The value of early renal biopsy in systemic lupus erythematosus patients presenting with renal involvement
The value of early renal biopsy in systemic lupus erythematosus patients presenting with renal involvement
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DOI：
10.5414/cn107094
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发表时间：
2012-01-01
影响因子：
1.1
通讯作者：
Chen, Moi L.
中科院分区：
文献类型：
--
作者：
Hsieh, Yao P.;Wen, Yao K.;Chen, Moi L.
背景资料：本研究的目的是确定早期肾活检的价值，作为系统性红斑狼疮（S LE）患者肾脏受累的治疗指导。研究方法：我们回顾性分析了2000年1月至2009年12月间在台湾某医学中心就诊的SLE患者的肾活检结果。纳入本研究的另一个标准是在首次检测到肾脏疾病体征后3个月内进行肾活检。结果：共有131例患者入组本研究。在急性肾衰竭患者中，91%的患者患有增生性狼疮肾炎（IV级，混合V+III级），9%的患者患有非增生性狼疮肾病（纯V级）。在表现为肾病范围蛋白尿的患者中，增殖性狼疮肾炎（III级、IV级、混合V+III级）和非增殖性狼疮肾病（II级、纯V级）分别占55%和36%; 9%的患者患有非狼疮肾病。在该组中，除了抗双链DNA抗体水平升高在增生性狼疮肾炎中更常见（p = 0.043）外，没有临床发现可以预测肾脏形态。在表现为亚肾病蛋白尿的患者中，49%的患者患有增生性狼疮性肾炎（III级、IV级、混合V+III级），51%的患者患有非增生性狼疮性肾病（II级、纯V级），C4水平降低在增生性狼疮性肾炎患者中更常见（p = 0.031）。在表现为孤立性血尿的患者中，所有患者都不是活动性肾病。29%的急性肾功能衰竭患者、43%的肾病范围蛋白尿患者和53%的亚肾病蛋白尿患者因活检结果而加强免疫抑制治疗。结论：我们的数据表明，相似的临床肾脏表现可能会被观察到，尽管非常不同类别的狼疮性肾炎。临床医生倾向于等待组织学鉴定的严重狼疮性肾炎之前，开始潜在的有害治疗与积极的免疫抑制治疗。因此，在有肾脏疾病临床体征的SUE患者中，早期肾活检可能有助于计划治疗。
Background: The goal of this study is to determine the value of early renal biopsy as a therapeutic guide in systemic lupus erythematosus (S LE) patients presenting with renal involvement. Methods: We retrospectively analyzed renal biopsies findings in SLE patients between January 2000 and December 2009 encountered at a medical center in Taiwan. An additional criterion for inclusion in this study was kidney biopsy done within 3 months of the first detection of sign(s) of renal disease. Results: There were 131 patients enrolled in this study. In patients presenting with acute renal failure, 91% of patients had proliferative lupus nephritis (Class IV, mixed Class V+III) and 9% had non-proliferative lupus nephropathy (pure Class V). In patients presenting with nephrotic range proteinuria, proliferative lupus nephritis (Class III, IV, mixed Class V+III) and non-proliferative lupus nephropathy (Class II, pure Class V) accounted for 55% and 36% of patients, respectively; and 9% had non-lupus nephropathy. In this group, except that elevated anti-double-stranded DNA antibody levels were more common in proliferative lupus nephritis (p = 0.043), no clinical findings could predict the renal morphology. In patients presenting with sub-nephrotic proteinuria, 49% of patients had proliferative lupus nephritis (Class III, IV, mixed Class V+III) and 51% had non-proliferative lupus nephropathy (Class II, pure Class V), and decreased C4 levels were more common in patients with proliferative lupus nephritis (p = 0.031). In patients presenting with isolated hematuria, all were not active forms of nephropathy. Immunosuppressive therapy was intensified because of biopsy findings in 29% of patients presenting with acute renal failure, 43% with nephrotic range proteinuria, and 53% with sub-nephrotic proteinuria. Conclusions: Our data suggested that similar clinical renal manifestations may be observed despite very different classes of lupus nephritis. Clinicians tended to wait for histological identification of severe lupus nephritis before initiating potential harmful treatment with aggressive immunosuppressive therapy. Therefore, in SUE patients with clinical sign(s) of renal disease, early renal biopsy may be helpful in planning treatment.