Conigliaro Paola, Giannini Clarissa, Ferrigno Sara, Nesi Carolina, Fonti Giulia Lavinia, Chimenti Maria Sole, Triggianese Paola, Aiello Francesco, Nucci Carlo, Bergamini Alberto, Cesareo Massimo
Rheumatology, Allergology and Clinical Immunology, Department of "Medicina dei Sistemi", University of Rome Tor Vergata, Rome, Italy.
Ophthalmology Unit, Department of Experimental Medicine and Surgery, University of Rome Tor Vergata, Rome, Italy.
Clin Exp Rheumatol. 2023 Mar;41(3):581-588. doi: 10.55563/clinexprheumatol/p1q482. Epub 2022 Jul 28.
Ocular and renal microvascular damage in lupus nephritis (LN) share similar physiopathological pathways that have investigated using traditional fundus examination and high-resolution colour electroretinography. Optical coherence tomography angiography (OCTA) is a recent, non-invasive technique for imaging the microvasculature of retina and choroid. Aim of the study was to investigate through OCTA analysis the relationship between retinal microvascular alterations and renal functional and histologic features.
Systemic lupus erythematosus (SLE) patients with LN, SLE without renal involvement and healthy controls were recruited and accomplished an ophthalmological evaluation, including OCTA. SLE-LN patients underwent a rheumatological evaluation, including disease-related clinical and laboratory features collection and kidney biopsy examination.
This cross-sectional study enrolled forty-six eyes of 23 LN patients, thirty-two eyes of 16 SLE patients and forty-two eyes of 21 controls. Thirteen SLE-LN patients (56.5%) displayed lupus retinopathy, 10 at moderate (77%) and 3 at severe stage (23%) by fundus oculi examination. Analysis of OCTA data showed with high/moderate accuracy a reduction of retinal capillary vessel density in both SLE and SLE-LN patients compared to controls in superficial and deep plexi. A reduction in fovea thickness and an increase in foveal avascular zone were also detected. OCTA data of LN patients correlated with LN duration, disease activity, kidney function and the presence of LN-vascular lesions at kidney biopsy.
Our results suggest the role of OCTA in early detection of systemic vascular involvement in SLE-LN patients and related kidney functional-histological impairment.
狼疮性肾炎（LN）中的眼部和肾脏微血管损伤具有相似的生理病理途径，以往已通过传统眼底检查和高分辨率彩色视网膜电图进行了研究。光学相干断层扫描血管造影（OCTA）是一种用于视网膜和脉络膜微血管成像的最新非侵入性技术。本研究的目的是通过OCTA分析探讨视网膜微血管改变与肾功能及组织学特征之间的关系。
招募了LN的系统性红斑狼疮（SLE）患者、无肾脏受累的SLE患者和健康对照者，并完成了包括OCTA在内的眼科评估。SLE-LN患者接受了风湿病学评估，包括收集与疾病相关的临床和实验室特征以及肾脏活检检查。
这项横断面研究纳入了23例LN患者的46只眼、16例SLE患者的32只眼和21例对照者的42只眼。13例SLE-LN患者（56.5%）表现出狼疮性视网膜病变，眼底检查显示10例为中度（77%），3例为重度（23%）。OCTA数据分析显示，与对照组相比，SLE和SLE-LN患者的视网膜毛细血管密度在浅层和深层血管丛中均有高/中度降低。还检测到黄斑厚度减小和黄斑无血管区增大。LN患者的OCTA数据与LN病程、疾病活动度、肾功能以及肾脏活检时LN血管病变的存在相关。
我们的结果表明OCTA在早期检测SLE-LN患者的全身血管受累及相关肾功能-组织学损害方面具有作用。
