Department of Rheumatology, Kanazawa University Graduate School of Medicine, Kanazawa, Japan.
Department of Hematology and Immunology, Kanazawa Medical University, Kanazawa, Japan.
Lupus. 2020 Apr;29(4):407-412. doi: 10.1177/0961203320905652. Epub 2020 Feb 10.
Wire-loop lesion (WL) is one of the active lesions of lupus nephritis (LN). However, few reports have focused on the clinicopathological relationships of WL to serological immune abnormality and renal prognosis.
We enrolled 126 Japanese LN patients subjected to renal biopsy in 11 hospitals from 2000 to 2018. In patients with class III or IV of the International Society of Nephrology/Renal Pathology Society classification, we retrospectively compared clinicopathological findings between those with WL (WL+ group) and without WL (WL- group) to detect factors associated with WL. Chronic kidney disease (CKD) was defined as an estimated glomerular filtration rate of <60 mL/min/1.73m for more than three months. We also compared these findings between those with CKD (CKD+ group) and without CKD (CKD- group) at the last visit to investigate factors associated with renal prognosis.
Of 126 patients, 100 (79.4%) were classified as class III or IV. WL was found in 36 (36.0%) of them. Although the renal function did not differ, the WL+ group had a higher titre of serum anti-dsDNA antibodies and lower serum complement 3 levels than the WL- group. Linear regression analysis revealed a significant association only between anti-dsDNA antibodies and WL (β = 0.27, 95% confidence interval (CI) 0.001-0.100, = 0.01). Of these patients, 69 were tracked for 59.6 ± 55.1 months. Kaplan-Meier analysis showed no difference in renal prognosis between these groups. Next, the CKD+ group included 15 (22.1%) patients. They were older and had higher frequencies of hypertension and hyperuricaemia, serum creatinine (Cr) level, glomerulosclerosis, interstitial inflammation, interstitial fibrosis and tubular atrophy than the CKD- group at the time of renal biopsy. The frequency of WL was not significantly different. Cox regression analysis revealed significant associations of CKD with hypertension, hyperuricaemia, serum Cr level at the time of renal biopsy clinically and with tubular atrophy histologically.
WL was associated with serum anti-dsDNA antibodies but not with renal prognosis, suggesting that WL reflects immune abnormality but is not an independent factor predictive of renal prognosis in LN.
线环病变（WL）是狼疮性肾炎（LN）的活动性病变之一。然而，很少有报道关注 WL 与血清免疫异常和肾脏预后的临床病理关系。
我们纳入了 2000 年至 2018 年在 11 家医院接受肾活检的 126 例日本 LN 患者。在国际肾脏病学会/肾脏病理学会分类的 III 或 IV 类患者中，我们回顾性比较了有 WL（WL+组）和无 WL（WL-组）患者的临床病理发现，以确定与 WL 相关的因素。慢性肾脏病（CKD）定义为估计肾小球滤过率<60mL/min/1.73m2持续三个月以上。我们还比较了最后一次就诊时 CKD（CKD+组）和无 CKD（CKD-组）患者的这些发现，以探讨与肾脏预后相关的因素。
126 例患者中，100 例（79.4%）为 III 或 IV 类。其中 36 例（36.0%）发现 WL。尽管肾功能无差异，但 WL+组的血清抗 dsDNA 抗体滴度较高，血清补体 3 水平较低。线性回归分析显示仅抗 dsDNA 抗体与 WL 显著相关（β=0.27，95%置信区间 0.001-0.100，P=0.01）。这些患者中，69 例随访 59.6±55.1 个月。Kaplan-Meier 分析显示两组间肾脏预后无差异。接下来，CKD+组包括 15 例（22.1%）患者。与肾活检时的 CKD-组相比，这些患者年龄更大，高血压和高尿酸血症、血清肌酐（Cr）水平、肾小球硬化、间质炎症、间质纤维化和肾小管萎缩的发生率更高。WL 的频率无显著差异。Cox 回归分析显示 CKD 与高血压、高尿酸血症、肾活检时血清 Cr 水平在临床上以及与肾小管萎缩在组织学上均显著相关。
WL 与血清抗 dsDNA 抗体相关，但与肾脏预后无关，提示 WL 反映免疫异常，但不是 LN 肾脏预后的独立预测因素。
