Bartaula Bijay, Subedi Manish, Dhakal Sushil, Mudbhari Bandana, Tripathi Prashant Mani, Sharma Sanjib Kumar
Department of Internal Medicine, B. P. Koirala Institute of Health Sciences, Dharan, Nepal.
Department of Pathology, B. P. Koirala Institute of Health Sciences, Dharan, Nepal.
Saudi J Kidney Dis Transpl. 2019 Mar-Apr;30(2):462-469. doi: 10.4103/1319-2442.256853.
Lupus nephritis (LN) is one of the common complications of systemic lupus erythematosus (SLE). Timely treatment will decrease progression to chronic kidney disease. Treatment varies with different stages for which biopsy is needed. Controversies still exist regarding its requirement in management. This is a retrospective study from September 2014 to August 2016 in B. P. Koirala Institute of Health Sciences, Dharan, Nepal among all patients with SLE and undergone renal biopsy. Of 92 patients, most were female 85 (92.4%) with a median age of 32 years. In this study, 80.4% had some clinical symptomatology. Of the clinical manifestations, 41.3% had polyarthritis, edema (20.7%), and malar rash (17.4%). Anti-nuclear antibody was positive in 80.4% and ds DNA in 70.7%. Renal biopsy showed more number of patients 27 (35%) had Stage IV LN, followed by Stage I, 19 (24%), and Stage II, 16 (20%) LN. Median urinary protein in Class I was 1.05 g, Class II (0.63 g), Class III (1.5 g), Class IV (2.44 g), Class V (3.99 g), and Class VI (4.7 g). Only Stage IV had Kappa of 0.269 {P = 0.003) showing agreement between proteinuria and histological staging which was statistically significant (P <0.005). However, overall Kappa analysis showed none to fair strength of agreement for different stages of LN (-0.014-0.269) with proteinuria. Kappa (k) analysis showed none to fair strength of agreement for different stages of LN and proteinuria. Hence, only proteinuria is not sufficient to replace the need of renal biopsy in LN.
狼疮性肾炎（LN）是系统性红斑狼疮（SLE）常见的并发症之一。及时治疗可减少发展为慢性肾脏病的风险。治疗因不同阶段而异，需要进行活检。在其管理要求方面仍存在争议。这是一项于2014年9月至2016年8月在尼泊尔达兰的BP柯伊拉腊健康科学研究所针对所有患有SLE并接受肾活检的患者进行的回顾性研究。在92例患者中，大多数为女性，共85例（92.4%），中位年龄为32岁。在本研究中，80.4%的患者有一些临床症状。在临床表现中，41.3%的患者有多关节炎，20.7%有水肿，17.4%有蝶形红斑。抗核抗体阳性率为80.4%，双链DNA阳性率为70.7%。肾活检显示，更多患者（27例，35%）为IV期LN，其次是I期，19例（24%），II期，16例（20%）LN。I类患者的尿蛋白中位数为1.05g，II类（0.63g），III类（1.5g），IV类（2.44g），V类（3.99g），VI类（4.7g）。只有IV期的卡方值为0.269（P = 0.003），表明蛋白尿与组织学分期之间存在一致性，具有统计学意义（P <0.005）。然而，总体卡方分析显示，LN不同阶段与蛋白尿之间的一致性强度为无到一般（-0.014 - 0.269）。卡方（k）分析显示，LN不同阶段与蛋白尿之间的一致性强度为无到一般。因此，仅蛋白尿不足以取代LN患者肾活检的必要性。
