Sharma Manjuri, Das Himanab Jyoti, Doley Prodip Kumar, Mahanta Pranab Jyoti
Department of Nephrology, Gauhati Medical College and Hospital, Gauhati, Assam, India.
Saudi J Kidney Dis Transpl. 2019 Mar-Apr;30(2):501-507. doi: 10.4103/1319-2442.256857.
Lupus nephritis (LN) is an immune-complex glomerulonephritis that is usually manifested by proteinuria, active urinary sediment, hypertension, and renal failure. The objective of this study is to study the clinical and histopathological profile of LN and the response to treatment with cyclophosphamide. This was a retrospective study conducted in a tertiary care center in Assam, India, where 176 LN patients who underwent renal biopsy were included. The presenting features, laboratory parameters such as proteinuria, hematuria, and the histopathological class of the patients were studied. Among the 176 patients, 89.8% were female and 10.2% were male and maximum patients (61.3%) were in the age group of 20-40 years. Pedal edema was present in 100% of the patients, decreased urine output in 43.7%, malar rash in 38%, joint pain in 42%, hair loss in 63%, hypertension in 41.4%, oral ulcers in 31.8%, seizures in 17%, psychosis in 13%, hematuriain 78.4%, anemia in 72.1%, thrombocytopenia in 51.1%, and leukopenia in 31.7% of patients. The anti-nuclear antibody was positive in all patients and anti-dsDNA was positive in 70.5% of the patients. The most common histopathological type was class IV (50%), followed by class III (17.6%). One hundred and two patients received intravenous cyclophosphamide as initial treatment of whom, 40 received the Eurolupus regimen and 62 received the NIH regimen. The number of patients who underwent remission in both the regimen was compared. The response rate of initial treatment with cyclophosphamide in the Eurolupus group was 62.5% and in the NIH group was 64.5% (P >0.05). Majority of the patients had proliferative LN in this study, of which class IV was the most common. Proliferative LN, if not detected and treated early, leads to poor outcome in terms of patient and renal survival. Hence, patients with systemic lupus erythematosus should be evaluated for kidney involvement and treated accordingly for better outcome.
狼疮性肾炎（LN）是一种免疫复合物性肾小球肾炎，通常表现为蛋白尿、活动性尿沉渣、高血压和肾衰竭。本研究的目的是研究LN的临床和组织病理学特征以及环磷酰胺治疗的反应。这是一项在印度阿萨姆邦一家三级医疗中心进行的回顾性研究，纳入了176例行肾活检的LN患者。研究了患者的临床表现、蛋白尿、血尿等实验室参数以及组织病理学类型。176例患者中，89.8%为女性，10.2%为男性，最大患者群体（61.3%）年龄在20 - 40岁。100%的患者有足背水肿，43.7%尿量减少，38%有蝶形红斑，42%有关节痛，63%有脱发，41.4%有高血压，31.8%有口腔溃疡，17%有癫痫发作，13%有精神病，78.4%有血尿，72.1%有贫血，51.1%有血小板减少，31.7%有白细胞减少。所有患者抗核抗体均为阳性，70.5%的患者抗双链DNA阳性。最常见的组织病理学类型为IV级（50%），其次是III级（17.6%）。102例患者接受静脉环磷酰胺作为初始治疗，其中40例接受欧洲狼疮方案，62例接受美国国立卫生研究院方案。比较了两个方案中病情缓解的患者数量。欧洲狼疮组环磷酰胺初始治疗的缓解率为62.5%，美国国立卫生研究院组为64.5%（P>0.05）。本研究中大多数患者为增殖性LN，其中IV级最常见。增殖性LN若未早期发现和治疗，患者和肾脏生存率方面的预后较差。因此，系统性红斑狼疮患者应评估肾脏受累情况并相应治疗以获得更好的预后。
