Clinical And Pathological Analysis Of1032Cases With Lupus Nephritis

Background and ObjectiveLupus nephritis (LN) is the most common and serious clinical manifestations ofsystemic lupus erythematosus (SLE), and also one of the most common secondaryglomerulonephritis. LN has a great influence on the prognosis of SLE. And renaldysfunction is one of the major causes of death of SLE. As the clinical manifestationsand pathological changes of LN are heterogeneity and diversity, renal biopsy isessential in establishing treatment regimen and determining the prognosis of SLE. Ithas been shown that LN was variable in different countries and regions. Our studywas aimed to analyze the clinical and pathological characteristics of1032LN patientsin Henan province.Materials and Methods1032LN patients were included in this study，who visited the department ofnephrology of the First Affiliated Hospital of Zhengzhou University from January2003to March2012. All the patients received renal biopsy. Clinical data werecollected from the history records. The histological classifications were categorizedaccording to2003ISN/RPS classification, and the AI, CI and SLEDAI werecalculated. We retrospectively analyzed the general characteristics, pathological types, clinical and immunology characteristics and then drew a conclusion by statisticalanalysis.Results1. General information:1032patients were enrolled in this study, of which therewere924female patients（89.5%） and108male patients（10.5%）. The male andfemale ratio was1:8.6. The age of onset was ranged from6to68years old，with anaverage age of30.20±11.55years old.2. The distribution of different age groups:≤20years:32male patients,165femalepatients;20～29years:28male patients,318female patients;30～39years:23malepatients,234female patients;40～49years:16male patients,159female patients;50～59years:5male patients,36female patients;≥60years:4male patients,12female patients; In≤20years group, the percentage of male patients was significantlyhigher than female (29.6%vs17.9%，P<0.01), there were no significant differencesin other groups(P>0.05).3. The distribution of pathological types: typeⅠ:16patients (1.6%), Type Ⅱ:127patients (12.3%), type Ⅲ:160patients (15.5%), type Ⅳ:322patients (31.2%), typeⅤ:133patients (12.9%), type Ⅵ:2patients (0.2%), type Ⅲ+Ⅴ:97patients (9.4%),type Ⅳ+Ⅴ:175patients (17.0%). The most common pathological type in Henan LNpatients was proliferative LN. 4. Outer renal symptoms: the most common manifestations were: anemia691patients (67%), fever498patients (48.3%), facial erythema450patients (43.6%),arthritis378patients (36.6%).5. Clinical manifestation of renal: latent nephritis151patients (14.6%), nephritissyndrome390patients (37.8%), nephrotic syndrome438patients (42.4%), Renalfailure141patients (13.7%).6. The association of Clinical manifestations and pathological types:(1) Outerrenal symptoms: facial erythema was most common in type Ⅱ(54.3%), and arthritiswas most common in type Ⅲ(49.4%), and anemia was most often found in typeⅣ(81.7%);(2) manifestation of renal: latent nephritis was most commonly seen intpye Ⅱ(38.6%), nephritis syndrome was most commonly occured in type Ⅲ(56.9%),nephrotic syndrome was most common in type Ⅳ(55.3%), typeⅤ(55.6%), typeⅣ+Ⅴ(61.1%).7. The association of antibodies and pathological types: The positive rates of anti-ds-DNA antibody and anti-Nuc antibody in type Ⅳ of LN was80.1%,25.2%,respectively, and were significantly higher than those of other pathological types (P＜0.05).8. The association of active index and pathological types: AI was lowest in typeⅡ(1.72±0.95) and highest in type Ⅳ(7.44±1.16), there were significant differencebetween groups(P＜0.05). CI was lowest in type Ⅱ(0.75±1.16) and highest in typeⅣ+Ⅴ(2.15±1.59)(P＜0.05); SLEDAI was lowest in type Ⅱ(13.97±5.53) andhighest in type Ⅲ (17.48±6.44)(P＜0.05).Conclusions 1. The age of disease onset of male patients is ahead of female patients;2. The most common pathological type in Henan LN patients was proliferative LN.3. There are associations between Clinical manifestations and pathological types. Incombination with clinical and pathology is essential to guide treatment.