Division of Allergy, Immunology, and Rheumatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
Institute of Clinical Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
Rheumatology (Oxford). 2024 Sep 1;63(9):2467-2472. doi: 10.1093/rheumatology/keae226.
To evaluate the risk of end-stage kidney disease (ESKD) in LN patients using tubulointerstitial lesion scores.
Clinical profiles and histopathological presentations of 151 biopsy-proven LN patients were retrospectively examined. Risk factors of ESKD based on characteristics and scoring of their tubulointerstitial lesions [e.g. interstitial inflammation (II), tubular atrophy (TA) and interstitial fibrosis (IF)] were analysed.
The mean age of 151 LN patients was 36 years old, and 136 (90.1%) were female. The LN cases examined included: class I/II (n = 3, 2%), class III/IV (n = 119, 78.8%), class V (n = 23, 15.2%) and class VI (n = 6, 4.0%). The mean serum creatinine level was 1.4 mg/dl. Tubulointerstitial lesions were recorded in 120 (79.5%) patients. Prior to receiving renal biopsy, nine (6.0%) patients developed ESKD. During the follow-up period (mean, 58 months), an additional 47 patients (31.1%) progressed to ESKD. Multivariate analyses identified serum creatinine [hazard ratio (HR): 1.7, 95% CI: 1.42-2.03, P < 0.001] and IF (HR: 3.2, 95% CI: 1.58-6.49, P = 0.001) as independent risk factors of ESKD. Kaplan-Meier analysis further confirmed a heightened risk of ESKD associated with IF.
Tubulointerstitial involvement is commonly observed in the histopathological presentation of LN. However, IF, rather than II or TA, was found to increase the risk of ESKD in our cohort. Therefore, to predict renal outcome in LN patients prior to adjusting immunosuppressive treatment, the degree of IF should be reviewed.
通过肾小管间质病变评分评估狼疮肾炎（LN）患者发生终末期肾病（ESKD）的风险。
回顾性分析 151 例经活检证实的 LN 患者的临床特征和组织病理学表现。分析基于肾小管间质病变（如间质炎症（II）、肾小管萎缩（TA）和间质纤维化（IF））特征和评分的 ESKD 危险因素。
151 例 LN 患者的平均年龄为 36 岁，136 例（90.1%）为女性。检查的 LN 病例包括：I/II 级（n=3，2%）、III/IV 级（n=119，78.8%）、V 级（n=23，15.2%）和 VI 级（n=6，4.0%）。血清肌酐水平的平均值为 1.4mg/dl。120 例（79.5%）患者有肾小管间质病变。在接受肾活检之前，有 9 例（6.0%）患者发生 ESKD。在随访期间（平均 58 个月），另外 47 例（31.1%）进展为 ESKD。多变量分析确定血清肌酐（危险比[HR]：1.7，95%置信区间[CI]：1.42-2.03，P<0.001）和 IF（HR：3.2，95%CI：1.58-6.49，P=0.001）是 ESKD 的独立危险因素。Kaplan-Meier 分析进一步证实 IF 与 ESKD 风险增加相关。
LN 的组织病理学表现常伴有肾小管间质受累。然而，在我们的队列中，IF 而不是 II 或 TA 增加了 ESKD 的风险。因此，在调整免疫抑制治疗之前，为预测 LN 患者的肾脏预后，应评估 IF 的程度。
