratios was 5.8 µg/mmol (IQR 4.6–7.9) and N- acetyl-β-D- glucosaminidase (NAG)/creatinine ratio was 11 U/mmol (IQR 7.8–14.5). None had sCr values >ULRI. Ntawm cov kev tshuaj xyuas ntawm 6 lub hlis (n=39), 12 yog los ntawm pawg AKI (36 feem pua). Tsis muaj leej twg muaj macroalbuminuria lossis haematuria. Cov zis nruab nrab ACR yog 4.6 mg / mmol (IQR 2.6-4.5). RBP / creatinine thiab NAG / creatinine piv tsis tau rov ntsuas dua nyob rau theem no. Tag nrho cov nqi sCr tseem nyob
Kev sib thamPeb qhov kev paub nrog PIMS-TS qhia tau tiasraum tsis ua haujlwm is common. In total, 62% had a peak sCr >ULRI, thiab 30 feem pua tau tsim AKI. AKI qhov xwm txheej hauv peb pawg neeg muaj ntau dua qhov ntawd hauv kev sim ntau lub tebchaws uas ntsuas PICU kev nkag mus rau txhua hom. 13 Tsuas yog 98 (89 feem pua) ntawm peb cov neeg mob tau txais kev saib xyuas PICU-level li ntawd
Kev sib piv ntawm AKI tau siab dua. sCr qhov tseem ceeb tau nce siab thaum lub sijhawm nkag mus thiab txhim kho sai sai thaum nyob hauv tsev kho mob. Tag nrho cov kev mob tshwm sim hnyav dua rau cov neeg uas muaj AKI, cuam tshuam los ntawm kev xav tau ntau dua rau PICU nkag thiab PICU nyob ntev dua. Kev txhawb nqa ua pa tawm hauv pawg AKI tau ntau dua, qhia txog ntau qhov kev mob ntawm lub cev ntau dua nrog cov qib siab tshaj plaws ntawm cov mob hnyav-theem reactants. Ib qho kev xav tau ntau dua rau inotropes haum nrograum tsis ua haujlwmexacerbated los ntawm cov kua-refractory shock nrog pre-lub raum'ntaus'. Cov haiv neeg dub ua rau muaj feem ntau ntawm pawg AKI (58 feem pua) piv nrog cov pab pawg uas tsis yog AKI (26 feem pua). Txawm li cas los xij, qhov kev tshuaj ntsuam univariate tsis txhawb kev koom tes ntawm haiv neeg dub thiab AKI. Cov kev txiav txim siab tseem ceeb yog tias lub ntsiab lus ntawm AKI hauv txoj kev tshawb no yog nyob ntawm ULRI qhov tseem ceeb, tsis yog kev sib piv ntawm cov hauv paus ntsiab lus sCr, thiab cov haiv neeg dub paub tias muaj cov hauv paus loj dua sCr piv nrog cov phooj ywg los ntawm lwm haiv neeg. 14 Qhov no, yog li ntawd, muaj kev pheej hmoo tsis ncaj ncees rau suav nrog ntau haiv neeg ntawm haiv neeg dub hauv pawg AKI.
