Department of Nephrology, The First Affiliated Hospital of Sun Yat-Sen University, 58Th, Zhongshan Road II, Guangzhou, 510080, China.
Key Laboratory of Nephrology, Ministry of Health and Guangdong Province, Guangzhou, People's Republic of China.
J Nephrol. 2023 Nov;36(8):2345-2354. doi: 10.1007/s40620-023-01622-y. Epub 2023 Jun 21.
The clinicopathological features, outcomes, and pathogenesis of lupus nephritis with scanty immune deposits in the kidney biopsy remain unclear.
Four hundred ninety-eight biopsy-proven lupus nephritis patients were included, and clinical and pathological data were collected. The primary endpoint was mortality, while the secondary endpoint was doubling baseline serum creatinine or end-stage renal disease. Associations between scanty immune deposits lupus nephritis and adverse outcomes were analyzed by Cox regression models.
Among 498 lupus nephritis patients, 81 were diagnosed with scanty immune deposits. Patients with scanty immune deposits had significantly higher serum albumin and serum complement C4 than those with immune complex deposits. The proportion of anti-neutrophil cytoplasmic antibodies was similar between the two groups. In addition, patients with scanty immune deposits showed less proliferative features at kidney biopsy and lower activity index score, accompanied by milder mesangial cell and matrix hyperplasia, endothelial cell hyperplasia, nuclear fragmentation, and glomerular leukocyte infiltration. Patients in this group also had a milder degree of foot process fusion. Overall, renal survival and patient survival showed no significant difference between the two groups. 24-h proteinuria and chronicity index were significant risk factors for renal survival, and 24-h proteinuria and positive anti-neutrophil cytoplasmic antibodies were risk factors for patient survival in scanty immune deposits lupus nephritis patients.
Compared with other lupus nephritis patients, scanty immune deposits lupus nephritis patients had significantly lower activity features on kidney biopsy, but have similar outcomes. Positive anti-neutrophil cytoplasmic antibodies may be a risk factor for patient survival in scanty immune deposits lupus nephritis patients.
肾活检中免疫沉积物稀少的狼疮肾炎的临床病理特征、结局和发病机制仍不清楚。
纳入 498 例经肾活检证实的狼疮肾炎患者，收集其临床和病理资料。主要终点为死亡率，次要终点为血清肌酐翻倍或终末期肾病。采用 Cox 回归模型分析免疫沉积物稀少性狼疮肾炎与不良结局的关系。
在 498 例狼疮肾炎患者中，81 例诊断为免疫沉积物稀少。与免疫复合物沉积患者相比，免疫沉积物稀少患者的血清白蛋白和血清补体 C4 显著升高。两组抗中性粒细胞胞质抗体的比例相似。此外，免疫沉积物稀少患者的肾活检表现出较少的增生性特征，活动指数评分较低，伴有轻度系膜细胞和基质增生、内皮细胞增生、核碎裂和肾小球白细胞浸润。该组患者的足细胞融合程度也较轻。总的来说，两组患者的肾脏存活率和患者存活率无显著差异。24 小时蛋白尿和慢性指数是肾脏存活率的显著危险因素，而 24 小时蛋白尿和抗中性粒细胞胞质抗体阳性是免疫沉积物稀少性狼疮肾炎患者患者存活率的危险因素。
与其他狼疮肾炎患者相比，免疫沉积物稀少性狼疮肾炎患者的肾活检活动特征明显较低，但结局相似。抗中性粒细胞胞质抗体阳性可能是免疫沉积物稀少性狼疮肾炎患者患者存活率的危险因素。
