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JASN:免疫检查点抑制剂相关AKI的临床特征和结局

2020-01-11 xing.T MedSci原创

由此可见,这项多中心研究确定了与免疫检查点抑制剂相关的AKI患者危险因素、临床特征、组织病理学结果以及肾脏和总体预后的情况。

尽管人们越来越认识到与免疫检查点抑制剂相关AKI的重要性,但有关这种免疫疗法并发症的数据仍然很少。

近日,肾脏病领域权威杂志Journal of the American Society of Nephrology上发表一篇研究文章,研究人员对138例与免疫检查点抑制剂相关的AKI患者进行了多中心研究,AKI定义为血清肌酐增加2倍以上或直接归因于免疫检查点抑制剂的新透析需求。研究人员还收集了276例接受这些药物但未发展为AKI的对照患者数据。

较低的基线eGFR、使用质子泵抑制剂和联合免疫检查点抑制剂治疗均与免疫检查点抑制剂相关的AKI风险增加相关。从开始接受免疫检查点抑制剂治疗到AKI的中位(四分位间距)时间为14(6-37)周。大多数患者患有肾下蛋白尿,约一半患者有脓尿。43%的患者发生肾外免疫相关不良事件;69%的患者同时接受了引起肾小管间质性肾炎的药物治疗。在60例活检患者中,肾小管间质性肾炎是主要的疾病。大多数患者(86%)接受了类固醇治疗。分别有40%、45%和15%的患者出现完全、部分或没有肾脏恢复。伴随肾外免疫相关的不良事件与肾预后不良相关,而伴随肾小管间质性肾炎开始的药物治疗和类固醇治疗均与改善肾预后相关。免疫检查点抑制剂相关的AKI后未能实现肾脏恢复与更高的死亡率相关。22%的患者重新接受免疫检查点抑制剂治疗,其中23%的患者出现了复发性相关性AKI。

由此可见,这项多中心研究确定了与免疫检查点抑制剂相关的AKI患者危险因素、临床特征、组织病理学结果以及肾脏和总体预后的情况。

原始出处

Frank B. Cortazar,et al.Clinical Features and Outcomes of Immune Checkpoint Inhibitor–Associated AKI: A Multicenter Study.JASN,2019.https://jasn.asnjournals.org/content/early/2020/01/01/ASN.2019070676

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    2020-04-14 chenhongpeng
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    2020-08-02 jklm09
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