狼疮足细胞病伴发急性肾损伤的危险因素及预后分析

Risk factors and prognosis of acute kidney injury in patients with lupus podocytopathy

目的:分析合并急性肾损伤(AKI)的狼疮足细胞病患者临床病理特征和相关危险因素及其对肾脏预后的影响。方法:选取国家肾脏疾病临床研究中心经肾活检确诊为狼疮足细胞病患者90例,根据是否合并AKI分为AKI组和非AKI组。肾组织光镜、免疫荧光及电镜检查后进行肾小管间质急性损伤(ATI)和慢性损伤(CTI)半定量评分。肾脏终点包括终末期肾病或估算的肾小球滤过率(eGFR)较基线值下降>50%。结果:90例狼疮足细胞病患者中32例(35.6%)合并AKI。与非AKI组相比,AKI组患者尿蛋白量、尿N-乙酰-β-D-氨基葡萄糖苷酶和尿视黄醇结合蛋白、ATI评分及足突融合范围显著增高,血红蛋白、血清白蛋白、血清C3和C4水平显著降低(均P<0.05)。多因素分析显示,尿蛋白升高(OR=1.195,95%CI 1.015~1.408,P=0.033)、补体C3减低(OR=0.015,95%CI 0.001~0.225,P=0.002)是狼疮足细胞病患者发生AKI的独立危险因素。两组患者的完全肾脏缓解率无显著差异,中位随访67.1月,均无患者达到肾脏终点,AKI组肾脏复发的比例显著高于非AKI组(80.0%vs 50.0%,P=0.010)。结论:狼疮足细胞病患者AKI发生率高,高尿蛋白和低C3水平是发生AKI的独立危险因素;并发AKI患者的肾脏复发风险显著增加,对远期肾脏存活无显著影响。

Objective:We aimed to analyze the clinical-morphologic features of and risk factors for acute kidney injury(AKI) in patients with lupus podocytopathy, and to assess the impact of AKI on renal prognosis. Methodology:90 patients with lupus podocytopathy were included and divided into AKI group and non-AKI group. The kidney histological semi-quantitative scors of acute/chronic tubule-interstitial injury(ATI/CTI) were evaluated by light micnoscopy, immumofluore-scence and electron microscopy. Kidney endpoint included end-stage kidney disease, or a sustained decline in eGFR of at least 50%. Results:Among 90 lupus podocytopathy patients, 32 patients(35.6%) had AKI. Compared with patients in non-AKI group, patients in AKI group showed a significantly higher levels of urine protein, urine NAG, urine RBP, ATI score, and higher proportion of podocyte foot process effacement, but a significantly lower blood levels of hemoglobin, serum albumin, C3, and C4. Multivariate analysis indicated that high urine protein(OR=1.195, 95%CI 1.793~21.678, P=0.033), and low serum C3(OR=0.015, 95%CI 0.001~0.225, P=0.002) were two independent risk factors for AKI.There was no significant difference in the renal remission between two groups. None of patients reached the kidney endpoint during a median follow-up of 67.1 months, but patients in AKI group showed significantly higher kidney relapse rate than patients in non-AKI group(80.0% vs 50.0%, P=0.010). Conclusion:We found that patients with lupus podocytopathy had a high incidence of AKI, and that high proteinuria and low serum C3 level were risk factors for the development of AKI. AKI in lupus podocytopathy patients significantly increased the risk of kidney relapse but showed no effects on long-term renal survival.