Division of Rheumatology, Department of Internal Medicine, 37991Yonsei University College of Medicine, Seoul, Korea.
Division of Rheumatology, Department of Internal Medicine, St Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Lupus. 2022 Apr;31(5):588-595. doi: 10.1177/09612033221088437. Epub 2022 Mar 22.
Proliferative lupus nephritis (LN) is a crucial complication in systemic lupus erythematosus (SLE). This study evaluated the clinical implications of coexistence of membranous LN in proliferative LN in terms of clinical characteristics and long-term outcome.
We retrospectively reviewed the medical records of patients with SLE who underwent renal biopsy between 2005 and 2018. Patients with proliferative LN based on the 2003 International Society of Nephrology/Renal Pathology Society classification were subclassified into pure (Class III or IV only) and mixed (Class III or IV + Class V) proliferative LN. The clinical features at the time of renal biopsy, incidence of end-stage renal disease (ESRD), and all-cause mortality were compared between patients with mixed or pure proliferative LN.
Of the 171 patients, 30 and 141 were classified into mixed and pure proliferative LN groups, respectively. Patients with pure proliferative LN showed higher anti-dsDNA antibody and lower hemoglobin, platelet, and complement 3 levels than patients with mixed proliferative LN. The SLE disease activity index was also higher in patients with pure proliferative LN ( = 0.047). The pure proliferative LN group showed a higher proportion of Class IV and higher histologic activity index scores ( < 0.001 and = 0.004, respectively). During the follow-up period of 58.3 months, 18 patients developed ESRD and 15 patients died. ESRD was exclusively observed in patients with pure proliferative LN, although the incidence of ESRD was not statistically different ( = 0.055). All-cause mortality was comparable between the two groups.
Pure proliferative LN was associated with higher clinical and histological activities and modestly increased risk of ESRD. Active immunosuppressive treatment would be required to control the renal inflammation in patients with proliferative LN, regardless of the coexistence of membranous LN.
增生性狼疮肾炎（LN）是系统性红斑狼疮（SLE）的一个关键并发症。本研究评估了增生性 LN 中膜性 LN 共存的临床意义，包括临床特征和长期预后。
我们回顾性分析了 2005 年至 2018 年间接受肾活检的 SLE 患者的病历。根据 2003 年国际肾脏病学会/肾脏病理学会分类，增生性 LN 患者被分为单纯（仅 III 或 IV 级）和混合（III 或 IV 级+V 级）增生性 LN。比较混合和单纯增生性 LN 患者肾活检时的临床特征、终末期肾病（ESRD）发生率和全因死亡率。
在 171 例患者中，30 例和 141 例分别被分类为混合和单纯增生性 LN 组。单纯增生性 LN 患者的抗 dsDNA 抗体水平较高，血红蛋白、血小板和补体 3 水平较低。单纯增生性 LN 患者的 SLE 疾病活动指数也较高（=0.047）。单纯增生性 LN 组的 IV 级比例较高，组织学活动指数评分较高（均<0.001 和=0.004）。在 58.3 个月的随访期间，18 例患者发生 ESRD，15 例患者死亡。仅在单纯增生性 LN 患者中观察到 ESRD，尽管 ESRD 的发生率无统计学差异（=0.055）。两组的全因死亡率相当。
单纯增生性 LN 与更高的临床和组织学活动以及稍高的 ESRD 风险相关。无论是否存在膜性 LN 共存，都需要积极的免疫抑制治疗来控制增生性 LN 患者的肾脏炎症。
