The Clinical Analysis Of Treatment Complications Of Lupus Nephritis

Objective:To retrospectively investigate the epidemiological characteristics of treatment complications in patients with lupus nephritis (LN) and the occurrence law of infection and osteonecrosis of the femoral head (ONFH)Methodology:There were699LN patients (607females and92males, average age27.8±9.4years, SLE disease duration30.7±43.4months, LN duration14.3±28.4months)in Nanjing Institution of Nephrology from Jan2005to Jun2009,with moderate and severe complications associated with the treatment. The types and degrees of complications were according with the the Adverse Reaction Terminology Criteria (CTCAE).All patients had renal biopsy. Infection etiology was according to clinical manifestation, imaging examination and body fluid of pathogeny. The follow-up baseline was the first time biopsy date. The induction phase of treatment was set to6months; the maintenance phase was the period for maintenance therapy after remission6months later. To syudy the the types and incidences of treatment complications with LN patients,and the occurrence rule of infection and osteonecrosis of the femoral head (ONFH)Results:(1) There were380(54.4%) cases of699LN patients with treatment complication, the follow-up duration was (45.9±16.9) months, the total complications were491times. All sorts of complications as follows:infection (n=191,27.3%), amenorrhea (n=92,13.2%), bone marrow depression (n=57,8.15%), elevated liver enzymes (n=50,7.15%), ONFH (n=26,3.72%), hyperglycemia (n=8,1.14%), allergic reaction (n=7,1.0%), thrombogenesis (n=7,1.0%), gastrointestinal disorders (n=5,0.72%), cataract (n=4,0.57%), tumor(n=3,0.43%) and nervous system disorders (n=3,0.43%). In induction phase, infection was the most common (64.2%); the maintenance phase included infection (34%), amenorrhea (25.6%), bone marrow depression (15.9%) and elevated liver enzymes (11.1%); and the ONFH was significantly increased.(2) There were191cases of699LN patients with infection complication; the incidence of infection was27.3%.191patients had225infection episodes,30cases with two episodes of infection,2cases with three episodes of infection.Of225infection episodes,124(55.1%) episodes occurred in the induction phase, after a follow-up period of (2.6±1.6) months.101(44.9%) episodes in the maintenance phase,time of occurrence were (24.3±16.6) months. The common affected sites were skin、lung and urinary system (89.3%). The most common pathogen was bacteria(54.2%), pathogen detection rate was not high, only29.5%, followed by virus, deep fungus and protozoon were rare.In the induction phase, the most common affected sites were skin(50.8%)、lung(32.3%)and urinary system(11.3%).However, in the maintenance phase, the infection sites were urinary system(35.6%)、skin(30.7%)and lung(16.8%).The induction and maintenance phase, the most pathogens were respectively bacteria (42.7%Vs68.3%)、virus (50.8%Vs25.7%)、fungus (6.5%Vs1%)(3) The incidence of ONFH was3.72%(26/699),1case occurred in the induction phase,25cases happened in the maintenance phase, the average time was (28.1±15.6)months, mainly occurred after the6months later, more common in the treatment from13to18months and25to30months. The incidence of ONFH in LN-Ⅴ+Ⅲ was highest, followed by LN-Ⅴ and LN-Ⅲ. LN complicated ONFH were related with oral ulcers and hyperlipidemia (P<0.05).Conclusions:The treatment complications of lupus nephritis most commonly occurred in the first three months of initial treatment. Infection was predominating, followed by amenorrhea, bone marrow depression, elevated liver enzymes, and ONFH. The infection rate was27.3%, and usually occurred within the3months. There were significant differences in affected sites and pathogens about the induction and maintenance phase. The incidence of ONFH was3.72%, mainly happened in the28months. The rate of ONFH in LN-V+III was highest, followed by LN-V and LN-III. And LN complicated ONFH were related with oral ulcers and hyperlipidemia.