The Analysis Of Clinical Characteristics And Pathological Type In Lupus Nephritis

Objective:To analysis the relationship between clinical feathers and immunological characteristics, activity index of systemic lupus erythematosus (SLE) and renal pathological classifications in lupus nephritis (LN), to investigate the characteristics of LN, and to improve the basis for the diagnosis and treatment.Methods:The clinical and pathological data of 227 patients with LN were analyzed retrospectively, controlled by 778 patients with SLE in the same period. We used Kruskal-Wallis H test to investigate the relationships of the clinical and pathological features. Comparisons between different pathological classifications were by the chi-square method and a multiple linear regression.Results:1. General situation:(1) 778 cases of SLE patients,75 male and 703 female, the ratio of male and female patients is 1:9.4. The renal biopsy confirmed 227 cases of LN patients,28 male and 199 female, the ratio of male and female patients is 1:7.1(2) The mean onset age of SLE patients is (37.62±13.540) years (10-80years), the onset age of male patients is earlier than that of female patients (P=0.020). The mean onset age of confirmed LN patients is (34.41±11.86) years (13-75 years), there is no significant difference between male patients and female patients (P>0.05).2. Pathological types:the renal pathological types show typeⅠ12.3%; typeⅡ12.8%; typeⅢ18.1%; typeⅣ37.5%; typeⅤ16.7%; typeⅥ2.6%. TypeⅣwith the highest proportion, which followed by typelll.3. Clinical manifestations:(1) In 778 cases of SLE patients, there are 441 patients manifested by kidney injury, while 337 patients without kidney injury. In 227 cases of LN patients, hematuria only is 36 cases, proteinuria only is 81 cases, while hematuria combined with proteinuria is 110 cases. Manifested by nephritic syndrome is 53 cases, renal dysfunction is 37 cases.(2) TypeⅣLN is mainly showed as hematuria combined with proteinuria or nephritic syndrome, and even showed as renal dysfunction (P=0.000); TypeⅤLN showed as proteinuria only for common.(3) As respect to the outer-renal symptoms, the incidence of facial erythema and arthritis was highest in typeⅡLN (P=0.004). While the photosensitive, oral ulcers, serositis and blood system involved with no statistical difference.(4) The incidence of hypertension is 24.2%, type IV has the significant difference compared with other types.4. Laboratory parameters(1) Average hemoglobin (HGB) levels of patients with kidney injury lower than those without kidney injury, while serum creatinine (Scr) levels of patients with kidney injury is significantly higher than that of without kidney injury (P=0.000). Patients of type IV LN is with the most prominence(2) ANA patterns of SLE patients is most showed as particle type, followed by homogenous type. Positive rate of anti-nucleosome antibodies in SLE patients with kidney injury is higher than patient without kidney injury. And the ds-DNA antibody titer is significantly higher than the patient without kidney injury (P=0.011).(3) Anti-nuclear antibody series in every type are in general no significant difference (P>0.05).(4) AI,CI and SLEDAI scores are the highest in type IV LN compared with other types. LACC standard reflects the limitation combined with SLEDAI standard.5. Correlation analysis of clinical and pathological types:Hemoglobin and complement level are negative correlation with the SLEDAI score; urine protein and serum creatinine level are positive correlation with the AI score, while complement level is negative correlation with the AI score; serum creatinine level is positive correlation with the CI score. Pathological types are correlated with age, C3 level, SLEDAI score, AI score and CI score.Conclusion:1. The prevalence of SLE and LN are highest in 30-50 years old. The prevalence in female is much higher than male.2. The most prevalent type in LN patients is type IV LN with the most severe laboratory indicators.3. TypeⅣLN has the highest incidence of anemia, hemouria, proteinuria and complement decrease, and the active index is the highest.4. Positive rate of anti-nucleosome antibodies in SLE patients with kidney injury is higher than patient without kidney injury. Anti-nuclear antibody series in each type are in general no significant difference.5. Hemoglobin and complement level are negative correlation with the SLEDAI score; urine protein and serum creatinine level are positive correlate with the AI score, while complement 3 level is negative correlation with the AI score; serum creatinine level is positive correlation with the CI score. Pathological types are correlated with age, C3 level, SLEDAI score, AI score and CI score.