Song Kangkang, Liu Xiaomin, Liu Jiaona, Yin Zhong, Chen Pu, Cai Guangyan, Chen Xiangmei
Department of Nephrology, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Diseases, Medical School of Chinese PLA, the First Medical Centre, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, China.
Clin Rheumatol. 2020 Nov;39(11):3353-3363. doi: 10.1007/s10067-020-05115-2. Epub 2020 May 20.
This study aimed to analyse the clinical and laboratory characteristics of different pathologic classifications of lupus nephritis (LN) patients in terms of age at systemic lupus erythematosus (SLE) diagnosis and nephritis onset.
Clinical, laboratory, and pathological data of 710 LN patients diagnosed by renal biopsy at our institution between 2000 and 2018 were retrospectively analysed. Patients were divided into the different pathological classification groups; childhood-, adult- and elderly-onset SLE groups and early- and late-onset LN groups.
Class IV occurred most frequently and had the lowest complement C3 level. There was an obvious increase in active index in class IV and class V + IV. Patients with class VI showed some clinical characteristics similar to end-stage renal disease. Patients with proliferative nephritis were younger at SLE diagnosis and had higher blood pressure, higher frequency of proteinuria and urinary erythrocyte and lower haemoglobin and complement C3. Pathologic classification between childhood-, adult- and elderly-onset SLE patients or between early- and late-onset LN patients was not significantly different. Elderly-onset SLE patients had the highest chronic index (CI), IgA, IgG and Sjögren's syndrome A antibodies and Sjögren's syndrome B antibodies rates, whereas late-onset LN patients showed significantly higher CI, haemoglobin, complement C3 and C4 but lower uric acid, IgM and IgG.
LN patients present with different clinical and laboratory characteristics according to pathological classification, age at SLE diagnosis and nephritis onset. These results might be valuable for estimating the pathology and guiding treatment and prognosis. Key Points • Patients with proliferative nephritis have more severe immune disorders, worse renal function and stronger inflammatory state. • The elderly-onset SLE patients showed a poorer condition. • The late-onset LN patients might have a more stable status.
本研究旨在根据系统性红斑狼疮（SLE）诊断时的年龄和肾炎发病情况，分析狼疮性肾炎（LN）患者不同病理分类的临床和实验室特征。
回顾性分析2000年至2018年间在我院经肾活检确诊的710例LN患者的临床、实验室和病理数据。患者被分为不同的病理分类组；儿童期、成年期和老年期发病的SLE组以及早期和晚期发病的LN组。
IV型最常见，补体C3水平最低。IV型和V+IV型的活动指数明显升高。VI型患者表现出一些与终末期肾病相似的临床特征。增殖性肾炎患者SLE诊断时年龄较小，血压较高，蛋白尿、尿红细胞频率较高，血红蛋白和补体C3较低。儿童期、成年期和老年期发病的SLE患者之间或早期和晚期发病的LN患者之间的病理分类无显著差异。老年期发病的SLE患者慢性指数（CI）、IgA、IgG及干燥综合征A抗体和干燥综合征B抗体率最高，而晚期发病的LN患者CI、血红蛋白、补体C3和C4显著较高，但尿酸、IgM和IgG较低。
LN患者根据病理分类、SLE诊断时的年龄和肾炎发病情况表现出不同的临床和实验室特征。这些结果可能对评估病理、指导治疗和预后有价值。要点•增殖性肾炎患者免疫紊乱更严重，肾功能更差，炎症状态更强。•老年期发病的SLE患者病情较差。•晚期发病的LN患者可能病情更稳定。
