Xia Wen, Deng Jiayi, Zhuang Lulu, Xu Feng, Jin Ying, Zhou Houan, Zhang Ti, Liu Zhengzhao, Zhang Haitao, Zeng Caihong, Liu Zhihong, Hu Weixin
National Clinical Research Center of Kidney Diseases, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China.
Clin Kidney J. 2024 May 10;17(6):sfae148. doi: 10.1093/ckj/sfae148. eCollection 2024 Jun.
Patients with lupus podocytopathy show a high incidence of acute kidney injury (AKI) and relapse, but the risk factors and mechanisms were unclear. This study analysed the clinicopathological features and risk factors for AKI and relapse in lupus podocytopathy patients.
The cohort of lupus podocytopathy was generated by screening the biopsies of patients with lupus nephritis (LN) from 2002 to 2022 and was divided into the mild glomerular lesion (MGL) and focal segmental glomerulosclerosis (FSGS) groups based on glomerular morphological characteristics. The acute (ATI) and chronic (CTI) tubulointerstitial lesions were semi-quantitatively scored. Logistic and Cox regressions were employed to identify the risk factors for AKI and relapse, respectively.
Among 6052 LN cases, 98 (1.6%) were diagnosed as lupus podocytopathy, with 71 in the MGL group and 27 in the FSGS group. All patients presented with nephrotic syndrome and 33 (34.7%) of them had AKI. Seventy-seven (78.6%) patients achieved complete renal response (CRR) within 12 weeks of induction treatment, in which there was no difference in the CRR rate between glucocorticoid monotherapy and combination therapy with glucocorticoids plus immunosuppressants. Compared with the MGL group, patients in the FSGS group had significantly higher incidences of hypertension and haematuria; in addition, they had higher Systemic Lupus Erythematosus Disease Activity Index 2000, ATI and CTI scores but a significantly lower CRR rate. Urinary protein ≥7.0 g/24 h and serum C3 ≤0.750 g/l were independent risk factors for AKI. During a median follow-up of 78 months, 57 cases (60.0%) had relapse and none reached the kidney endpoint. Failure to achieve CRR within 12 weeks, maintenance with glucocorticoid monotherapy and AKI at onset were independent risk factors for kidney relapse.
In this study, histological subtypes of lupus podocytopathy were found to be associated with clinical features and treatment response. In addition, several risk factors associated with AKI occurrence and kidney relapse were identified.
狼疮性足细胞病患者急性肾损伤（AKI）和复发的发生率较高，但危险因素和机制尚不清楚。本研究分析了狼疮性足细胞病患者的临床病理特征以及发生AKI和复发的危险因素。
通过筛查2002年至2022年狼疮性肾炎（LN）患者的活检样本建立狼疮性足细胞病队列，并根据肾小球形态特征分为轻度肾小球病变（MGL）组和局灶节段性肾小球硬化（FSGS）组。对急性（ATI）和慢性（CTI）肾小管间质病变进行半定量评分。分别采用逻辑回归和Cox回归确定AKI和复发的危险因素。
在6052例LN病例中，98例（1.6%）被诊断为狼疮性足细胞病，其中MGL组71例，FSGS组27例。所有患者均表现为肾病综合征，其中33例（34.7%）发生AKI。77例（78.6%）患者在诱导治疗12周内达到完全肾缓解（CRR），糖皮质激素单药治疗与糖皮质激素联合免疫抑制剂治疗的CRR率无差异。与MGL组相比，FSGS组患者高血压和血尿的发生率显著更高；此外，他们的系统性红斑狼疮疾病活动指数2000、ATI和CTI评分更高，但CRR率显著更低。尿蛋白≥7.0 g/24 h和血清C3≤0.750 g/l是AKI的独立危险因素。在中位随访78个月期间，57例（60.0%）复发，无患者达到肾脏终点。12周内未达到CRR、糖皮质激素单药维持治疗以及起病时发生AKI是肾脏复发的独立危险因素。
在本研究中，发现狼疮性足细胞病的组织学亚型与临床特征和治疗反应相关。此外，还确定了几个与AKI发生和肾脏复发相关的危险因素。
