41 Patients Of Lupus Nephritis With Repeated Renal Biopsy Clinical And Pathological Analysis

ObjectiveTo explore the rationality and clinical indications of repeated renal biopsy in patients with lupus nephritis,and to understand the changes in its clinicopathological types and the correlation with the treatment plan.Methods41 patients with lupus nephritis from the First Affiliated Hospital of Zhengzhou University from January 2012 to December 2016 were enrolled in the nephrology and repeated renal biopsy.The related information of patients during primary renal biopsy and repeated renal biopsy was recorded,including general information,pathological diagnosis and clinical manifestations.And laboratory examination,clinical treatment plan and so on,and all data were retrospectively analyzed.Results1.general information of patients:There were 2 males and 39 females,male and female ratio of 1:19.5.The primary renal biopsy age was 14-52(28.88±9.95)years old.The age of repeated renal biopsy was 15-57 years(33.27 ±10.36)years,and the average interval time of kidney biopsy was 4.36 ± 2.51 years.2.Analysis of clinical types of two renal biopsy:The distribution of clinical types before the first renal biopsy was:21 cases of nephritis syndrome(51.2%),10 cases of nephrotic syndrome(24.4%),6 cases of occult nephritis(14.6%),4 cases of renal insufficiency(9.8%).The clinical type distribution before renal biopsy:19 cases of renal insufficiency(46.3%)and nephrotic syndrome in 15 cases.(36.6%)7 cases(17.1%)of nephritis syndrome and 0 cases of occult nephritis(0%).The distribution of clinical types before and after two renal biopsy was statistically analyzed.The results showed significant changes in clinical types(P<0.05),which was compared to the first renal biopsy and before repeated renal biopsy.Patients with latent nephritis and nephritis syndrome were significantly reduced,while patients with renal insufficiency increased,and the overall clinical performance of patients showed an increasing trend.3.Laboratory analysis of two renal biopsies:The results of the two laboratory tests were statistically analyzed.The differences of the four indexes of hemoglobin,plasma albumin,total 24h urine protein and serum creatinine were statistically significant(P<0.05).The total hemoglobin and plasma albumin of the patients before the repeated renal biopsy were significantly lower than that of the primary renal biopsy,while the total 24h urine samples were significantly lower than those of the primary renal biopsy.Protein and serum creatinine increased significantly,and the overall condition increased.4.Analysis of clinical manifestations in two renal biopsy:The 9 clinical manifestations of facial erythema,edema,hypertension,anemia,renal insufficiency,hematuria,massive albuminuria,hypoproteinemia,and hypocomplement were statistically different(P<0.05)in the clinical manifestations and diagnosis of the anterior and posterior renal biopsy before and after the two renal biopsy.The number of patients with erythema,edema,hypertension,anemia,renal insufficiency,hematuria,and a large number of proteinuria increased significantly.The clinical data showed that the overall condition of the patients was obviously aggravated,and the other items were not statistically different(P>0.05).5.Analysis of SLE disease activity index before and after two renal biopsies:The SLEDAI was 13.85 ± 6.01 points before the first renal biopsy,and the SLEDAI of the patients before the repeated renal biopsy was 16.59 ± 5.45.The statistical analysis of the SLE disease activity index before two renal biopsy showed that the two renal biopsy results showed that the SLEDAI had statistical difference(P<0.05).The overall score of the patients was higher than that before the primary renal biopsy.Disease activity increased,and the number of patients with heavy activity increased significantly compared with the first time.6.Distribution of pathological types in two renal biopsies:The pathological types of primary renal biopsy were ? type 15(36.6%),type ? 7 cases(17.1%),?+? type 5 cases(12.2%),?+? type 5 cases(12.2%),? type 5 cases(12.2%),and? 4 cases(9.7%).The pathological types of repeated renal biopsy were ?+? 16 cases(39%),? type cases(?),?+? type cases 3 cases of type ?(7.3%),type ? 2 cases(4.9%),? type 1 cases(2.4%),and two renal biopsy patients' pathological types were statistically significant(P<0.05).7.change of pathological type:Pathological changes in 5 patients were relieved,24 cases were aggravated,and 12 cases had no obvious change.Of the 5 patients relieved,2 cases changed from type ? to ? type,1 cases ?+? type to ? type,1 cases ?+? type to ? type,1 cases ? type to ? type ?????.8.clinical treatment plan before repeated renal biopsy:The distribution of clinical treatment regimens before repeated renal biopsy:single hormone 21(51.2%),hormone +CTX 11 cases(8.7%),hormone +MMF 6 cases(14.6%),hormone +FK5063 cases(7.3%),hormone + MMF + FK506 0 cases(0%),repeated renal biopsy,clinical treatment scheme distribution:single hormone 16(39%),hormone +CTX 6 cases(14.6%)hormone +MMF 16 cases(39%),hormone +FK506 0 cases(0%),hormone + MMF + FK506 3 cases(7.3%),statistical analysis,there were statistical differences(P<0.05).Hormone +MMF treatment regimen increased significantly compared with that before repeated renal biopsy.In addition,statistics showed that 28(68.3%)patients had changed after repeated renal biopsies.Conclusion1.Repeated renal biopsy is essential for redefining the pathological type of lupus nephritis with renal biopsy,and most of the patients are accompanied by clinical manifestations and increased tissue lesions.2.Repeated renal biopsy is the guiding significance for the formulation of clinical treatment protocols for patients with lupus nephritis who have undergone renal biopsy.