Clinical And Pathological Analysis Of Lupus Nephritis Complicated With Infection

Objectives:To retrospectively analyze the clinical and pathological characteristics of lupus nephritis(LN)patients complicated with infection in different treatment periods,and to provide basis for the treatment and improvement of prognosis of LN patients.Methods:Choose the patients with LN who were admitted to the Second Hospital of Jilin University from September 2010 to September 2020 and met the diagnostic criteria of systemic lupus erythematosus(SLE)established by the American College of Rheumatology(ACR)in 1997,and who were confirmed by renal biopsy pathology in the nephropathy department of our hospital and met the screening criteria.According to the treatment period,it can be divided into pre-treatment period(before the application of glucocorticoid or immunosuppressant therapy),induction period(6 months before the initial application of glucocorticoid or immunosuppressant therapy,the first 6 months after the change of treatment regimen)and maintenance period(6months after the application of glucocorticoid or immunosuppressant therapy).According to whether they were co-infected,they were divided into infected group and non-infected group.The hospitalization information at the time of renal biopsy was collected,including general data,laboratory data,pathological data,infection status,treatment plan,and prognosis.Use the statistical software SPSS 24.0 to analyze the collected data and compare the differences between the infected group and the non-infected group in different treatment periods.Results:1.After screening by inclusion and exclusion criteria,a total of 271 patients with LN were collected.In the pre-treatment period,there were 155 patients,including 116 patients in the infection group.There were 73 patients in the induction period,including 50 in the infection group.There were 43 patients in the maintenance period,including 21 patients in the infection group.The infection rates in three treatment periods were 42.80%,18.45% and 7.75%,respectively.This suggests that the disease itself is susceptible to infection before glucocorticoid or immunosuppressant therapy is applied to LN patients.2.In the pre-treatment period,compared with the non-infected group,the infected group had higher white blood cell count and C-reactive protein(p <0.05),and lower red blood cell count,erythrocyte sedimentation rate /C-reactive protein and immunoglobulin M(p <0.05).In the pre-treatment period,there was no statistical difference in renal pathological types and immunofluorescence between the two groups(p >0.05),in terms of pathological changes,the formation of crescent was more in the infection group before treatment(p < 0.05).In the pre-treatment period,the main infected sites were lung(40.52%),urinary system(28.45%)and lung + urinary system(18.97%),and the main pathogens of infection were Gram-negative bacteria(54.55%)and fungi(31.82%),the pulmonary infection was mainly caused by fungi(candida albicans),and the urinary infection was mainly caused by gram-negative bacteria(escherichia coli).3.In the induction period,compared with the non-infected group,the infected group had longer hospital stay,higher serum creatinine and SLEDAI score(p <0.05),and lower white blood cell count,blood lymphocyte count,red blood cell count,hemoglobin content,platelet count,blood albumin and complement C3(p <0.05).There was no statistical difference in renal pathological types and immunofluorescence between the two groups during the induction period(p >0.05),in terms of pathological changes,renal interstitial inflammatory cell infiltration was more and activity index(AI)was higher in infected group(p < 0.05).In the induction period infection group,the main infection sites were lung(46.00%),lung + urinary system(20.00%)and urinary system(18.00%),and the main pathogens of infection were Gram-negative bacteria(54.55%)and fungi(31.82%),the pulmonary infection was mainly caused by fungi(candida albicans),and the urinary infection was mainly caused by gram-negative bacteria(escherichia coli).The infection rates of two or more immunosuppressive regimens and glucocorticoid shock +glucocorticoid + cyclophosphamide regimens were 85.71% and 77.78%,respectively.4.In the maintenance period,compared with the non-infected group,the infected group had longer hospital stay,higher serum creatinine、blood uric acid and C-reactive protein(p <0.05),and lower blood lymphocyte count,red blood cell count,serum albumin and immunoglobulin A(p <0.05).There was no statistical difference in renal pathological types and immunofluorescence between the two groups during maintenance period(p >0.05),in terms of pathological changes,crescent formation,loop necrosis,more proliferation of glomerular endothelial cells and higher activity index(AI)were observed in the infection group(p < 0.05).In the maintenance period infection group,the main infection sites were lung(47.62%)and urinary system(28.57%),and the pathogens of infection were Gram-negative bacteria and fungi.The infection rate of glucocorticoid + cyclophosphamide was the highest,which was 66.67%.5.In the patients with LN complicated with infection,181 patients improved and were discharged from hospital,4 patients died,and 2patients refused treatment and were discharged voluntarily.Among the deaths,two patients had pulmonary infection and two patients had pulmonary infection with urinary tract infection.Conclusions:1.The highest infection rate in the pre-treatment period indicates that LN itself is prone to infection.2.More crescent bodies were formed in the infection group in the pre-treatment period.In the induction period infection group,the infiltration of renal interstitial inflammatory cells was more and the AI was higher.In the maintenance period infection group,crescent formation,loop necrosis,proliferation of glomerular endothelial cells were more,and AI was higher.3.In the infection group at different treatment periods,most of the infected sites were in the lungs and urinary system,and the main pathogens of infection were Gram-negative bacteria and fungi.4.The infection rate of two or more immunosuppressant regiments and glucocorticoid shock + glucocorticoid + cyclophosphamide regimen during induction period was higher,and that of glucocorticoid +cyclophosphamide regimen during maintenance period was the highest.