| Objective: Systemic lupus erythematosus(SLE)is a multisystem autoimmune disease.It has a wide spectrum of clinical manifestations.Its characteristic is can be detected a variety of auto-antibodies(e.g.antinuclear antibodies,etc.)and immunological abnormalities in serum of the patients.In the 13 th century,Rogerius Frugard offered to the term “lupus” describe the erosion of facial skin ulcer.In 1872,Mortertz Kaposi first describes the systemic characteristics of SLE.With the deepening of the research on this disease,people gradually realize that SLE can affect a multiple system and organs such as the heart,lung,kidney,digestive system and nervous system,and so on.And the kidney is the most often affected by SLE.SLE has a variety of clinical manifestations.Different patients or the same patients at different stages of disease can have different symptoms.When the children who were diagnosed with SLE appear hematuria,proteinuria and renal insufficiency or abnormal renal biopsy,can be diagnosed with lupus nephritis(LN).Lupus nephritis is one of the most common secondary glomerular diseases in pediatrics,and it is also the main cause of death in SLE.With the rapid development of medicine,it was found that children who were diagnosed with SLE prone to kidney damage than others.According to the research data shows that most children who the first time to visit without kidney damage can be found that have more renal pathological damage,which caused doctors ignore the kidney pathological damage of children.Otherwise,Lupus nephritis is easy to move again and again and to become poor prognosis.If children were not given proper treatment in time,it can increase the renal pathological damage,reduce the patient’s quality of life,even threaten them life and caused them to end-stage renal disease.So the diagnosis and the treatment of Lupus nephritis are of great significance.The pathogenesis of lupus nephritis is complex,and it is not clear now.Because of the lupus nephritis has various clinical manifestation and pathological types,it brought difficulties to clinical diagnosis and treatment.The purpose of this study is to summarize the clinical manifestation,laboratory examination and kidney pathological characteristics in children with lupus nephritis,to discuss the correlation between clinical manifestation and pathological type,to improve the understanding of lupus nephritis pathogenesis regularity,and to provide theoretical basis for further guide clinical treatment.Methods: Children who have been diagnosed with lupus nephritis after renal biopsy examination are selected from the Second Hospital of He bei Medical University from January 2000 to October 2015.We collected the data of clinical manifestation,laboratory renal pathology to analyze by retrospective analysis method.The clinical data included age,gender,and for the first time,the clinical manifestation of the disease.The laboratory data including blood routine,urine routine,24 hour urine protein,blood biochemistry,immunology related quantitative test and the result of renal biopsy pathology,etc.Then through analyzed by statistical methods,we can have the corresponding conclusion.We use the diagnostic criteria which revised by systemic lupus international collaborating clinics(SLICC)in 1997 for SLE.Lupus nephritis is diagnosed by the standard which is formulated by international society of nephrology and renal pathology association in 2003.According to clinical manifestations to defined the clinical classification.And the histological classifications were categorized according to 2003 international society of nephrology and renal pathology institute jointly formulated by the international standards(ISN/RPS)classification.We use the SPSS 13.0 software to analysis the data.When the probability less than 0.05,there is a statistical significance.Results:1 There are 62 cases of children in the study,of which 11 cases(17.7%)of male,female 51 cases(82.3%).The sex ratio for these children was 1:4.636.Their ages are varying from 5 to 15 years old when diagnosed.And the average age was 10.5.There is no relationship between gender and renal pathological types,as well as all ages with no correlation between renal pathology classification(P>0.05).2 62 cases of children with lupus nephritis were associated with different clinical manifestations and different initial symptoms of disease,starting symptoms of fever in 34 cases(54.8%),rash in 29cases(46.8%),edema in 27 cases(43.5%),proteinuria in 19 cases(30.6%),hematuria in 15 cases(24.2%),arthritis in 8 cases(12.9%),3 cases(4.8%)in headache,and 1 cases(1.6%)of abdominal pain.The most common clinical manifestation is fever.3 Laboratory examinations included ANA positive in 56 cases(90.3%),anti dsDNA antibodies positive in 43 cases(69.4%),anti Sm antibodies positive in 28 cases(45.2%),anti SSA antibody positive for 22 cases(35.5%),anti SSB antibody positive in 21 cases(33.9%),complement(C)3 reduced in 55 cases(88.7%),complement(C)4 reduced in 48 cases(77.4%),anti cardiolipin antibody increased in 16 cases(25.8%),anti neutrophil cytoplasmic antibody increased in 19 cases(30.6%),immune globulin heighten in 36 cases(58.1%),erythrocyte sedimentation(ESR)increased fast in 56 cases(90.3%),and renal insufficiency in 39 cases(62.9%).The type of renal insufficiency mainly exists in Ⅳ LN.The rest of the laboratory indexes and there was no significant correlation between renal pathological types(P>0.05).4 The clinical classification of simple hematuria and(or)proteinuria is in 15 cases(24.2%),acute nephritis type is in 11 cases(17.7%),nephritic syndrome is in 32 cases(51.6%),accelerated nephritis is in 1 case(1.6%),chronic nephritis is in 2 cases(3.2%),subclinical type is 1 case(1.6%),and the tubulointerstitial damage is none.5 The renal pathology classification of type Ⅱ is 4 cases(6.45%),type III is 11 cases(17.7%),type IV is 44 cases(71.0%),type V is 2case(3.2%),type V +III 1 case(1.6%),with no cases of type Ⅰ and type Ⅵ.6 The clinical manifestation of nephrotic syndrome mainly present for the pathological type of Ⅳ(26/32,81.3%),followed by Ⅴ(2/32,6.25%).Simple hematuria and(or)proteinuria is the most common type for Ⅳ(9/15,60.0%).Acute nephritis is the most common type for Ⅳ(6/11,54.5%),1 case of radical nephritis pathological types for Ⅳ type(1/1,100%),2 case of chronic nephritis pathology types for Ⅳ type(2/2,100%),1 case of subclinical type for Ⅱ type(1/1,100%).Conclusions:1 Children of lupus nephritis who are diagnose by renal biopsy examination in our hospital,are more common in adolescent girls.There is no relationship between gender and renal pathological types,as well as age(P>0.05).2 Immunological indexes such as the ANA,anti ds DNA antibody,C3,C4,immunoglobulin and ESR are very helpful in the diagnosis of the disease.But the laboratory indexes and kidney had no significant correlation between pathological type(P>0.05).3 The most common clinical type of lupus nephritis is nephritic syndrome type,and the second is simple hematuria and(or)proteinuria and acute nephritis.4 The most common pathological classification of lupus nephritis is Ⅳtype,and the following is Ⅲtype and Ⅱ type.There are no Ⅰ type and Ⅵtype in this study.5 The clinical manifestations has a certain correlation between the pathological classification,but there is no corresponding relation. |
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