Risk Factors Of Renal Insufficiency In Lupus Nephritis

Objectives:To explore the associated risk factors of renal insufficiency in lupus nephritis.Methods:The Clinical data of 98 patients with lupus nephritis who undergone a renal biopsy from January 1,2008 to July 31,2018 in the department of nephrology or rheumatology of the Second Affiliated hospital of the Second Affiliated hospital of Zhejiang University School of Medicine was collected.All subjects fulfilled four or more of the 1997American College of Rheumatology(ACR)classification criteria for systemic lupus erythematosus.Renal insufficiency was defined when glomerular filtration rate eGFR<60ml/min.We analyzed and summarized the statistical differences between the patients with renal insufficiency and those without renal insufficiency among the common records,clinical presentations,laboratory indices and pathology-related manifestations.Results:l.The incidence of renal insufficiency in patients with lupus nephritis was 24.5%.2.Univariate analysis:2.1 The proportion of males in patients with renal insufficiency was higher than that in patients without renal insufficiency,which was statistically significant(P<0.05).2.2 The incidence rate of thrombocytopenia and serositis in patients with renal insufficiency was higher than that in patients without renal insufficiency,which was statistically significant(P<0.05).2.3 The SLEDAI score of patients with renal insufficiency was significantly higher than that without renal insufficiency(11.7±2.8 versus 9.7±3.8,P<0.05).2.4 The incidence rate of hematuria and leucocyturia in patients with renal insufficiency was significantly higher than that in patients without renal insufficiency(P<0.05).2.5 The proportion of patients with pathological classifications of type IV or type IV+V in patients with renal insufficiency was higher than that in patients without renal insufficiency,which was statistically significant(P<0.05).2.6 The pathological activity index in patients with renal insufficiency was significantly higher than that in patients without renal insufficiency(10.6±6.0 vs 5.4±4.4,P<0.05).Moreover,the chronicity index of patients with renal insufficiency is significantly higher than that without renal insufficiency(2.8±2.3 vs 0.6±0.9,P<0.05).3.Multivariate analysis:Thrombocytopenia(OR 18.613,95%CI 1.776-195.076),serositis(OR 20.873,95%CI 3.293-132.317),and leucocyturia(OR=5.007,95%CI 1.197-20.943)wereindependent risk factors for renal insufficiency in lupus nephritis.4.Correlation analysis between eGRF and the occurrence of thrombocytopenia,serositis and pyuria:The occurrence of thrombocytopenia was negatively correlated with eGFR(r=-0.261,P=0.009).The occurrence of serositis was negatively correlated with eGFR(r=-0.391,P<0.001).The occurrence of leucocyturia was negatively correlated with eGFR(r=-0.259,P=0.010).Conclusion:1.Patients with lupus nephritis are prone to suffering renal insufficiency.2.Thrombocytopenia,serositis,and leucocyturia are the independent risk factors for renal insufficiency in lupus nephrotic patients,possibly predicting that patients suffering thrombocytopenia,serositis,or leucocyturia might be accompanied by renal insufficiency.