Muaj kev paub txog kev sib txuas ntawm AKI thiab haiv neeg tsis sib xws, txawm hais tias qhov twg ntawm cov caj ces, kev kho mob thiab kev lag luam kev lag luam cuam tshuam qhov kev sib raug zoo no tsis meej. 15 Lub pathophysiology ntawm PIMS-TS yog txuam nrog kev tiv thaiv kab mob dysregulation uas feem ntau tshwm sim tom qab tus kab mob hnyav tau ploj mus, raws li pov thawj los ntawm seropositivity hauv 95 feem pua ntawm peb pawg neeg tiv thaiv PCR zoo hauv tsuas yog 30 feem pua. Vim li cas qee tus CYP tau ua rau muaj qhov txawv txav tom qab tiv thaiv kab mob tiv thaiv kab mob tseem tsis paub meej. Lub immunophenotype ntawm tus kab mob yog txawv los ntawm lwm yam mob zoo sib xws, xws li kab mob Kawasaki, raws li tshwm sim los ntawm qhov sib txawv ntawm cytokine tso tawm uas tej zaum yuav yog lwm yam rau impaired antigen kev nthuav qhia. 16 17 As with acute SARS- CoV- 2 infections, the pathogenesis ofraumKev ua haujlwm tsis zoo hauv PIMS-TS yog qhov ua tau zoo nrog kev sib cuam tshuam ntawm cov kua dej refractory hypovolaemic shock, cardiogenic poob siab thiab cov lus teb hyperinflammatory nrog kev tso tawm ntawm yam uas ua rau cov hlab ntsha endothelial puas thiab microvascular thrombosis. 18 Tsis muaj leej twg ntawm peb pawg AKI tau raug lees paub
a raumbiopsy yog li precluding histopathological under-standing ntawmraumkev koom tes, thiab kev soj ntsuam seb puas yoglub raumkev tiv thaiv-complex deposition tshwm sim. Cov pov thawj ntxov ntawm nephritis hauv SARS- CoV- 2 kev kis kab mob tuaj yeem yog qhov muaj txiaj ntsig zoo rau cov teeb meem xws li capillary leak syndrome thiab xav tau kev pab ua pa. 19 Nrog rau kev ua haujlwm glomerular, cov zis ACR qhov tseem ceeb tau siab dua hauv peb pawg AKI. Cov zis tubular proteins RBP thiab NAG tuaj yeem ua raws li cov cim ntawm kev raug mob ntawm tubular, 20 21 tab sis peb pom tsis muaj qhov sib txawv hauv tubular proteinuria ntawm cov pab pawg txawm tias qhov no tau cuam tshuam los ntawm qhov tsis muaj kev ntsuam xyuas hauv 97 cov neeg mob (88 feem pua).
Qee qhov chaw kuaj mob yuav ua rau muaj kev nce siab hauv cov neeg uas muaj AKI tab sis nws nyuaj rau kev sib txawv seb cov no puas yog cov kws kho mob rauraumkev ua haujlwm tsis zoo, lossis seb lawv puas tau nce siab raws li qhov tshwm sim ntawm txo GFR. D- dimers, piv txwv li, yog cov protein tso tawm los ntawm fibrinolysis, muaj kev cuam tshuam ntawm lub xeev hypercoagulable.Lub raumKev ua haujlwm tsis zoo predisposes rau hypercoagulability thiab D- dimer tshem tawm tshwm sim ib nrab ntawm covraum. 22 Yog li ntawd, D- dimers yog cov cim tsis tshwj xeeb ntawm AKI thiab, ntxiv rau, qib yuav raug cuam tshuam los ntawm kev tsis meej pem xws li kab mob thiab lub siab ua haujlwm tsis zoo. Nws yog qhov xav tsis thoob tias NT-proBNP yuav tsum tau nce siab hauv AKI thaum tsis muaj echocardiographic sib txawv ntawm qhov muaj myocardial dysfunction ntawm AKI thiab non-AKI pawg. Txawm li cas los xij, LVEF ib leeg yog tus cim tsis zoo ntawm LV muaj nuj nqi thiab kev ntsuas echocardiographic ntxiv, suav nrog cov cim ntawm diastolic muaj nuj nqi, tuaj yeem ua rau muaj kev ntsuam xyuas ntau dua ntawm LV tsis ua haujlwm. 23 Peb cov qauv sib txawv tau pom tias muaj kev sib koom tes ywj pheej ntawm triglyceride ncov thiab qhov sib txawv ntawm kev loj hlob AKI. Triglycerides raug xaiv rau tus qauv no vim AKI tsis paub tias yog qhov ua rau hypertriglyceridemia. Kev mob hnyav hypertriglyceridaemia tau pom tias ua rau hnyav dualub raum dysfunction, but only in the context of acute pancreatitis. 24 However, pancreatitis is not a distinguishing feature of PIMS- TS, and serum lipase or amylase was not routinely checked due to lack of clinical indication. Hypertriglyceridaemia is also seen in glomerular dysfunction associated with nephrotic syndrome. 25 Although the AKI group had higher urine ACR values, no patients had nephrotic-range proteinuria (>200 mg / mmol) qhia txog kev koom tes ntawm glomerular. Hmoov tsis zoo, qib triglyceride tsis tau rov ntsuas dua ntawm kev ua raws li kev txheeb xyuas seb puas muaj qhov normalization tshwm sim. Yog tias hypertriglyceridaemia daws tau, nws yog qhov kev xav tias triglycerides tuaj yeem ua raws li theem mob tshwm sim hauv PIMS-TS uas lawv tau txuas nrog rau qhov kev xav rau kev tsim AKI. Yog tias qib triglyceride tsis zoo li qub, ces hypertriglyceridemia tuaj yeem yog qhov muaj feem pheej hmoo rau AKI hauv PIMS-TS, lossis rau PIMS-TS nws tus kheej. Ntawm lwm qhov sib txawv ntawm cov qauv tsis sib xws, cov haiv neeg tsis-dawb tau raug xaiv vim muaj feem ntau ntawm cov neeg tsis-dawb nyob hauv pawg AKI. Mob raws plab raws li cov tsos mob tshwm sim tau suav nrog vim qhov no yog qhov ua rau ua rau AKI ua ntej lub raum tab sis tsis yog tshwm sim los ntawm txo GFR nws tus kheej.
