| ObjectiveThe study analyzed the clinical manifestations and renal pathological characteristics of children with lupus nephritis(LN)and explored the relationship between clinical manifestations and renal pathology in children with lupus nephritis.MethodsThe analysis was performed retrospectively in 70 children with LN admitted to The Children’s Hospital Affiliated to Soochow University from Jan.2010 to Dec.2016 about clinical manifestations,laboratory examination and renal pathology.Analysis:1.The difference of sex,clinical manifestations,laboratory examination,Systemic lupus erythematosus disease activity index(SLEDAI)score,tubulointerstitial lesion(TIL)score,activity index(AI)score and chronic index(CI)score were compared between groups classified by renal pathological classification.2.The difference of Urine N-Acetyl-betaD-Glucosaminidase(NAG)/urine creatinine(Cr)ratio,urine α1 microglobulin(α1MG)/ urine Cr ratio,urine β2 microglobulin(β2MG)/ urine Cr ratio and serum creatinine(SCr)were compared between groups classified by TIL classification.3.The relationship between 24-hour urinary protein excretion,AI score,CI score and TIL grade was analyzed.4.The relationship between SLEDAI score and AI score,CI score was analyzed.Result1.The ratio of male to female was 1:3.21 in children with lupus nephritis,type Ⅳ(42.9%)were the most common pathological type,followed by type Ⅲ(31.4%)and type Ⅱ(21.4%).The most common TIL grade is grade Ⅰ(64.3%),and grade Ⅱ(4.3%),31.4% patients without TIL.“A full house pattern” on immunofluorecence was found in 78.6% patients,pauci-immmune LN was found in 2 patients,3 patients only with IgM deposition.Proteinuria(61.4%),sterile pyuria(52.9%)and hematuria(48.6%)were more common renal clinical manifestations.The most common renal clinical classification was subclinical type(31.4%),followed by hematuria or(and)proteinuria(30.0%)and nephrotic syndrome(25.7%).Blood system damage(87.1%),facial rash(67.1%)and fever(67.1%)were more common extrarenal clinical manifestations.2.Type Ⅲ(34.0%)and type Ⅳ(45.3%)were more common in females,type Ⅳ(35.3%)was more common in males.The proportion of type Ⅴ + Ⅳ in males was higher than that in females(17.7% vs.0.0%,P<0.05).3.The patients with type Ⅱ and type Ⅲ didn’t have TIL or had grade TIL,grade TIL Ⅰ and Ⅱ were more common in patients with type Ⅳ and type Ⅴ + Ⅳ.The TIL score of patients with type Ⅳ and typeⅤ + Ⅳ were significantly higher than that of patients with type Ⅱ and type Ⅲ(P <0.01).The AI score of patients with type Ⅳ and typeⅤ + Ⅳ were significantly higher than that of patients with type Ⅱ and type Ⅲ(P <0.01),and AI score of patients with type Ⅲ were significantly higher than that of patients with type Ⅱ(P <0.01).The proportion of “A full house pattern” in patients with type Ⅲ and type Ⅳ was significantly higher than that in patients with type Ⅱ(P <0.01).4.The incidence rate of hematuria in patients with type Ⅱ was significantly lower than that in patients with type Ⅲ and type Ⅳ(P <0.01).The incidence rate of hypertension,aseptic pyuria and proteinuria in patients with type Ⅳwas significantly higher than that in patients with type Ⅱ(P <0.01).The 24-hour urinary protein excretion of patients with type Ⅳ and typeⅤ + Ⅳ was significantly higher than that of patients with type Ⅱand type Ⅲ,and the 24-hour urinary protein excretion of patients with type Ⅲ was significantly higher than that of patients with type Ⅱ.Nephrotic syndrome was more common in patients with type Ⅳand typeⅤ + Ⅳ,subclinical type was more common in patients with type Ⅱ,there was significantly different between groups classified by renal pathological classification(P <0.05).Severe renal pathological types(type Ⅲand type Ⅳ)were found in patients with subclinical type.The incidence rate of facial rash in patients with type Ⅳ was significantly higher than that in patients with typeⅡand typeⅤ + Ⅳ(P <0.01).The incidence rate of fever in type Ⅳ was significantly higher than that in typeⅡ(P <0.01).5.The positive rate of anti-dsDNA antibody in patients with type Ⅲ and type Ⅳ was significantly higher than that in patients with typeⅡ(P <0.01).The decrease rate of C3 in patients with type Ⅳ was significantly higher than that in patients with typeⅡ(P <0.01).6.Serum albumin level,blood urea nitrogen(BUN),serum creatinine(SCr)level and serum cystatin C(Cys-C)level were significantly different between groups classified by renal pathological classification(P <0.05).7.urine NAG/ urine Cr ratio,urine α1MG/ urine Cr ratio and SCr level were significantly different between groups classified by TIL classification(P <0.05).TIL grade was positivetly correlated with the 24-hour urinary protein excretion,AI score and CI score(r = 0.300,r = 0.434,r = 0.334,p <0.05).8.Severe type of SLEDAI(52.9%)was the most common.SLEDAI score of type Ⅱ was significantly lower than that of other types(P <0.05),and SLEDAI score of patients with typeⅤ+Ⅳ were higher than that of patients with type Ⅲ(P <0.05).SLEDAI score was positivetly correlated with AI score(r = 0.402,P <0.05).There was no significant correlation between SLEDAI score and CI score(r = 0.041,P> 0.05).Conclusion:1.The renal clinical classification was not completed consistent with renal pathological classification in children with lupus nephritis.Patients without obvious clinical manifestations of renal lesion might have severe renal pathological damage,emphasizing the importance of renal biopsy2.The AI score of patients with type Ⅳ and typeⅤ + Ⅳ were higher,the renal pathologic activity of type Ⅳ and typeⅤ + Ⅳ was higher.3.Tubulointerstitial lesions in children with typeⅣand typeⅤ + Ⅳ was more common and serious.AI score,CI score and 24-hour urinary protein excretion were positively correlated with tubulointerstitial lesions grade.Urine NAG / urine Cr ratio and urine α1MG / urine Cr ratio,to a certain extent,could reflect the degree of tubulointerstitial lesions4.SLEDAI score of patients with lupus nephritis was positivetly correlated with AI score. |
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