Predicting outcomes of lupus nephritis with tubulointerstitial inflammation and scarring.
Predicting outcomes of lupus nephritis with tubulointerstitial inflammation and scarring.
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DOI：
10.1002/acr.20441
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发表时间：
2011-06
影响因子：
4.7
通讯作者：
Clark, Marcus R.
中科院分区：
文献类型：
--
作者：
Hsieh, Christine;Chang, Anthony;Brandt, Daniel;Guttikonda, Riteesha;Utset, Tammy O.;Clark, Marcus R.
在狼疮性肾炎中，肾小球损伤与进展为肾衰竭的相关性很差。虽然tubuloacetitium也是常见的参与，这种参与的重要性还没有得到很好的定义。因此，我们开发了一种简单的方法来评估测量肾小管间质炎症（TI）的预后效用。入选68例SLE合并狼疮性肾炎患者。通过抗CD45抗体染色和标准组织化学染色定量肾小管间质淋巴细胞浸润。获得随访数据并进行生存分析，以确定哪些组织学特征可预测随后的肾衰竭。通过CD45染色，TI是一种常见的病理学发现，72%的活检有中度或重度受累。TI的程度与血清肌酐相关，但与dsDNA抗体、血清C3或肾小球炎症无关。TI的严重程度，而不是肾小球损伤，确定患者的肾功能衰竭的风险更大（p=0.02）。高NIH慢性指数也确定患者有肾衰竭的风险。然而，当在双变量模型中将NIH慢性指数的肾小球和肾小管间质亚组分分开时，只有肾小管间质慢性提供了预后信息（HR 2.2，95% C.I. 1.3、3.6，p=0.002 vs. HR 1.0，95% CI。0.7，1.5。p=0.97（肾小球慢性化）。TI确定狼疮性肾炎患者进展为肾衰竭的风险最大。TI的免疫学机制可能为治疗干预提供新的靶点。
In lupus nephritis, glomerular injury correlates poorly with progression to renal failure. While the tubulointerstitium is also commonly involved, the importance of such involvement is not well defined. Therefore, we developed a simple method to assess the prognostic utility of measuring tubulointerstitial inflammation (TI). Sixty-eight SLE patients with lupus nephritis were enrolled. Tubulointerstitial lymphocytic infiltrates were quantitated both by anti-CD45 antibody staining and standard histochemical staining. Follow-up data was obtained and survival analysis carried out to determine which histologic features were predictive of subsequent renal failure. By CD45 staining TI was a common pathological finding, with 72% of biopsies having moderate or severe involvement. The extent of TI correlated with serum creatinine, but not with dsDNA antibodies, serum C3, or glomerular inflammation. TI severity, but not glomerular injury, identified patients at greater risk for renal failure (p=0.02). A high NIH chronicity index also identified patients at risk for renal failure. However, when the glomerular and tubulointerstitial subcomponents of the NIH chronicity index were separated in a bivariate model, only tubulointerstitial chronicity provided prognostic information (HR 2.2, 95% C.I. 1.3, 3.6, p=0.002 vs. HR 1.0, 95% C.I. 0.7, 1.5. p=0.97 for glomerular chronicity). TI identifies lupus nephritis patients at greatest risk for progression to renal failure. The immunological mechanisms underlying TI may provide novel targets for therapeutic intervention.
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影响因子：
19.6
作者：
Contreras, G.;Lenz, O.;Smith-Norwood, B.
通讯作者：
Smith-Norwood, B.
影响因子：
5.9
作者：
APPEL, GB;COHEN, DJ;ESTES, D
通讯作者：
ESTES, D
DOI：
10.4049/jimmunol.1001983
发表时间：
2011-02-01
期刊：
Journal of immunology (Baltimore, Md. : 1950)
影响因子：
--
作者：
Chang A;Henderson SG;Brandt D;Liu N;Guttikonda R;Hsieh C;Kaverina N;Utset TO;Meehan SM;Quigg RJ;Meffre E;Clark MR
通讯作者：
Clark MR
影响因子：
13.6
作者：
Appel, Gerald B.;Contreras, Gabriel;Wofsy, David
通讯作者：
Wofsy, David
影响因子：
13.2
作者：
BAKIR, AA;LEVY, PS;DUNEA, G
通讯作者：
DUNEA, G