輸尿管結石患者之急性腎損傷：回顧性風險因素分析

郭炫廷、張心湜、王曉暹、陳光國、謝啟誠、黃家倫、楊景偉 與 蔡昇翰

振興醫療財團法人振興醫院泌尿部

A Retrospective Risk Factor Analysis of Acute Kidney Injury in Patients with Ureteral Stones

Hsuan-Ting Kuo, Luke S. Chang, Hsiao-Hsien Wang, Kuang-Kuo Chen, Chi-Chen Hsieh, Chia-Lun Huang, Ching-Wei Yang and Sheng-Han Tsai

Department of Urology, Cheng Hsin General Hospital, Taipei, Taiwan

Purpose: Ureteral stones are a common cause of post-renal acute kidney injury (AKI), which can lead to lasting damage to kidney function. Yet not every patient with ureteral stones experiences AKI. Our study's goal is to identify the risk factors of AKI in patients diagnosed with ureteral stones.

Materials and Methods: A retrospective cohort of 195 patients with ureteral stones who was treated with ureteroscopic lithotripsy at our institution from January to December 2022 was examined, with a thorough collection of data including demographics, diagnostic imaging, and lab results. AKI was diagnosed according to the Acute Kidney Injury Network (AKIN) and the Kidney Disease: Improving Global Outcomes (KDIGO) criteria, defined as an elevation in serum creatinine by ≥ 0.3 mg/dL or an increase by ≥ 50% from the patient's baseline. After exclusions for missing imaging data, insufficient demographic and laboratory details, and patients with multiple or bilateral stones, 161 subjects were considered suitable for analysis. Risk factors were assessed using both univariable and multivariable logistic regression models.

Results: Out of the 161 patients included, 51 (31.68%) developed AKI. The initial univariable analysis indicated that factors such as advanced age (OR=1.032, 95% CI=1.003-

1.062, p=0.031), the presence of hypertension (OR=3.382, 95% CI=1.625-7.307, p=0.001), diabetes (OR=2.182, 95% CI=1.041-4.574, p=0.039), fever (OR=7.222, 95% CI=2.605-20.025, p<0.001), leukocytosis (OR=2.841, 95% CI=1.431-5.640, p=0.003), and anemia (OR=2.857, 95% CI=1.255-6.506, p=0.012) were linked with an increased AKI risk. However, when adjusting for multiple variables, only fever (OR=5.500, p=0.020), leukocytosis (OR=2.538, p=0.038), and anemia (OR=3.395, p=0.035) remained statistically significant.

Conclusions: This study suggests that individuals with ureteral stones who exhibit fever, leukocytosis, and anemia are more susceptible to developing AKI. While age, hypertension, and diabetes may also be considered risk factors, their association with AKI did not remain statistically significant in the multivariate analysis. These observations warrant further investigation to confirm these associations and to explore the underlying biological processes.