Clinical Characteristics And Long-Term Outcomes In Lupus Nephritis Patients With Lupus Enteritis

Obejective:Lupus nephritis(LN)is a common manifestation of systemic lupus erythematosus(SLE)and an important factor leading to the poor prognosis in SLE.Lupus enteritis(LE)is a disease that SLE involved the gastrointestinal system.Clinically,it is often misdiagnosed as other intestinal diseases due to a lack of clinical features.LN patients with LE are more likely to be misdiagnosed,which affects the treatment and prognosis of LN.This study intends to analyze the epidemiology and clinical characteristics of LN patients with LE,the correlation between LN pathology and LE,and prognosis.Merhods:Patients with clinical and imaging conformity to LE were screened in the LN cohort of our center.The pathological type of LN was based on the ISN/RPS standard,and lupus podocytopathy was added.The patients undergoing renal biopsy were divided into the LN with LE group and the LN without LE group.The propensity score matching method was used to match the two groups 1:2 to explore the renal prognosis of the two groups.Class Ⅱ LN and lupus podocytopathy were classified as non-proliferative LN group,and ClassⅢ,Ⅳ,and Ⅴ+Ⅲ/Ⅳ were classified as proliferative LN group.The Kaplan-Meier survival curve was used to compare the difference in survival rates.Cox multivariate regression analysis was used to analyze the risk factors of progression in LN patients with LE.Results:Of the 3430 patients with LN admitted to our center from January 2010 to November 2019,90(2.6%)patients were diagnosed with LE.23 cases had identified the precipitating factor before the LE onset(11 patients had respiratory tract infection,10 cases related to diet).90 cases of LN with LE both clinical and serology showed lupus activity,and the SLEDAI-2K score was 11.71±4.87 when LE occurred.The main manifestations of LE were abdominal pain(80.0%),nausea and vomiting(67.8%),and diarrhea(64.4%).Other manifestations include abdominal distension(28.9%),hematemesis or melena(6.7%),and abnormal liver function(14.4%).The majority of 81 patients with abdominal CT prompt bowel wall edema(67.9%),thickening(79.0%),and intestinal cavity expansion(40.7%),ascites in 51 cases,12 patients of "Target sign".The hematologic(75.6%),heart disorders(11.1%),and neurological involvement(4.4%)were observed.And 26 patients were hydronephrosis and hydroureters concomitantly.The clinical features of LN were acute kidney injury and nephrotic syndrome in 23 cases(25.6%)and 24 cases(26.7%),respectively.Among the 2900 patients undergoing renal biopsies,73 cases were simultaneously diagnosed with LE.The incidence of LE in lupus podocytopathy(14.3%)and class II(11.8%)LN were higher than that in class V(2.6%)and proliferative LN(1.7%).The proportion of diarrhea(85.7%vs 54.1%,P=0.015),hydronephrosis and hydroureters(47.6%vs 16.2%,P=0.010),colon involvement(61.9%vs 35.1%,P=0.049)in the non-proliferative LN with LE group were significantly higher than the proliferative LN.After immunosuppressive therapy,88 patients were improved and 13 cases(14.4%)had LE recurrence.Comparing with the LN without LE group,the 5 yr patient(87.3%vs 95.5%,P<0.05)and renal survival rates(78.7%vs 90.8%,P<0.05)in LN with LE group(n=73)decreased significantly.And the 5 yr renal survival rate in the proliferative LN with LE group(59.7%)was significantly lower than that of the non-proliferative LN group(95.2%)and the class V LN group(100.0%,P<0.05).Cox multivariate analysis showed that gastrointestinal bleeding(HR=10.897,P<0.001),LN course(HR=8.257,P=0.001),renal insufficiency(HR=4.727,P=0.002),and cardiac insufficiency(HR=3.431,P=0.036)were independent risk factors affecting the renal prognosis of patients with LN and LE.Conclusions:2.6%of LN combined with LE.Lupus podocytopathy and class Ⅱ LN had a higher incidence of LE,which were characterized by diarrhea,hydronephrosis and hydroureters,and colon involvement.The renal survival rates in the proliferative LN with LE were significantly reduced.Gastrointestinal bleeding,LN course,cardiac and renal insufficiency were independent risk factors that affect the survival rate of LN with LE.