Clinical And Pathological Analysis Of Lupus Nephritis Complicated With Abnormal Renal Function

Objective:Through a retrospective analysis of the relevant data of lupus nephritis（LN）patients included in this study,to investigate the correlation between abnormal renal function and clinical indicators and renal pathological damage in patients with LN,and find out the risk factors that may lead to abnormal renal function in patients with lupus nephritis,so as to provide a basis for the treatment and improvement of the prognosis of patients with lupus nephritis in order to delay the occurrence of end-stage renal disease（ESRD）.Method:Select the patients who were admitted to the Department of Nephrology,Second Hospital of Jilin University from January 2012 to September 2021,met the diagnostic criteria for SLE established by the American College of Rheumatology（ACR）in1997,and were diagnosed as LN by renal biopsy.According to the glomerular filtration rate（GFR）,the patients were divided into abnormal renal function group（e GFR<90ml/min）and normal renal function group（e GFR≥90ml/min）.Collect The general data,laboratory data and pathological data during renal biopsy.SPSS 26.0statistical software was used for statistical analysis to compare the differences between the normal renal function group and the renal function abnormal group,as well as the risk factors of LN patients with renal dysfunction.Results:According to the inclusion and exclusion criteria,a total of 255 LN patients were included in this study,including 27 males（10.59%）and 228 females（89.41%）.Among them,118 cases in the normal renal function group accounted for 46.27%,and137 cases in the abnormal renal function group accounted for 53.73%.1.The proportion of males,smoking history,drinking history and the incidence of hypertension in abnormal renal function group were higher than those in normal renal function group.2.The incidence of serositis and blood system damage in the abnormal renal function group is higher than that in the normal renal function group,and the incidence of thrombocytopenia in the blood system damage is higher,and the incidence of joint damage in the normal renal function group is lower than that in the normal renal function group（P<0.05）;patients in the abnormal renal function group had higher SLEDAI scores,the proportion of moderately active patients was significantly higher than that of normal renal function group,and the proportion of mildly active patients was significantly lower than that of normal renal function group（P<0.05）;Spearman correlation analysis showed that the occurrence of serositis and blood system damage and the SLEDAI score were negatively correlated with e GFR.3.Compared with the normal renal function group,the abnormal renal function group had the levels of uric acid,lactate dehydrogenase,triglycerides（TG）,low-density lipoprotein（LDL）,Neutrophil-lymphocyte ratio（NLR）,neutrophil percentage,neutrophil count,24-hour urine protein quantification,the incidence of proteinuria,hematuria,and leukocyturia,erythrocyte sedimentation rate（ESR）,C-reactive protein（CRP）,the positive rate of anti-ds DNA antibody and nucleosome antibody and histone antibody were higher,and the levels of CO₂ binding capacity,total protein,albumin（Alb）,alanine aminotransferase（ALT）,high-density lipoprotein（HDL）,lymphocyte percentage,lymphocyte count,red blood cell count,hemoglobin（Hb）,platelet count（PLT）,Ig M,C3 were lower（P<0.05）.Spearman correlation analysis showed that uric acid,TG,neutrophil percentage,NLR,CRP,anti-ds DNA antibody,proteinuria,hematuria,leukocyte urine and 24-hour urine protein were negatively correlated with e GFR,and Alb,red blood cell count,Hb and PLT were significantly correlated with e GFR.4.The most common pathological types of LN patients were type IV+V（36.86%）,type IV（20.39%）,type V（17.25%）and type III+V（14.12%）.The most common pathological type in abnormal renal function group was type IV+V（44.53%）,followed by type IV（26.28%）,and the most common pathological type in normal renal function group was type V（28.81%）,followed by type IV+V（27.97%）.The activity index（AI）and chronic index（CI）of the abnormal renal function group were higher than those of the normal renal function group（P<0.05）.After detailed comparison of the renal pathological changes of the two groups of patients,the abnormal renal function group showed that the incidence of glomerular sclerosis,balloon adhesion,nuclear fragmentation,crescent formation,endothelial cell hyperplasia,loop microthrombosis,platinum ear-like changes,subendothelial erythrophilic deposition,tubular atrophy,interstitial inflammatory cell infiltration,interstitial fibrosis,fibrinoid necrosis of renal arterioles,and arterial wall thickening were higher compared with normal renal function group.Spearman correlation analysis showed that AI,CI,glomerular sclerosis,balloon adhesion,nuclear fragmentation,crescent formation,endothelial cell hyperplasia,loop microthrombosis,subendothelial erythrophilic deposition,tubular atrophy,interstitial inflammatory cell infiltration,interstitial fibrosis,renal vascular fibrinoid necrosis,vascular sclerosis,arterial wall thickening,and arterial wall hyaline degeneration were negatively correlated with e GFR.5.According to the comparison results between the normal renal function group and the abnormal renal function group,the variables with statistical significance were screened for Logistic multivariate regression analysis.The results showed that male,serositis,24-hour urine protein,AI and CI were LN independent risk factors for the abnormal renal function.Conclusion:1.LN patients with abnormal renal function are more likely to have dyslipidemia,anemia,hematuria and leukocytouria,as well as increased levels of uric acid,erythrocyte sedimentation rate,24-hour urine protein,NLR,CRP,and increased positive rates of anti-ds DNA antibodies,nucleosome antibodies,and histone antibodies increased,while albumin,Ig M and C3 decreased.2.LN patients with abnormal renal function have higher SLEDAI scores.Serositis,blood system damage,hair loss and rash are the most common extrarenal clinical manifestations of LN with abnormal renal function.3.The most common pathological type of LN patients with abnormal renal function is typeⅣ+Ⅴ,followed by typeⅣ,and active and chronic lesions are more serious.4.Male,occurrence of serositis,higher 24-hour urinary protein,AI and CI were independent risk factors for LN patients with abnormal renal function.