The Occurrence Of Renal Involvement In Primary Sjogren's Syndrome: A Clinical And Pathological Study Of 141 Patients

Objective. To ascertain the incidence rate,Clinical,immunological and pathological feature of renal involvement in patients with primary Sj?gren's syndrome(pSS).Enhance our knowledge of the disease.Methods. We assemble the clinical data of 141 patients with pSS(128 femaleand 13 male,with an average age of 46.8) ,who have been hospitalized in the first affiliated hospital of guangxi medical university during January 2006 to June 2010.These patients are divided into two groups:the patients with renal involvement(RI) make up the first one,with a total number of 39(33 female and 6 male,with an average age of 49);the second gloup is make up with the Patients without renal involvment.The following laboratory tests were Performed in all patients:blood and urine rutine examination,blood biochemistry,ANA,ds-DNA,anti-ENA antibody repertoire,RF,complement(C3,C4),serum immunoglobulin(IgG,IgA,IgM),24h Urine protein quantitation and blood gas analysis.26 paitient in the first group have made Renal biopsies.Results. 39 patients of 141 have had laboratory evidence of renal involvement,with a incidence rate of 27.7%.types of the renal involvement includes:â‘ renal tubule impairment(RTI):I-form renal tubular acidosis(RTA)was found in twenty-two patients ( 56.4% ) ; hypopotassaemia in twenty ;hypokalemic plegia in five; osteoporosis in three; nephrolithiasis in twelve.â‘¡renal glomerulus impairment(RGI):six patients presented with overt renal glomerulus impairment, nephrotic syndrome(NS) in five, chronic glomerulonephritis in one.â‘¢renal failure:sixteen patients presented with renal failure,nine of tnem were in compensatory stage,six in decomp stage,one have enterd the stage of exhaustion.the comparison of immunological index between two groups:the group with renal involvement have statistical significantive higher serum RF as compared with patients without renal involvement.and there are not statistical difference in serum level of IgG,IgA,IgM,ANA,anti-SSA,anti-SSB,C3 and C4 between two group. Renal biopsies(RB):â‘ light microscope examination: Renal biopsies from twenty-six patients (96.2%)showed chronic interstitial nephritis(IN) in twenty-five. mesangial proliferative glomerulonephritis have concurrented in twelve of them (46.2%), hyperplastic and sclerosing glomerulonephritis in three(11.5%), partly sclerosing glomerulonephritis in three(11.5%) and membranous nephropathy in two(7.7%). Light affection of glomerulonephRitis is found in one patient.â‘¡immunofluorescence: IgG were detected in Seven patients(26.9%), IgA were detected in five(19.2%),IgM in twenty-one(80.8%), C3 in seven(26.9%), C4 in five(19.2%)and C1q in six(23.1%).Conclusions. 1.Renal involvement is a frequent extraglandular manifestation of primary Sj?gren's syndrome,it's mainly presented with I-form renal tubular acidosis; 2.Renal biopsies from patients with pSS mainly showed interstitial nephritis.however,there are not a low incidence rate of deposition of immune complex in glomerulus and the happening of glomerulonephritis; 3. rheumatoid factor(RF) may have a certain relationship with the accurrence of renal involvement in patients with pSS; 4. Renal biopsies is a necessary test for patients with pSS when renal involvement have been found.