Relationship Between Vascular Lesions And Clinical And Prognostic Outcomes In Patients With Lupus Nephritis

Objective: To understand the incidence of vascular lesions in patients with lupus nephritis and proliferative lupus nephritis,to explore the relationship between vascular lesions and clinicopathology in patients with LN,and to further explore whether vascular lesions and their severity are related to LN,especially the progression of proliferative LN to ESRD and death,so as to provide a possible theoretical basis for delaying the progression of LN.Methods: From September 1,2008 to October 31,2021,225 patients with LN who underwent renal biopsy in the Department of Nephrology,General Hospital of Ning Xia Medical University were retrospectively analyzed.They met the LN diagnostic criteria revised by the American Society of Rheumatology(ACR)in 2012.They were divided into no vascular disease group and vascular disease group according to the severity of vascular disease under light microscope.The patients with vascular disease were divided into mild vascular disease group,moderate vascular disease group and severe vascular disease group.The grouping method of 156 patients with proliferative LN was the same as above.To compare the clinical,laboratory and pathological characteristics of renal biopsy baseline in four groups of LN patients,and to further explore the risk factors affecting the prognosis of LN patients.Results1.A total of 225 patients with lupus nephritis met the inclusion and exclusion criteria,including 197 females(87.56%),with a male-to-female ratio of 7.04.The average age at the time of renal biopsy was(35.61±12.01)years.101 cases(44.89%)were complicated with vascular lesions,including 72 cases(71.29%)in mild vascular disease group and 17 cases(16.83%)in moderate vascular disease group.There were 12 cases(11.88%)in severe vascular disease group and 124 cases(55.11%)in non-vascular disease group.2.Compared with non-angiopathy group,LN patients with angiopathy were older,complicated with sphenoid erythema,oral ulcer,alopecia,neuropsychiatric involvement,proportion of hypertension,SLEDAI score,serum creatinine,urea,uric acid,CRP,CI,TIN total score was higher,SLE course was longer and e GFR was lower at renal biopsy.3.The results of multi-group comparison showed that there were significant differences in the incidence and age of butterfly erythema,alopecia,arthritis,hypertension,SLEDIA score,SLE course at biopsy,renal function,uric acid,triglyceride,CRP,CI score and total score of TIN lesion between different severity vascular disease group and non-vascular disease group.The incidence of arthritis in mild vascular disease group was the highest,the incidence of butterfly erythema,SLEDIA score,serum creatinine and uric acid in moderate vascular disease group was the highest,and e GFR was the lowest.In severe vascular disease group,the incidence of alopecia and hypertension,CRP,CI score and total score of TIN lesion were the highest,SLE course was the longest and age was the oldest,and triglyceride was the lowest in severe vascular disease group.4.During the median follow-up period(57.52 ±43.45)months,7 patients lost follow-up and 46 patients had endpoint events,including 13 deaths and 33 compound endpoint events.There were 26 cases of end point events in the group with vascular disease and 20 cases in the group without vascular disease.Compared with the group without vascular disease,the proportion of end point events in the group with vascular disease was higher,but the difference was not statistically significant(P > 0.05).5.Kaplan-Meier survival analysis: compared with the non-vascular disease group,the renal survival rate in the vascular disease group was lower and the risk of renal complex end point was higher.The results of intergroup comparison showed that compared with the non-vascular disease group,the renal survival rate was lower in mild vascular disease group,moderate vascular disease group and severe vascular disease group.Vascular injury,acute renal injury and longer course of SLE at biopsy were independent risk factors for end-point events in patients with LN.6.The proportion of proliferative LN patients with vascular lesions was higher than that of total LN patients with vascular lesions.Compared with the group without vascular disease,the patients with proliferative LN with vascular disease had worse clinical and pathological manifestations,lower renal survival rate and higher risk of end point events.Conclusion:1.In this group of LN patients,vascular lesions accounted for 44.89%,of which the incidence of mild vascular disease group was higher,accounting for 71.29%.2.Compared with the group without vascular disease,the renal survival rate in the group with vascular disease was lower,and decreased with the increase of the degree of vascular disease.It is suggested that vascular lesions and the degree of vascular lesions in LN are closely related to the prognosis of kidney.Vascular disease,acute renal injury and longer course of SLE during renal biopsy were independent risk factors for end-point events in patients with LN.3.The proportion of proliferative LN patients with angiopathy was higher.Compared with the non-angiopathy group,the patients with proliferative LN with angiopathy had worse clinical and pathological manifestations,lower renal survival rate and higher risk of end point events.