尿沉渣可区分毛细血管内增生性狼疮性肾炎和毛细血管内增生性 IgA 肾病。

Urinary sediments could differentiate endocapillary proliferative lupus nephritis and endocapillary proliferative IgA nephropathy.

机构信息

Renal Division, Department of Medicine, Peking University First Hospital, Institute of Nephrology, Peking University, Key Laboratory of Renal Disease, Ministry of Health of China, Beijing 100034, PR China.

出版信息

Int Immunopharmacol. 2021 Jan;90:107122. doi: 10.1016/j.intimp.2020.107122. Epub 2020 Nov 14.

DOI:10.1016/j.intimp.2020.107122

PMID:33199236

Abstract

OBJECTIVE

This study investigated the differences in urinary sediment findings between patients with endocapillary proliferative lupus nephritis (LN) and patients with endocapillary proliferative IgA nephropathy (IgAN) and further evaluated the associations of leukocyturia with disease activity, pathological features and prognosis.

METHODS

The urinary sediments of 126 patients, including 92 with LN and 34 with IgAN, with renal-biopsy-proven endocapillary proliferative glomerulonephritis (EPGN) were examined by a standardized method. The urinary elements investigated included various cells, casts and crystals. The associations of leukocyturia with disease activity, pathological features and prognosis were further analyzed.

RESULTS

In the patients with EPGN, normal to mild leukocyturia (≤12/HPF) and moderate to severe leukocyturia (>12/HPF) were found in 52 (41.27%) and 74 (58.73%) patients, respectively. The proportion of moderate to severe leukocyturia and the frequencies of urinary white blood cell casts and waxy casts were significantly higher in endocapillary proliferative LN than those in endocapillary proliferative IgAN (P < 0.001, P = 0.020, P = 0.010, respectively). In the endocapillary proliferative LN group, the levels of leukocyturia were significantly correlated with serum creatinine (r = 0.288, P = 0.005), eGFR (r = -0.284, P = 0.006), serum C3 (r = -0.275, P = 0.009), SLEDAI scores (r = 0.383, P ≤ 0.001) and glomerular leukocyte infiltration (r = 0.285, P = 0.002). A multivariate analysis showed that leukocyturia was an independent risk factor for renal outcomes in endocapillary proliferative LN (HR: 1.456, 95% CI: 1.083-1.957, P = 0.013) but not in IgAN.

CONCLUSIONS

Urinary sediments of LN with EPGN and IgAN with EPGN differed in many aspects. Leukocyturia could reflect the disease activity and prognosis of EPGN, especially in endocapillary proliferative LN.

摘要

目的

本研究旨在探讨表现为内皮下细胞增生的狼疮性肾炎（LN）与表现为内皮下细胞增生的 IgA 肾病（IgAN）患者的尿沉渣检查结果的差异，并进一步评估白细胞尿与疾病活动度、病理特征和预后的相关性。

方法

采用标准化方法检测 126 例经肾活检证实为内皮下细胞增生性肾小球肾炎（EPGN）患者的尿沉渣，其中 LN 患者 92 例，IgAN 患者 34 例。检测的尿成分包括各种细胞、管型和晶体。进一步分析白细胞尿与疾病活动度、病理特征和预后的相关性。

结果

在 EPGN 患者中，52 例（41.27%）患者表现为轻至中度白细胞尿（≤12/HPF），74 例（58.73%）患者表现为中重度白细胞尿（>12/HPF）。与内皮下细胞增生性 IgAN 相比，内皮下细胞增生性 LN 患者中中重度白细胞尿的比例以及尿白细胞管型和蜡样管型的发生率更高（P<0.001，P=0.020，P=0.010）。在内皮下细胞增生性 LN 组中，白细胞尿水平与血清肌酐（r=0.288，P=0.005）、估算肾小球滤过率（r=-0.284，P=0.006）、血清 C3（r=-0.275，P=0.009）、SLEDAI 评分（r=0.383，P≤0.001）和肾小球白细胞浸润（r=0.285，P=0.002）显著相关。多因素分析显示，白细胞尿是内皮下细胞增生性 LN 患者肾脏结局的独立危险因素（HR：1.456，95%CI：1.083-1.957，P=0.013），但不是 IgAN 患者的独立危险因素。