Clinical And Pathological Characteristics In Primary Sjogren’s Syndrome With Renal Involvement

Objective:Retrospectively analyzed the clinical dates of primary Sjogren’s syndrome to investigate thoroughly the clinical and pathological characteristics and influencing factors in primary Sjogren’s syndrome with renal involvement.Methods:133 cases of patients with primary Sjogren’s syndrome were collected,who were in the first Hospital of Jilin university from 2012 to 2017,and respectively analyzed the clinical dates.All of them are accord with the 2002 International Classification Standard for Sjogren syndrome,and except Connective tissue disesse(CTDs).They are divided into two groups:the one group with renal involvement,the other one without it.12 patients in the renal involvement group had Renal core biopsis.All of them were examined by light microscopy,transmission electron microscopy and immunohistochemistry.And the pathological characteristics were statistically.Selected the patients combined primary Sjogren syndrome with renal involvement as the p SS group,the normal renal tissue from 2cm above renal tumor operation as the control group.CD68 expression in renal biopsy specimens of this two groups was detected by immunohistochemical techniques.SPSS22.0 software was adopted for all statistical analysis.Results:The average age of these 133 cases patients with p SS was 49.02±12.96 years old,the prevalence of male and female was 1:21.17,and the Middle-aged women were common.The patients with or without renal involvement in age and gender have no statistically differences.Mouth dryness,fatigue,lymphadenectasis,pulmonary involvement and hematological diseases have statistically differences between this two groups;Laboratory results showed that there was a statistically difference in the red blood cell count,hemoglobin,blood urea nitrogen,serum creatinine,serum cystatin C,serum potassium,serum calcium,total bilirubin,indirect bilirubin,total albumin,albumin,serum calcium,urine PH and erythrocyte sedimentation rate.This case showed 27 cases(51.92%)patients with renal tubular lesions,25cases(48.08%)patients with glomerular lesions,and 12 cases(23.08%)patients with this two lesions in patients with renal involvement from p SS.This case series supports renal tubular impairment as the predominant finding in patients with renal involvement from p SS and illustrates glomerular impairment is also common.The group with renal involvement showed 31 cases(59.62%)had renal tubular acidosis,22cases(42.31%)haematuria,27 cases(51.92%)proteinuria,19 cases(36.54%)had elevated serum creatinine,and 22 cases(42.31%)with glomerular filtration rate decrease.The Renal biopsies’ s results in renal involvement group under light microscope showed:(1)the injury of the renal tubular,glomerular,renal interstitial and renal vessel can be exist alone or in combination.The main manifestation were renal tubular epithelial cell degeneration,tube type formation,inflammatory cell infiltration,glomerular hyperplasia,inflammatory cell infiltration,renal interstitial fibrosis,inflammatory cell infiltration,renal vessel vascular edema and fibrous thickening.(2)The results of immunohistochemistry was mainly the deposition of Ig M,Ig G,C3 and Ig A,of which 3 cases(25%)immunofluorescence was all negative.(3)The degree of macrophage infiltration was significantly increased in the renal tissue of patients with Sjogren’s syndrome.The results of binary Logistic regression analysis showed that the increase of Cys C,blood urea nitrogen,erythrocyte sedimentation rate and the decrease of serum potassium,Complement 3,immunoglobulin A,Creactive protein are the risk factors for whether p SS is associated with renal involvement.The ROC curve was used to analyze the predictive value of Cys C for the occurrence of adverse events,and the area under the curve was(AUC)=0.827,(95%CI:0.753~0.902)(P<0.01).It is found that Cys C has the predictive value for the patients who have p SS combined with renal damage.Conclusions:1.This case shows renal tubular acidosis as the main clinical manifestation in patients with renal involvement from p SS.It also illustrates glomerular impairment was common.2.The infiltration of macrophages in patientss combined p SS with renal involvement was significantly increased than normal kindey tissue,and macrophages may be involved in the occurrence and development of Sjogren’s syndrome with renal involvement.4.Cys C is the risk factors for p SS patients with renal involvement,and can be used as a predictor of whether p SS is associated with renal involvement.