Renal Division, Department of Medicine, Peking University First Hospital, Institute of Nephrology, Peking University, Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, People's Republic of China.
Lupus. 2011 Dec;20(14):1557-65. doi: 10.1177/0961203311417035. Epub 2011 Oct 12.
In this study we assess clinicopathologic characteristics, treatment and prognosis of acute kidney injury (AKI) in a large cohort of Chinese patients with lupus nephritis.
The clinical, laboratory, renal histopathology, treatment and outcome data were retrospectively collected and compared between lupus nephritis patients with and without AKI. The impact of AKI on renal outcome was evaluated.
Among 322 patients with renal biopsy-proven lupus nephritis, 66 (20.5%) were identified as AKI. Male predominance was observed in patients with AKI (p < 0.001). In comparison with the non-AKI group, patients with AKI had significantly higher proportions of serositis (p < 0.001), neurologic disorder (p = 0.026), anemia (p < 0.001), thrombocytopenia (p = 0.013) and nephrotic syndrome (p = 0.011), but significant lower serum C3 (p < 0.001). The Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) scores, renal pathological activity indices and chronicity indices were significantly higher in the AKI group (p < 0.001 in all cases). Regarding outcome, the AKI group had a significantly poorer renal outcome compared with non-AKI group (p < 0.001). In the AKI group, patients with crescentic glomerulonephritis and thrombotic microangiopathy had the worst renal outcome. AKI was an independent risk factor for renal outcome (hazard ratio [HR] = 5.819, 95% confidence interval 2.411-14.044, p < 0.001).
AKI is common in lupus nephritis and is an independent risk factor for renal outcome.
本研究评估了中国狼疮肾炎患者中大量病例的急性肾损伤（AKI）的临床病理特征、治疗和预后。
回顾性收集狼疮肾炎患者的临床、实验室、肾组织病理学、治疗和转归数据，并比较 AKI 患者与非 AKI 患者之间的差异。评估 AKI 对肾脏结局的影响。
在 322 例经肾活检证实的狼疮肾炎患者中，66 例（20.5%）被确定为 AKI。AKI 患者中男性居多（p<0.001）。与非 AKI 组相比，AKI 组患者的浆膜炎（p<0.001）、神经病变（p=0.026）、贫血（p<0.001）、血小板减少症（p=0.013）和肾病综合征（p=0.011）的比例明显更高，而血清 C3 水平明显更低（p<0.001）。AKI 组的系统性红斑狼疮疾病活动指数（SLEDAI）评分、肾脏病理活动指数和慢性指数均明显更高（所有情况下均 p<0.001）。在结局方面，AKI 组的肾脏结局明显差于非 AKI 组（p<0.001）。在 AKI 组中，新月体性肾小球肾炎和血栓性微血管病患者的肾脏结局最差。AKI 是肾脏结局的独立危险因素（危险比[HR]=5.819，95%置信区间 2.411-14.044，p<0.001）。
AKI 在狼疮肾炎中很常见，是肾脏结局的独立危险因素。