CISTANCHE yuav txhim kho lub raum / raum tsis ua haujlwm
Feem ntau CYP yuav rov qab los ntawm PIMS-TS txawm hais tias muaj neeg tuag lawm. 26 Kev tshawb nrhiav thawj zaug ntawm cov neeg mob PIMS-TS ntawm 6 lub hlis qhia tias cov txiaj ntsig ntawm lub plawv thiab hematological tau txais txiaj ntsig zoo tab sis kev ua haujlwm tsis zoo ntawm lub paj hlwb yog ib txwm muaj. 12 Peblub raum follow-up data are reassuring so far, with sustained normalisation of sCr and no evidence of persistent nephritis. Three patients had elevated systolic BP (>90th centile) ntawm 6 lub hlis tab sis cov no yog cov kev ntsuas hauv tsev kho mob uas tuaj yeem raug cuam tshuam los ntawm cov xwm txheej suav nrog lub tsho dawb los ntawm 31 Lub Kaum Ob Hlis 2020, Alpha variant tau hloov cov kab mob qus hauv tebchaws Askiv, thiab yog lub luag haujlwm rau peb lub hlis twg. of all new SARS-CoV- 2 case. 27 Qhov kev hloov pauv no tau nthuav dav thoob plaws ntiaj teb vim nws muaj kev sib kis ntau ntxiv. 28 Peb cov ntaub ntawv qhia tias nthwv dej thib ob tau ntsib hauv tebchaws Askiv, suav tias yuav nthuav tawm los ntawm Alpha variant, tsis cuam tshuam nrog nce ntxiv.lub raumpathogenicity hauv PIMS-TS cov ntaub ntawv piv nrog thawj nthwv dej. Peb txoj kev tshawb fawb yog txwv los ntawm nws ib leeg-centre retrospective design, lub siab acuity ntawm cov neeg mob hloov mus rau peb lub chaw vim nws tertiary/quaternary xwm, me me ntawm kev soj ntsuam thiab tsis muaj lub hauv paus sCr qhov tseem ceeb los txhais AKI. Muaj qhov txwv tsis pub ntsuas ntawm ntau qhov tsis suav nrog interleukin - 6, RBP thiab NAG, thiab tsis muaj kev soj ntsuam ntawm qib triglyceride.
Cov lus xausTxawm hais tias muaj qhov xwm txheej siab ntawm AKI hauv PIMS-TS,lub raumrov qab tshwm sim sai heev nyob rau hauv cov ntsiab lus ntawm cov kua resuscitation thiab muaj kev kho mob. Cov txiaj ntsig luv luv thiab ntev ntev rau cov neeg uas muaj AKI yog qhov zoo, tsis muaj pov thawj ntawm kev loj hlob mus rau ntev.mob raum.Qhov tseem ceeb ntawm hypertriglyceridemia yuav tsum tau soj ntsuam ntxiv nrog kev soj ntsuam kom ntseeg tau tias cov qib normalization.
