Kurginian K V, Stoliarevich E S, Litvinova M A, Kokhanchuk V A, Shevchenko S N, Pugach V A, Novikov P I, Moiseev S V, Bulanov N M
Sechenov First Moscow State Medical University (Sechenov University).
Moscow City Hospital No. 52.
Ter Arkh. 2024 Jul 7;96(6):587-592. doi: 10.26442/00403660.2024.06.202726.
To analyze associations between clinical and morphological features of kidney involvement in patients with systemic lupus erythematosus.
In the retrospective cohort study, we enrolled adult (≥18 years) patients with morphologically proven lupus nephritis (LN) stratified according to the ISN/RPS classification. Systemic lupus erythematosus was classified in accordance with ACR/EULAR classification criteria (2019). Antiphospholipid syndrome was diagnosed according to the 2006 classification criteria. Disease activity was assessed with SELENA-SLEDAI score.
We enrolled 62 patients with LN, among them 84% were females. Median age of SLE onset was 23 (16,3; 30,8) years. In all cases kidney involvement was accompanied by extrarenal manifestations, among which joint (82%), skin (57%) and hematological involvement (68%) was the most common. LN class I was proven in one patient, class II - in three patients, class III - in 24, including III+V in seven, class IV - in 18, including IV+V in two, class V - in 13, class VI - in three patients. APS nephropathy was diagnosed in 4 (6.5%) of patients with LN. The most common clinical manifestation was proteinuria (85%), however its prevalence, level and the frequency of nephrotic syndrome showed no significant differences between the LN classes. LN III/IV±V was characterized by the highest levels of serum creatinine (and the lowest eGFR) at the time of biopsy.
LN is characterized by the high heterogeneity of the clinical and morphological manifestations, which makes LN class prediction impossible without kidney biopsy.
分析系统性红斑狼疮患者肾脏受累的临床和形态学特征之间的关联。
在这项回顾性队列研究中，我们纳入了成年（≥18岁）经形态学证实为狼疮性肾炎（LN）的患者，并根据国际肾脏病学会/肾脏病理学会（ISN/RPS）分类进行分层。系统性红斑狼疮根据美国风湿病学会/欧洲抗风湿病联盟（ACR/EULAR）分类标准（2019年）进行分类。抗磷脂综合征根据2006年分类标准进行诊断。疾病活动度采用系统性红斑狼疮疾病活动指数（SELENA-SLEDAI）评分进行评估。
我们纳入了62例LN患者，其中84%为女性。SLE发病的中位年龄为23（16.3；30.8）岁。在所有病例中，肾脏受累均伴有肾外表现，其中关节受累（82%）、皮肤受累（57%）和血液系统受累（68%）最为常见。1例患者被证实为LN I级，3例为II级，24例为III级，其中7例为III+V级，18例为IV级，其中2例为IV+V级，13例为V级，3例为VI级。4例（6.5%）LN患者被诊断为APS肾病。最常见的临床表现是蛋白尿（85%），然而其患病率、水平和肾病综合征的发生率在LN各等级之间无显著差异。LN III/IV±V级在活检时血清肌酐水平最高（估算肾小球滤过率最低）。
LN的临床和形态学表现具有高度异质性，若无肾脏活检则无法预测LN等级。
