Pyuria tsis muaj Casts thiab ob sab raum loj yog qhov tshwm sim ntawm qhov mob raum mob hnyav raug mob los ntawm mob Pyelonephritis: Daim Ntawv Qhia Txog Cov Ntaub Ntawv thiab Kev Tshawb Fawb Ⅱ
Jan 30, 2024
Kev sib tham
Peb tau ntsib ib rooj plaub tsis tshua muaj nrogAPN-induced hnyav AKIuas tau lees paub los ntawm lub raum biopsy. Mob AKI los ntawm kev mob ntsig txog hemodynamics yog muaj nyob rau hauv APNs thiab daws sai nrog kev kho mob.
Txawm li cas los xij, hnyav AKI thaum tsis muajcoexisting urinary ib ntsuj av obstructiontsis tshua muaj (5). Peb cov ntaub ntawv cuam tshuam nrog ib tug txiv neej hnub nyoog nruab nrab uas nthuav tawm cov tsos mob ntawm kev cai lij choj thiab leej twg sivNSAIDs; nws lub raum ua haujlwm tsis zoo tom qab 24 teev tom qab siv tshuaj tua kab mob nrog dej txaus. Yog li, peb xav tias lwm yam ua rau AKI (tshwj tsis yog APN-induced AKI) yuav tsum raug txiav txim siab txij li nws tau tshaj tawm tias APN cov neeg mob tsis muajtso zisKev cuam tshuam yuav zoo dua li ntawm 24 mus rau 48 teev tom qabtshuaj tua kab mob (5).
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Cov yam ntxwv ntawm cov neeg laus uas muaj mob hnyav AKI tshwm sim los ntawm APN yam tsis muaj kev cuam tshuam ntawm cov zis,ib lub raum, los yogmob raum mob (CKD), that were reported in the relevant English literature from 1969 to 2019 are shown in Table (6-24). Severe AKI was defined as KDIGO stage 2 or 3. However, the AKI stage could not be confirmed due to the limited data that were available in some cases. APN-induced AKI was proven by histopathology or by clinical course with antibiotic therapy. A total of twenty-six cases (T-group) were reported over the approximately 50-year period. Among them, 19 cases were histopathology-proven (H-group). The incidence of AKI stage 3 (serum creatinine 4.0 mg/dL or renal replacement therapy) (2) was 84.6% in the T-group and 89.4% in H-group. Female patients accounted for 61.5% of the patients in the T-group and 63.1% of the patients in the H-group. The mean ages were 53.8 years in the T-group and 55.1 years in the H-group. The analysis of available data showed that the incidence of oliguria was 46.1% in the T-group and 52.5% in the H-group. The rates of pyuria, which was defined as a urine WBC count of >5/high-power field los yog dipstick positivity rau leukocyte esterase (25), thiab tsis muaj pathologic casts yog 73. , raws. Qhov tshwm sim ntawm ob sab ob lub raum loj ntawm cov duab yog 61.5% hauv T pawg thiab 68.4% hauv pawg H. Cov zis thiab/los yog ntshav tau zoo rau E. coli hauv 73.0% ntawm cov neeg mob hauv ob pawg. Ob leeg ntshav thiab zis tau zoo rau Klebsiella hauv 15.3% ntawm cov neeg mob hauv pawg T thiab 21.0% hauv pawg H. Cev xeeb tub, indwelling catheter, immunocompromised status, thiab nonsteroidal anti-inflammatory tshuaj (NSAID) / analgesic siv tau tshaj tawm raws li cov yam ntxwv predisposing.
NSAIDs tau siv nyob rau hauv 30.7% ntawm cov neeg mob hauv pawg T thiab 26.3% ntawm cov neeg mob hauv pawg H. Tag nrho ntawm 38.4% ntawm cov neeg mob hauv T-pawg thiab 36.8% ntawm cov neeg mob hauv H-pawg tau rov qab los ntawm AKI; 38.4% ntawm cov neeg mob hauv pawg T thiab 31.5% ntawm cov neeg mob hauv H-pawg pom kev txhim kho ntawm AKI tab sis tsim CKD; 11.5% ntawm cov neeg mob nyob rau hauv ob pab pawg tau los ua dialysis-dependant; thiab 11.5% tus neeg mob hauv ob pawg neeg tuag. Raws li, cov yam ntxwv tseem ceeb ntawm APN-induced AKI yog pyuria tsis muaj casts thiab ob sab raum o. Ob sab ob lub raum o tuaj yeem tshwm sim los ntawm interstitial infiltration, edema, thiab cov kua paug pov tseg hauv cov tubules ntawm ob qho tib si.mob raum. Oligoanuria feem ntau cuam tshuam. Kev siv NSAID yog qhov muaj feem cuam tshuam rau APN-induced hnyav AKI. Txawm li cas los xij, kev sib raug zoo ntawmKev siv NSAID thiab APN-induced hnyav AKItsis paub. NSAIDs tuaj yeem ncua qhov kev nthuav qhia ntawm APN cov neeg mob vim yog kev txo qis ntawm qhov mob thiab ua npaws ib ntus, thiab yog li ncua kev tswj kom tsim nyog. Tsis tas li ntawd, NSAIDs tuaj yeem txo qhov glomerular pom tus nqi, pab txhawb kev txhim kho ntawm APN-induced hnyav AKI. Peb cov ntaub ntawv muaj cov yam ntxwv ntawm APN-induced hnyav AKI, suav nrog kev siv NSAID, oliguria, pyuria tsis muaj casts, thiab ob lub raum loj. Peb tsis tau kuaj xyuas tus kab mob HIV rau tib neeg kev tiv thaiv kab mob, vim nws tsis tau qhia txog keeb kwm, tsos mob, lossis kev kuaj mob txawv txav qhia tias muaj kab mob HIV. Tsuas yog kev siv NSAID, nws tsis muaj lwm yam tshaj tawm txog qhov tshwm sim rau ob sab APN. Interestingly, nws tau noj tizanidine hydrochloride, cov leeg nqaij so, uas cuam tshuam rau lub zais zis pob txha cov leeg ua haujlwm, thiab uas tuaj yeem siv los kho lub zais zis tsis ua haujlwm hauv cov neeg mob uas muaj ntau yam sclerosis spasticity (26). Tsis muaj ntawv ceeb toom ntawm tizanidine-koom nrog APN; Txawm li cas los xij, tus neeg mob tam sim no yuav tsum tau ua tib zoo saib xyuas cov tsos mob, nrog rau lub zais zis ntau dhau.
