The Clinicopathological Analysis Of Male Lupus Nephritis

Background and ObjectiveSystemic lupus erythematosus(SLE) is a chronic inflammatory connective tissue disease characterized by the mediation of autoimmune and the deposition of immune complexes in various tissues. Many kinds of autoantibodies can be detected in the serum of SLE patients, such as antinuclear antibody (ANA), antidouble strained DNA antibody, antiextractable nuclear antigen antibody and so on. It has a high rate of occurrence in young women and1:8～1:10F:M ratio.It always invades many organs and multiple systems in body, and the clinical manifestations varies.At present, some genetic, environmental, immunologic, hormonal factors and some drugs are thought to be the main pathogenic agents for SLE.As we know, genes in susceptibility to SLE are the basement to generate SLE, and infectious agents and various toxin may act as a trigger mechanism for the development of SLE.The disorder of immunologic tolerance,polyclonal self-activation lymphocyte or abnormal apoptosis and the production of autoantibody play a pivotal role in the development of SLE. It often involves the kindey, and the kindey damage is the major factor which can influence the prognosis.In recent years, with the medical staff continuously exploring and the advancement of the immune technology, the pathogenesis of SLE and autoantibody pathogenicity are gradually being cognized by human. At the same time, the prognosis of SLE has been improved significantly by the way of early diagnosis and some effective combination therapy, which based on glucocorticoid, antimalarial and immunosuppressive agents. It had been found in some small-sample retrospectively study that the reason of the high incidence of fallibility and misdiagnosis were the lack of specific symptoms in early stage of disease,and the low morbidity of male SLE, a common set of views.In clinic, we should pay special attention to male SLE patients because they also have the features of severe illness status and rapid progress that the study had confirmed previously. This paper summarizes the clinical manifestation, laboratory examination, renal pathological data of the108male (lupus nephritis(LN) patients who were treated in the department of nephrology and rheumatology of the First Affiliated Hospital of Zhengzhou University in recent7years, making the clinicalopathological features explicit, so as to improve the early diagnosis rate and the long-term prognosis.MethodsWe analyzed retrospectively the general information, clinical features, laboratory examination,renal pathology, SLE Disease Activity Index (SLEDAI) of108male LN patients diagnosed by renal biopsy who were treated in the First Affiliated Hospital of Zhengzhou University from2004April to2011April,compared with another924female patients registered during the same period.ResultsGender ratio was1:8.56,108male patients ranged from8to68years old and924female ones ranged from2to68years old, the onset age of LN and disease duration between sexes were not significantly different; the thrombocytopenia and the positivity of antidsDNA antibody were more obvious in male patients (P<0.05), whereas the female ones had more prevalence of hair loss,Raynaud’phenomenon, antinRNP antibody(P<0.05);male patients presented more frequently with latent glomerulonephritis and renal dysfunction (P<0.05),while the female ones presented more with nephritis syndrome (P<0.05),though both the two groups had no differences in nephrotic syndrome; lupus nephritis class IV was the most common class in this study,but the proportion between sexes had no statistical differences,the proportion of class IV+V in male were higher than that in female (P<0.05), while class II and V were the opposite (P<0.05). As for the pathology, the activity index(AI) was higher in male patients than the female ones (P<0.05),but no differences of the chronic index(CI) and SLEDAI were found between the two groups.Conclusions1.The characteristics of clinical manifestation and laboratory findings of male LN patients were unique. It was difficult to diagnose at early stage, because the clinical features which didn’t include the renal manifestations were relatively dormant.2.While the thrombocytopenia occurred frequently and the renal injury was relatively severe indicated the prognosis was poor. Thus, It should be aware that the early diagnosis and active treatment are essential for male LN patients.