Remission of lupus nephritis: the trajectory of histological response in successfully treated patients.
Remission of lupus nephritis: the trajectory of histological response in successfully treated patients.
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DOI：
10.1136/lupus-2023-000932
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发表时间：
2023-05
影响因子：
3.9
通讯作者：
中科院分区：
文献类型：
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这项研究调查了接受免疫抑制治疗的狼疮性肾炎(LN)患者随时间的肾脏组织学变化。对增生性±膜性 LN患者进行了研究。在诊断性肾活检(Bx1)后，患者在9(6-15)个月时进行方案活组织检查2(Bx2)，在42(28-67)月时进行方案活组织检查3(Bx3)。测定肾脏组织学活动度和慢性指数(AI、CI)。AI呈双相下降，在Bx1和Bx2之间快速下降，然后在Bx2和Bx3之间下降得更慢。患者被分为在Bx3达到组织学缓解定义为AI=0的患者(组1)和在Bx3持续组织学活动(AI>；0)的患者(组2)。AI早期下降，第1组为第2组的1.6倍(95%可信区间1.30，1.91)(p=0.01)。在Bx2和Bx3之间，组1的AI下降是组2的2.19倍(95% CI 2.09，2.29)(p=7.34×10−5)。AI的各个组织学部分以不同的速度消失。Bx2组肾小球新月体、核破裂、坏死等炎性病变基本消失，而毛细血管内高细胞增多、内皮下透明沉积和间质炎症消退较慢，占活检3时残留的组织学活动。相反，CI迅速增加，在Bx1和Bx2之间增加0.15单位/月，然后趋于平稳。CI的增加与Bx1的肾小球新月体严重程度(p=0.044)、内皮下透明沉积(p=0.002)和间质炎症(p=0.015)显著相关。组织学活动需要几个月到几年的时间才能解决，这为需要长期、耐受性良好的维持免疫抑制提供了理论基础。尽管有反应，LN肾脏在治疗过程中早期就会出现慢性损害。这一发现为慢性进行性肾病与LN反复发作之间的关系提供了一个解释。
This study investigated changes in kidney histology over time in patients with lupus nephritis (LN) undergoing immunosuppressive treatment. Patients with proliferative±membranous LN were studied. After a diagnostic kidney biopsy (Bx1), patients had protocol biopsy 2 (Bx2) at 9 (6–15) months and protocol biopsy 3 (Bx3) at 42 (28–67) months. Kidney histological activity and chronicity indices (AI, CI) were measured. AI declined in a biphasic fashion, falling rapidly between Bx1 and Bx2 and then more slowly between Bx2 and Bx3. Patients were divided into those who achieved histological remission, defined as an AI=0 at Bx3 (group 1), and those with persistent histological activity (AI >0) at Bx3 (group 2). The early decline in AI was 1.6 times greater (95% CI 1.30, 1.91) in group 1 than group 2 (p=0.01). Between Bx2 and Bx3, the AI decline was 2.19-fold greater (95% CI 2.09, 2.29) in group 1 versus group 2 (p=7.34×10−5). Individual histological components of the AI resolved at different rates. Inflammatory lesions like glomerular crescents, karyorrhexis and necrosis mostly resolved by Bx2, whereas endocapillary hypercellularity, subendothelial hyaline deposits and interstitial inflammation resolved slowly, accounting for residual histological activity at biopsy 3 in group 2. In contrast, CI increased rapidly, by 0.15 units/month between Bx1 and Bx2, then plateaued. There were no differences in the rate of accumulation of chronic damage between group 1 and group 2. The increase in CI was significantly related to the severity of glomerular crescents (p=0.044), subendothelial hyaline deposits (p=0.002) and interstitial inflammation (p=0.015) at Bx1. LN histological activity takes months to years to resolve, providing a rationale for the need of long-term, well-tolerated maintenance immunosuppression. Despite responding, LN kidneys accrue chronic damage early during treatment. This finding provides an explanation for the association of chronic progressive kidney disease with recurrent episodes of LN.
影响因子：
6.2
作者：
Enfrein, Antoine;Pirson, Valerie;Le Guern, Veronique;Karras, Adexandre;Tamirou, Farah;Costedoat-Chalumeau, Nathalie;Houssiau, Frederic
通讯作者：
Houssiau, Frederic