Association of explanatory histological findings and urinary protein and serum creatinine levels at renal biopsy in lupus nephritis: a cross-sectional study
Association of explanatory histological findings and urinary protein and serum creatinine levels at renal biopsy in lupus nephritis: a cross-sectional study
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DOI：
10.1186/s12882-020-01868-9
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发表时间：
2020-06-01
期刊：
影响因子：
2.3
通讯作者：
Wada, Jun
中科院分区：
文献类型：
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作者：
Katsuyama, Eri;Miyawaki, Yoshia;Wada, Jun
本研究的目的是评估活动性和慢性病变的组织学与尿蛋白和血清肌酐（SCr）水平之间的关系，作为狼疮性肾炎（LN）临床试验中的常见临床终点。方法1990年至2015年期间，共有119例诊断为LN III、IV和V级（由国际肾脏病学会/肾脏病理学会定义）的患者入选本研究。进行多元回归分析，以探索与尿蛋白和SCr水平相关的半定量组织学变量。结果入选患者平均年龄45岁，79%为女性。肾活检时的平均SCr和平均尿蛋白水平分别为0.87 mg/dl和3.00 g/gCr。IV级（71%）是最常见的LN类型，其次是III级（17%）和V级（13%）。证实了单细胞浸润（方差膨胀因子[VIF] = 10.22）和间质纤维化（VIF = 10.29）之间以及核破裂（VIF = 4.14）和纤维素样坏死（VIF = 4.29）之间的多重共线性。随后排除纤维蛋白样坏死和单细胞浸润，多元回归分析显示，只有尿蛋白水平与线环病变相关（β系数[beta]：1.09，置信区间[CI]：0.35 - 1.83），SCr水平与肾小球硬化相关（β：1.08，CI：0.43 - 1.74）。结论由于尿蛋白和SCr水平与活动性病变无定量相关性，它们可能不能准确反映LN患者诱导缓解治疗的反应。
Background The aim of the present study was to evaluate the association between the histology of active and chronic lesions and urinary protein and serum creatinine (SCr) levels, as common clinical endpoints in clinical trials for lupus nephritis (LN). Methods In total, 119 patients diagnosed with LN class III, IV, and V, as defined by the International Society of Nephrology/Renal Pathology Society, between 1990 and 2015, were enrolled in the present study. Multiple regression analysis was performed to explore semi-quantitative histological variables associated with urinary protein and SCr levels. Results The mean age of the enrolled patients was 45 years, and 79% were female. The mean SCr and mean urinary protein levels at the time of renal biopsy were 0.87 mg/dl and 3.00 g/gCr, respectively. Class IV (71%) was the most common type of LN followed by class III (17%), and class V (13%). Multicollinearity was confirmed between monocellular infiltration (variance inflation factor [VIF] = 10.22) and interstitial fibrosis (VIF = 10.29), and between karyorrhexis (VIF = 4.14) and fibrinoid necrosis (VIF = 4.29). Fibrinoid necrosis and monocellular infiltration were subsequently excluded, and multiple regression analysis revealed that only the urinary protein level was correlated with wire loop lesions (beta-coefficient [beta]: 1.09 and confidence interval [CI]: 0.35 to 1.83), and that the SCr level was correlated with glomerular sclerosis (beta: 1.08 and CI: 0.43 to 1.74). Conclusion As urinary protein and SCr levels were not quantitatively associated with active lesions, they may not accurately reflect the response to remission induction therapy in patients with LN.