Qee cov lus hais saum toj no ntawm APN-inducedhnyav AKIzoo li lwm yamvim AKI, suav nrog AIN, mob tubular necrosis (ATN), thiab sai sai glomerulonephritis (RPGN). Tag nrho cov xwm txheej no tuaj yeem ua rau AKI nrog ob sablub raum loj(27, 28). Cov kev kho mob uas tshwm sim ntawm AIN tsis yog tshwj xeeb, suav nrog asthenia, anorexia, xeev siab, thiab ntuav. Cov ntaub ntawv kuaj pom AKI nrog lossis tsis muaj oliguria, microscopic hematuria, non-nephrotic proteinuria, thiab pyuria (29, 30). Tsis zoo li APN, AIN tuaj yeem cuam tshuam nrog WBC cam khwb cia thiab tsis muaj xim granular casts hauv zis (29). Cov neeg mob nrog ATN kuj muaj cov tsos mob tsis tshwj xeeb. Tsis zoo li APN, pigmented "muddy brown" granular casts los yog tubular epithelial cell casts, feem ntau pom muaj microscopic hematuria thiab me me proteinuria. Txawm li cas los xij, casts tuaj yeem tsis tuaj (29). Cov neeg mob uas muaj RPGN vim crescentic glomerulonephritis qhia qhov mob hauv plab, uas tsis tshua muaj tshwm sim (31). Leukocytosis, anemia, thiab inflammatory marker theem feem ntau pom muaj. Kev kuaj zis qhia pom cov proteinuria me me, microscopic hematuria, thiab RBC thiab WBC pov, tsis zoo li APN. Pyuria kuj yog ib qho kev tshawb nrhiav zis (32). Tsis tshua muaj, cov zis tshawb pom yuav tsawg, thiab qhov tsis muaj cov zis tso zis tsis suav nrog kev kuaj mob ntawm RPGN. Tus nqi ntawm kev loj hlob mus rau lub raum tsis ua haujlwm yog qhov sib txawv, txij li teev mus rau lub hlis.
Thaum cov yam ntxwv ntawm AIN, ATN, thiab RPGN raug muab piv, pyuria yam tsis muaj kab mob tshwm sim tuaj yeem yog lub cim ntawm APN-induced hnyav AKI. Kev rho tawm pyuria yog qhov txawv txav vim tias cov tshuaj tiv thaiv kab mob hauv lub raum los yog kev sib sau ua ke kuj cuam tshuam nrog hematuria. Lub xub ntiag ntawm WBCs nrog cov kab mob yog qhia tias pyelonephritis. Txawm li cas los xij, yog tias cov neeg mob tau siv tshuaj, xws li NSAIDs, uas tuaj yeem ua rau AIN lossis ATN (33, 34), nws nyuaj rau kev ntxub ntxaug AKI los ntawm APN-induced AKI, zoo li hauv peb rooj plaub. Ntxiv mus, hauv AKI cov neeg mob uas muaj cov tsos mob ntawm kev cai lij choj thiab cov txiaj ntsig tsis tshwj xeeb, qhov ua tau ntawm RPGN tsis tuaj yeem raug cais tawm. Kev kuaj pom tseeb ntawm APN-induced AKI yuav tsum tau kuaj lub raum. Txawm li cas los xij, hauv qee tus neeg mob, lub raum biopsy tsis tuaj yeem ua tau zoo thiab ua tau sai vim muaj mob. Yog tias cov neeg mob AKI muaj cov tsos mob tshwm sim, pyuria tsis muaj casts, thiab ob lub raum loj, tom qab pib kho cov tshuaj tua kab mob thiab tshem tawm cov tshuaj xav tau, lub raum biopsy tuaj yeem raug ncua mus txog rau lwm cov ntaub ntawv, suav nrog cov txiaj ntsig ntawm PRGN txog cov ntaub ntawv kuaj mob thiab kev siv tshuaj tua kab mob. tshaj lwm ob peb hnub, tuaj yeem tau txais. Hauv cov ntsiab lus, cov yam ntxwv tseem ceeb ntawm APN-induced hnyav AKI suav nrog ob lub raum loj nrog pyuria yam tsis muaj casts. Oligoanuria feem ntau cuam tshuam nrog APN-induced hnyav AKI, thiab NSAIDs tej zaum yuav yog ib qho kev pheej hmoo. Kev kho tshuaj tua kab mob sai raws li kev kho mob ntawm APN-induced AKI yog qhov tseem ceeb los txhim kho lub raum.
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