| ObjectiveThe study analyzed the clinical manifestations and renal pathological characteristics of 62 children with systemic lupus erythematosus(SLE)with no or mild proteinuria in order to explore the correlation between clinical manifestations and renal pathological types.MethodsThe clinical manifestations,laboratory examination and renal pathological data of 62 children with SLE with 24-hour urine protein excretion<0.5g(or early morning urine protein/creatinine<0.5mg/mg)diagnosed and hospitalized in the Department of Pediatrics of the First Affiliated Hospital of Zhengzhou University from January 2014 to December 2021 were retrospectively analyzed.According to the renal pathological type,they were divided into type Ⅰ-Ⅱ LN group and type III-V LN group.The differences in clinical characteristics,laboratory examination and SLEDAI-2000 scores of the two groups were compared.The receiver operating characteristic(ROC)curve was used to evaluate the value of C3 levels and SLEDAI-2000 score for predicting classes Ⅲ,Ⅳ or V LN in children with SLE with no or mild proteinuria.Results1.Among 96 cases of children with SLE patients with no proteinuria or mild proteinuria,11 cases were males and 51 cases were females,the ratio of male to female was 1:4.6,and the age of onset was from 6 to 15 years,median age was 11 years(9 years,12 years).The most common pathological type was type I(19 cases,31%),followed by type Ⅳ(17 cases,27%),type Ⅲ(16 cases,27%),type II(8 cases,13%)and type V(2 cases,3%).There were no type Ⅴ+Ⅲ,Ⅴ+Ⅳ and Ⅵ in this study.There were 27 cases(43.5%)in type Ⅰ-Ⅱ and 35 cases(56.5%)in typeⅢ-Ⅴ.2.There were significant differences in the distribution of renal pathological types between the non-proteinuria LN group and the mild proteinuria LN group(P<0.05).There were 32 cases in non-proteinuria LN group,type I was the most common pathological type,accounting for 56%,including 23 cases(71.9%)of typeⅠ-Ⅱ and 9 cases of type III-V(28.1%).There were 30 children in mild proteinuria LN group,the most common pathological types were type I V and type Ⅲ,accounting for 50%and 33%,including 4 cases(13.3%)of type Ⅰ-Ⅱ and 26 cases of type III-V(86.7%).The incidence of proteinuria in children with type Ⅲ-Ⅴ LN group was significantly higher than that in type Ⅰ-Ⅱ LN group(P<0.05).3.The SLEDAI-2000 score in type III-V LN group was higher than that in typeⅠ-Ⅱ LN group[13.00(10.00,15)/7.00(6.00,8.00),P<0.05];The incidence of proteinuria,hematuria,arthritis and the positive rate of anti-dsDNA antibody in type III-V LN group were higher than those in type Ⅰ-Ⅱ LN group.The level of Scr and BUN in type III-V LN group were higher than those in type Ⅰ-Ⅱ LN group.The level of C3 in type Ⅲ-Ⅴ LN group was lower than that in type Ⅰ-Ⅱ LN group[0.29(0.22,0.40)/0.58(0.43,0.86),P<0.05];the level of C4,HB and ALB in type III-V LN group were lower than those of the Ⅰ-Ⅱ LN group.There was no significant difference in clinical manifestations such as gender,age of onset,WBC,PLT between the type Ⅰ-Ⅱ LN group and type Ⅲ-Ⅴ LN group(P>0.05).4.The area under the curve of type Ⅲ,Ⅳ or V LN in children with SLE with no or mild proteinuria predicted by C3 level was 0.865,and 95%CI was 0.754-0.938,with 77.14%sensitivity and 88.52%specificity,and best cut-off value was 0.4 g/L.The area under the curve of type Ⅲ,IV or V LN in children with SLE with no or mild proteinuria predicted by SLEDAI-2000 score was 0.900,and 95%CI was 0.797-0.962,with 91.43%sensitivity and 81.48%specificity,and best cut-off value was 8 points(P<0.05).Conclusion1.The proteinuria level of SLE in children with no or mild proteinuria is not completely parallel to renal pathological type,and renal involvement should not be underestimated.2.For SLE in children with no or mild proteinuria,C3 levels and SLEDAI-2000 score can be used as reference indexes to predict renal pathological type.When SLEDAI-2000 score>8 or C3<0.4g/L,it is recommended to perform renal biopsy as soon as possible. |
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