Clinical And Pathological Analysis Of Tubulointerstitial Lesions In Lupus Nephritis

Objective:The clinical and pathological data of tubulointerstitial(TIN)lesions in patients with lupus nephritis(LN)were retrospectively analyzed to improve clinicians' attention to TIN lesions in patients with LN,so as to identify early and improve prognosis.Methods:A total of 145 patients diagnosed with LN by renal biopsy at the Bethune First Hospital of Jilin University from September 2010 to September 2019 were collected.The general data,clinical and pathological data of the patients were extracted,and semi-quantitative scores were scored for TIN lesion indicators(interstitial inflammation cell infiltration,renal tubular epithelial cell degeneration,renal tubular atrophy and interstitial fibrosis).Compare the characteristics of TIN lesions in LN patients under different pathological classifications,analyze the relationship between TIN lesions and glomerular lesions and renal function,analyze the relationship between TIN lesions and clinical and pathological indicators of LN patients,and screen out the independent risks that affect the degree of TIN lesions factor.Results:1.Among the 145 LN patients included,15 were male and 130 were female,and the male to female ratio was 1: 8.67.The course of disease was 6 days to 10 years,with an average course of 13.5 months.The average age was 25.48 ± 14.931 years(7to 66 years);136 patients with TIN lesions were enrolled,the incidence rate was93.7%,and the incidence rate of moderate to severe lesions was 63.4%.In 2003,there were 10 cases of type II LN(6.9%),32 cases of type III(22.1%),93 cases of type IV(64.1%)under the classification criteria for lupus nephritis of the International Kidney Association and Renal Pathology Association(ISN / RPS)in 2003.10 patients(6.9%)were included in this study.This study did not include patients with type I and VI,and included III + V LN as type III and IV + V LN as type IV.2.The relationship between TIN lesions and classification of lupus nephritis :(1)Among the selected LN patients,the degree of TIN lesions was the most severe among type IV LNs,followed by type III,and the lightest was type II and V.(2)In terms of interstitial cell infiltration and tubular epithelial cell degeneration: Type IV LN is the heaviest,followed by Type III,and Type II and V LN are the lightest.Renal tubular atrophy and interstitial fibrosis: Type IV is the heaviest,and there is no statistical significance between type II,III,and V(P> 0.05).3.The relationship between TIN lesions and kidney and glomerular lesions and their effects on renal function(eGFR):(1)There was no significant correlation between the glomerular lesion activity index and the degree of TIN lesions in this group of LN patients(P >0.05),Renal Activity Index(AI),Kidney Chronicity Index(CI),Total Renal Lesion Score(AICI),Glomerular Lesion Chronicity Index,Glomerular Lesion Total Score and Tubulointerstitial(TIN)Lesion There was a significant positive correlation(r was 0.625,0.820,0.794,0.421,0.231,P values were all <0.01).(2)Interstitial inflammatory cell infiltration of TIN lesion index is an independent influencing factor of eGFR(P <0.01),with an impact coefficient of-6.47.4.The relationship between TIN lesions and the clinicopathological characteristics of LN patients:(1)Correlation analysis between TIN acute and chronic lesion indicators(interstitial cell infiltration,renal tubular atrophy / interstitial fibrosis)and clinical and pathological characteristics of LN patients: Interstitial cell infiltration and age,course of disease,blood pressure,urea,blood creatinine,cholesterol,triglycerides,24-hour urinary protein,cell proliferation,cellular crescent,infiltration of glomerular leukocytes,palate necrosis / nucleus fragmentation,Spheroid sclerosis,fibrous crescent,hyaline degeneration,and thrombosis were positively correlated(all r> 0,P <0.05),and negatively correlated with eGFR,serum albumin,hemoglobin,and C3(all r <0,P all <0.05).Renal tubular atrophy / interstitial fibrosis and age,course of disease,blood pressure,urea,serum creatinine,24-hour urinary protein,cell proliferation,cellular crescent,glomerular leukocyte infiltration,sclerosis,fibrotic crescent There was a positive correlation between body and vessel wall thickening(all r> 0,P <0.05)and negative correlation with eGFR,serum albumin,hemoglobin,and anti-dsDNAIIF(all r <0,P <0.05).The clinical and pathological influencing factors of renal interstitial cell infiltration,interstitial fibrosis / tubular atrophy in LN patients are consistent except for individual factors.(2)The course of disease is an independent risk factor for the severity of TIN lesions(P <0.05),the severity of course ? 3 months is significantly lower than that of patients with course of> 3months,the coefficient is-1.419;hypertriglyceridemia is Independent risk factors for the degree of TIN lesions(P<0.05),the severity of the triglyceride-non-elevated group was significantly lower than that of patients with elevated triglyceride,with a coefficient of-0.83;anemia was independent of the degree of TIN lesions The risk factors were(P<0.05),and the severity of the hemoglobin-reduced group was significantly higher than that of the patients without the hemoglobin-reduced group,with a coefficient of 1.141;the cellular crescent was an independent risk factor for the degree of TIN lesions(P<0.05),The coefficient of influence is 0.394,that is,the heavier the cellular crescent,the higher the severity of the disease;spherical sclerosis is an independent risk factor for the degree of TIN lesions(P<0.05),and the coefficient of influence is 0.681,the spherical The more severe sclerosis,the higher the severity of the disease.Conclusion:1.In this group of patients with LN,the incidence of TIN lesions was 93.7%,of which the incidence of moderate to severe TIN was higher,63.4%.2.TIN lesions in LN patients are related to the 2003 ISN / RPS classification,but are not completely parallel to glomerular lesions.Interstitial cell infiltration is an independent risk factor for eGFR decline.3.The clinical and pathological factors that affect the acute and chronicindicators of TIN lesions are generally consistent;the course of disease is> 3 months,hypertriglyceridemia,anemia,cellular crescent,and sclerosis are the factors that affect the aggravation of TIN lesions.Independent risk factors.