Lakshmi V Ramya, Vangala Navatha, Uppin Megha S, Gudithi Swarnalatha, Taduri Gangadhar, Raju Sree Bhushan
Department of Pathology, Nizam's Institute of Medical Sciences, Punjagutta, Hyderabad, Telangana, India.
Department of Nephrology, Nizam's Institute of Medical Sciences, Punjagutta, Hyderabad, Telangana, India.
Indian J Nephrol. 2022 Jan-Feb;32(1):28-33. doi: 10.4103/ijn.IJN_131_20. Epub 2021 Nov 9.
The classification of lupus nephritis (LN) on biopsy is essentially focused on morphologic changes in glomeruli. Renal vascular lesions are not addressed in detail in current classifications and are often overlooked. We aimed to determine the prevalence of vascular lesions in LN on biopsies and to compare these with biopsies not showing the vasculopathies.
A total of 740 renal biopsies of LN were analysedfor presence of vasculopathies from January 2013 to June 2019. Of these, 527 (71.2%) biopsies showed vascular lesions (vascular group), which were further categorized into known five subtypes according to morphology and immunofluorescence (IF) findings. Remaining 213 (28.8%) biopsies constituted non-vascular group. Clinical, demographic and laboratory parameters were compared between these two groups.
The mean age was 27.95 ± 9.8 years and 27.0 ± 9.4 years in the vascular and non-vascular groups respectively with higher M:F (1:2 > 1:7) in vascular group. Majority of vasculopathies (257, 48.7%) were found in biopsies with class IV LN. Haematuria (69.8% vs. 20.1%), proteinuria (100% vs. 62%), anemia (48.3% vs. 3.60%) and hypertension (39.8% vs. 8.46%) were common in group I. Uncomplicated vascular immune deposits (426; 80.8%) were the most common vasculopathy and true vasculitis (4;0.8%) was least common. Activity and chronicity indices (7.35 ± 3 and 2.45 ± 1.5, respectively) were significantly higher in the vascular group. Activity index was highest in uncomplicated vascular immune deposits (7.45 ± 2.8) and chronicity index was highest in non-specific sclerotic vascular lesions (2.7 ± 1.6).
Vascular involvement is common in LN. Uncomplicated vascular immune deposits were common vasculopathies whereas true vasculitis was least common. The morphology and IF both need to be carefully screened for the diagnosis of vasculopathies.
狼疮性肾炎（LN）活检的分类主要集中在肾小球的形态学改变上。目前的分类中未详细涉及肾血管病变，且常被忽视。我们旨在确定LN活检中血管病变的患病率，并将其与未显示血管病变的活检进行比较。
对2013年1月至2019年6月期间740例LN肾活检进行血管病变分析。其中，527例（71.2%）活检显示血管病变（血管组），根据形态学和免疫荧光（IF）结果进一步分为已知的五种亚型。其余213例（28.8%）活检构成非血管组。比较两组的临床、人口统计学和实验室参数。
血管组和非血管组的平均年龄分别为27.95±9.8岁和27.0±9.4岁，血管组的男女比例更高（1:2>1:7）。大多数血管病变（257例，48.7%）见于IV级LN活检。血尿（69.8%对20.1%）、蛋白尿（100%对62%）、贫血（48.3%对3.60%）和高血压（39.8%对8.46%）在I组中常见。单纯性血管免疫沉积物（426例；80.8%）是最常见的血管病变，真正的血管炎（4例；0.8%）最不常见。血管组的活动指数和慢性指数（分别为7.35±3和2.45±1.5）显著更高。单纯性血管免疫沉积物的活动指数最高（7.45±2.8），非特异性硬化性血管病变的慢性指数最高（2.7±1.6）。
血管受累在LN中很常见。单纯性血管免疫沉积物是常见的血管病变，而真正的血管炎最不常见。诊断血管病变时需要仔细筛查形态学和IF。
