Clinicopathological Features And Prognosis Of Lupus Nephritis With Hypertension

Objective: to analyze the clinicopathological features and prognosis of lupus nephritis with or without hypertension,to explore the influencing factors of LN complicated with hypertension,and to evaluate the renal prognosis.Methods: a total of 133 patients with LN diagnosed by renal biopsy in the First Affiliated Hospital of Fujian Medical University from October 1,2010 to September30,2020 were included.According to the inclusion and exclusion criteria,113 patients were selected as the research objects and divided into ln hypertension group and LN normotensive group according to the diagnostic criteria of Chinese guidelines for the prevention and treatment of hypertension(revised in 2018)And pathological features.The patients were followed up for at least 6 months.Kaplan Meier method was used to compare the cumulative renal survival rate between the two groups.Cox regression model was used to analyze the risk factors affecting the poor prognosis of LN.result:1.A total of 113 ln patients were included,including 14 males and 99 females,with a male to female ratio of 1:7.07.There were 37 cases(32.74%)in LN combined with hypertension group.The age of renal biopsy,systolic blood pressure,diastolic blood pressure,mean arterial pressure,SLEDAI score and the proportion of patients with large amount of proteinuria in LN patients with hypertension were significantly higher than those in LN patients with normal blood pressure(P >0.05).There was no significant difference in the ratio of male to female and the course of disease before renal biopsy between the two groups(P > 0.05).2.The highest extrarenal involvement rate was anemia(70.27% vs 55.26%),followed by facial erythema(51.35% vs 44.74%)and joint pain(51.35% vs 40.79%),but there was no significant difference between the two groups(P >0.05).3.Compared with the patients with normal blood pressure in LN group,the levels of serum uric acid,serum creatinine and 24-hour urinary protein in LN combined with hypertension group were higher,and the level of EGFR was lower,the difference was statistically significant(P <0.05).There was no significant difference in the levels of triglyceride,total cholesterol,high density lipoprotein cholesterol,low density lipoprotein cholesterol,plasma albumin,complement C3 and C4,and the positive rates of autoantibodies ds DNA,ANA and ANCA between the two groups(P >0.05).4.The main pathological type of kidney was type IV(41.59%).The AI score,CI score and til score of LN with hypertension group were significantly higher than those of LN with normal blood pressure group(P<0.05).The pathological type of LN patients with hypertension was type IV + V,which was significantly higher than that of LN patients with normal blood pressure(P <0.05).Compared with the patients with normal blood pressure in LN group,the proportion of cellulose like necrosis / nuclear fragmentation,cellular crescent,microthrombosis / platinum ear,leukocyte infiltration and arteriole wall thickening in LN combined with hypertension group was significantly higher(P <0.05).There was no significant difference in glomerular cell proliferation,interstitial inflammatory cell infiltration and other renal pathological changes between the two groups(P > 0.05).5.Binary logistic regression analysis showed that age(or = 1.088,95% CI1.030-1.149,P = 0.002)and leukocyte infiltration(or = 1.644,95% CI 1.104-24.259,P = 0.037)were independent risk factors of LN with hypertension.Ln with hypertension was positively correlated with age and leukocyte infiltration.6.Kaplan Meier survival curve showed that the renal cumulative survival rate of LN patients with hypertension was significantly lower than that of LN patients with normal blood pressure(70.27% vs 89.47%,log rank test: = 6.674,P = 0.010).7.Univariate Cox regression analysis showed that hypertension,massive proteinuria,SLEDAI score,uric acid,creatinine,EGFR,cellulose like necrosis / fragmentation,and cellular crescent were risk factors for the prognosis of LN.After multivariate Cox regression analysis,high serum creatinine(HR = 1.009,P = 0.001)and fibrinoid necrosis / fragmentation(HR = 4.445,P = 0.038)were independent risk factors for poor prognosis of LN.Conclusion: ln patients with hypertension accounted for 32.74%.Ln patients with hypertension had older renal biopsy age,higher SLEDAI score,AI score,CI score,til score,serum uric acid,serum creatinine,24-hour urinary protein quantitative level,lower EGFR level,and the main renal pathological type was type IV,with cellulose like necrosis / nuclear fragmentation,cellular crescent,microthrombosis / platinum ear and leukopenia The proportion of cell infiltration and arteriole wall thickening in LN normotensive group was significantly higher than that in LN normotensive group,and the renal cumulative survival rate was significantly lower than that in LN normotensive group.Binary logistic regression analysis showed that age and leukocyte infiltration were independent risk factors for LN with hypertension.Cox regression analysis showed that serum creatinine level and fibrinoid necrosis /fragmentation were independent risk factors for the prognosis of LN.