The Analysis Of The Clinical Features And Prognosis In Patients With Lupus Nephritis Combined With Acute Renal Injury

Objective:To understand the clinical features and pathological characteristic in patients with lupus nephritis combined with acute renal injury,and to analysis the prognosis riskfactors in patients with lupus nephritis.Methods:This was a retrospective cohort study.The patients diagnosed with lupus nephritis from Ning Xia Medical university Hospital during the January 1^st,2008 and March30^st,2019.The patients with regular medical follow-up and complete date.The information of baseline demographic characteristics,laboratory and follow-up data were collected.According to the patients with and without AKI,the patients were divided into two groups（with AKI and with normal kidney function）,and followed up until June 30,2020.The primary end points was death and the second end points were end-stage renal disease,doubling of serum creatinine.The information of baseline demographic characteristics and pathologic data of two groups were compared,and risk factors afffecting renal prognosis of LN were analyzed by Cox regression.Results:1.276 patients with LN were included in this study,including 37 males（13.41%）,119 cases in patients with AKI（43.12%）,The average age was（36.73±12.21）years.During the follow up period of 276 patients,9 patients were lost to follow-up,the median follow-up time was（53.53±31.56）months,a total of 52 cases of 267 patients with endpoint events.2.In comparison with the normal kidney function group,patients with AKI had more male,higher proportions of fever,oral ulcers,edema,hematuria,musculoskeletal involved,cardiovascular involved.Lower hemoglobin,PLT,e GFR,total protein,albumin,triglycerides and complement C3.Higher urea nitrogen,creatinine,uric acid,24-hour urinary protein quantification,and lupus activity index Kaplan-meier survival analysis showed that the prognosis of LN patients combined with AKI was worse than the normal kidney function patients of LN.（log rank=94.475,P<0.05）.Multivariate COX regression analyses showed that combined with AKI,cardiovascular involved,neuropsychiatric involved and increased lupus activity index,decreased e GFR levels and baseline the level of 24-hour proteinuria>2g were independent risk factors for endpoint events in LN patients.3.This study consisted of 143 cases of LN confirmed by renal biopsy,including 16 male（11.19%）.In comparison with the the normal kidney function group,the pathologic type of IV more popular in LN with AKI（81.6%）,had higher AI index.Multivariate COX regression analyses showed that higher CI index was independent risk factors for endpoint events in biopsy-proven LN patients.4.According to the patients achieve and not-achieve end point event,the patients were divided into two groups,In comparison with not in the end point event group,patients in the end point group had shorter disease duration,higher proportions of AKI,hematologic involved,musculoskeletal involved,and cardiac involved;Higher serum urea nitrogen,creatinine,uric acid,complement C3 and lupus activity index.Lower levels of hemoglobin,PLT,e GFR.Conclusion:1.AKI is commonly clinical manifestation in LN,which is closely related to severity and the progress of LN disease.2.LN with AKI often occurs with the patients whose pathologic type is IV,and in patients with LN combined with AKI are more prone to present other system involvement,have more serious kidney injury or extrarenal injury.4.Acutekidney injury,cardiovascular system involved,neuropsychiatric involved and increased lupus activity index,baseline the level of 24-hour proteinuria>2g,decreased e GFR levels and CI index were independent risk predictors of LN patients receiving death or ESRD.Therefore,we must pay close attention to the patients with LN combined with baseline AKI.