Murugesan Venkatram, Mathew Anil, Rajasekharan Nair Rajesh, Kurian George, Paul Polachirakal Zachariah, Sreedharan Sandeep
Department of Nephrology, Amrita Institute of Medical Sciences, Kochi, IND.
Cureus. 2024 Aug 12;16(8):e66673. doi: 10.7759/cureus.66673. eCollection 2024 Aug.
Renal involvement, known as lupus nephritis (LN), is a common and serious complication of systemic lupus erythematosus (SLE), linked to significant morbidity and mortality. Histomorphological indices, such as the activity index (AI) and chronicity index (CI), are critical in predicting treatment responses and outcomes. This study aims to compare these histomorphological indices between adult and pediatric patients with LN and evaluate their impact on post-induction therapy outcomes.
A cross-sectional analysis was conducted at a single nephrology department from 2005 to 2019, including patients with biopsy-confirmed LN. Data on demographic characteristics, histomorphological indices, and clinical outcomes post-induction therapy were collected. Statistical analysis was performed using IBM SPSS Statistics for Windows, Version 20.0 (Released 2011; IBM Corp., Armonk, New York, United States) to identify significant correlations and differences.
Pediatric patients exhibited significantly lower AI (p=0.042) and CI scores compared to adults. Lower frequencies of hyaline thrombi (p=0.005) and tubular atrophy (p=0.028) were observed in the pediatric group. Key predictors of a complete response to induction therapy included interstitial inflammation <0.65 and tubular atrophy <0.63. Significant correlations were found between post-induction renal function tests (RFT) and indices such as AI (p=0.035), CI (p<0.001), cellular and fibrocellular crescents (p<0.001), and tubular atrophy (p<0.001). Proteinuria outcomes were significantly associated with CI (p=0.040), interstitial inflammation (p=0.006), and tubular atrophy (p=0.026).
The conclusion aligns with the established understanding that pediatric patients with LN often have a different disease trajectory compared to adults. Pediatric patients generally presented with less severe histomorphological damage, contributing to better responses to induction therapy. Detailed histopathological assessments are essential for guiding treatment strategies and improving patient prognosis in both adult and pediatric LN populations.
肾脏受累，即狼疮性肾炎（LN），是系统性红斑狼疮（SLE）常见且严重的并发症，与显著的发病率和死亡率相关。组织形态学指标，如活动指数（AI）和慢性指数（CI），对于预测治疗反应和结果至关重要。本研究旨在比较成人和儿童LN患者的这些组织形态学指标，并评估它们对诱导治疗后结果的影响。
于2005年至2019年在单一肾脏病科进行了一项横断面分析，纳入经活检确诊为LN的患者。收集了人口统计学特征、组织形态学指标及诱导治疗后临床结果的数据。使用IBM SPSS Statistics for Windows 20.0版（2011年发布；IBM公司，美国纽约州阿蒙克）进行统计分析，以确定显著的相关性和差异。
与成人相比，儿童患者的AI（p = 0.042）和CI评分显著更低。儿童组中透明血栓（p = 0.005）和肾小管萎缩（p = 0.028）的发生率更低。诱导治疗完全缓解的关键预测因素包括间质炎症<0.65和肾小管萎缩<0.63。诱导治疗后肾功能测试（RFT）与AI（p = 0.035）、CI（p<0.001）、细胞性和纤维细胞性新月体（p<0.001）以及肾小管萎缩（p<0.001）等指标之间存在显著相关性。蛋白尿结果与CI（p = 0.040）、间质炎症（p = 0.006）和肾小管萎缩（p = 0.026）显著相关。
该结论与已有的认识一致，即儿童LN患者的疾病轨迹通常与成人不同。儿童患者通常表现出较轻的组织形态学损伤，这有助于对诱导治疗产生更好的反应。详细的组织病理学评估对于指导成人和儿童LN患者的治疗策略及改善患者预后至关重要。
