The Relevant Discussion On Pathological Classification And Clinical Feature With Lupus Nephritis

Systemic lupus erythematosus (SLE)which shows unknown etiology is systemic autoimmune diseases accompanying multisystem involvement.SLE often involves the skin and mucous membranes, blood system, cardiovascular system, digestive system, nervous system, joints, kidneys and other body organs, causing various clinical manifestations.Lupus nephritis(LN)is the most common and serious clinical manifestations of SLE.LN impact on the prognosis of SLE. As different pathological types of Lupus nephritis, clinical manifestations and serological changesis different.So do treatment and prognosis.The clinical manifestations and pathological changes of LN is heterogeneity and diversity. Domestic and foreign scholars have done systematic studies on the relevation between pathological classification and clinical feature with lupus Nephritis and found their regularity. In this paper, we do a systematic study about the distribution of different pathological types, the relationship between different pathological types and a variety of extra-renal clinical manifestations (fever, skin lesions, oral ulcers, arthritis, serositis, liver damage, nervous system, high blood pressure) ,the relationship between different pathological types and the degree of renal disease, the relationship between a different pathological types and varieties of serum markers, to further explore the relationship between them, to improve the level of the disease's diagnosis and treatment.Objective:44 LN patients were included in this study,who choosed in the first clinical hospital of Jilin University from 2006 to 2010 . The purpose of this paper is to analyse the distrbitution,clinical manifestation,characteristics of laboratory examination and the relationship among them of different pathological types with LN by retrospectively reviewed,which had renal biopsy.Then we can understand the nature of LN further and provide better treatment for patients.Materials and Methods: Inclusion criteria:LN should meet the following three diagnosis. (1) LN's diagnosis must consistent with the diagnostic criteria for SLE which Rheumatology association formulated;(2) renal damage, cell type tubes, persistent proteinuria > 0.5 g/24h , mergeing with microscopically and(or) renal insufficiency; (3) excluding abnormal urine and kidney function by other diseases caused. Renal biopsy is examined by light microscopy, immunofluorescence (IF).According to the results of light microscopy, IF, combining with electron microscopy of renal tissue, and LN pathology classification scheme formulated by the 2003 International renal pathology, LN was categorized by I,II,III,IV,V,VI.The combined class of IV or III and V were recorded as IV+V or III+v. As follows, Mild mesangial lupus nephritis (I),Mesangial proliferative lupus nephritis(II), Focal segmental proliferative lupus nephritis(III), Diffuse proliferative lupus nephritis(IV), Membranous lupus nephritis(V), Severe sclerosing lupus nephritis(VI). IV with diffuse membrane lesion was recorded as IV+V. V with segmental glomerular proliferative lesions which is less than 50% was recorded as III+V. To observe:(1), What are ages and pathogenesises of male and female SLE patients respectively? whether age between male and female SLE patients has difference? (2), What are distributions of different pathological types? (3).What are the incidences of clinical manifestations of different pathological types? Whether the incidences of clinical manifestations of different pathological types have differences? (4).What are the incidences of renal impairment of different pathological types? Whether the incidences of renal impairment of different pathological types have differences? (5).What are the incidences of laboratory examination of different pathological types(such as microscopic hematuria, the decrease of hemoglobin,s amount, the decrease of leukopenia,s amount, the decrease of thrombocyt- openia,s amount, renal dysfunction, the decrease of C3 amount, the decrease of C4 amount)? Whether the incidences of laboratory examination of different pathological types have differences? (6).What are the variation of quantitative of 24-hour urine protein and serum albumin in different pathological types? Whether the variations have differences?Results:(1) 38 female patients(86.4%) ,age of onset in 13-76 years old,with an average of 32.50±5.25 .6 males(13.6%),age of onset in17-40 years old,with an average of 26.50±10.08 .Men and women with a ratio of 1:6.3 .The average onset age of male patients is the same as the female.(P=0.448>0.05 )(2) The renal pathological classes showed class IV(50%), III(25%), V(11.3%), II(9.1%), IV+V(2.3%), and III+V(2.3%). The most common pathological class was IV, followed by III.(3) Liver damage, nervous system damage were common in class IV, there is difference. (4) There are microscopic hematuria, the decrease of hemoglobin,s amount, the decrease of leukopenia,s amount, the decrease of thrombocytopenia,s amount, renal dysfunction in different pathological types. There is no difference.(5) 24-hour urine protein of class IV, V LN were higher than class II, III LN, while plasma albumin level of class IV,V LN were lower than other classes.There is difference.(6) Mild renal impairment were common in class II,III LN,nephritic syndrome were common in class IV,V LN.There is difference.Conclusions:(1) The class IV LN(50%) is the most common pathological type,and the onset age of male patients is the same as female.(2) Liver damage,nervous system damage were commom in class IV.(3) 24-hour urine protein of class IV, V LN were higher than class II, III LN, while plasma albumin level of class IV,V LN were lower than other classes.(4) Mild renal impairment were common in class II,III LN,nephritic syndrome were common in class IV,V LN.(5) For the atypical LN patients,we should combine the clinical manifestations with immunological tests and give the renal biopsy .This is very useful to improve the accuracy of clinical diagnosis and treatments.