Division of Nephrology, Department of Medicine, University of Celal Bayar, Manisa, Turkey.
Division of Pathology, Department of Medicine, University of Celal Bayar, Manisa, Turkey.
Indian J Med Res. 2019 Oct;150(4):399-406. doi: 10.4103/ijmr.IJMR_1234_17.
BACKGROUND & OBJECTIVES: Rapidly progressive glomerulonephritis (RPGN) is a clinical syndrome manifested by features of nephritic syndrome and progressive loss of renal function over a short time. The objective of this study was to investigate the relationship between neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and prognostic factors and pathological findings of renal biopsy in RPGN.
Consecutive newly diagnosed RPGN patients who had follow up for at least six months were retrospectively analyzed. The estimated glomerular filtration rate (eGFR) was calculated. Albumin, C-reactive protein (CRP) levels and CRP/albumin ratio were also calculated.
Fifty four patients were included in the study. The mean age was 48.92±20.12 years. Clinicopathological diagnosis was pauci-immune glomerulonephritis (GN) in 40 while two had postinfectious GN, six systemic lupus erythematosus, three IgA nephropathy, two Henoch-Schönlein purpura and one membranoproliferative GN. The mean NLR was 7.02±6.34 and mean PLR was 273.90±39.15. Positive correlations between NLR and CRP levels (P=0.009, r=0.511) and CRP/albumin ratios (P=0.005, r=0.542) were observed. PLR and CRP/albumin ratios (P=0.041, r=0.412) were correlated positively. The per cent of fibrocellular crescents was negatively correlated with NLR (P=0.019, r=-0.291), and positively correlated with the lymphocyte count (P=0.05, r=0.256). In secondary crescentic subgroup, the per cent of fibrinoid necrosis had a positive correlation with PLR (P=0.013, r=0.642). Both NLR (P=0.036) and PLR (P=0.051) detected at the first month of the treatment period, were observed to be significantly correlated with mortality.
INTERPRETATION & CONCLUSIONS: This study showed that NLR could predict mortality in patients with RPGN; correlated with systemic inflammation; showed a negative correlation with the per cent of fibrocellular crescents and could be regarded as a measure of glomerular inflammatory state. Moreover, PLR may be considered to be an indicator of disease severity in acute phase of crescentic GN.
急进性肾小球肾炎（RPGN）是一种临床综合征，表现为肾病综合征的特征和短期内肾功能进行性丧失。本研究旨在探讨中性粒细胞与淋巴细胞比值（NLR）、血小板与淋巴细胞比值（PLR）与 RPGN 患者肾活检的预后因素和病理表现之间的关系。
回顾性分析了连续确诊的 RPGN 患者，这些患者至少随访 6 个月。计算估计肾小球滤过率（eGFR）。还计算了白蛋白、C 反应蛋白（CRP）水平和 CRP/白蛋白比值。
本研究纳入了 54 例患者。平均年龄为 48.92±20.12 岁。临床病理诊断为少免疫性肾小球肾炎（GN）40 例，感染后性 GN2 例，系统性红斑狼疮 6 例，IgA 肾病 3 例，过敏性紫癜 2 例，膜增殖性 GN1 例。平均 NLR 为 7.02±6.34，平均 PLR 为 273.90±39.15。NLR 与 CRP 水平（P=0.009，r=0.511）和 CRP/白蛋白比值（P=0.005，r=0.542）呈正相关。PLR 与 CRP/白蛋白比值（P=0.041，r=0.412）呈正相关。纤维细胞性新月体的百分比与 NLR 呈负相关（P=0.019，r=-0.291），与淋巴细胞计数呈正相关（P=0.05，r=0.256）。在继发性新月体型亚组中，纤维蛋白样坏死的百分比与 PLR 呈正相关（P=0.013，r=0.642）。治疗第 1 个月时 NLR（P=0.036）和 PLR（P=0.051）均与死亡率显著相关。
本研究表明，NLR 可预测 RPGN 患者的死亡率；与全身炎症相关；与纤维细胞性新月体的百分比呈负相关，可作为肾小球炎症状态的指标。此外，PLR 可能被认为是新月体型急进性肾小球肾炎急性期疾病严重程度的指标。
