Analysis of clinical and laboratory characteristics and pathology of lupus nephritis-based on 710 renal biopsies in China.
Lupus nephritis
Onset
Pathology
Systemic lupus erythematosus
Journal
Clinical rheumatology
ISSN: 1434-9949
Titre abrégé: Clin Rheumatol
Pays: Germany
ID NLM: 8211469
Informations de publication
Date de publication:
Nov 2020
Nov 2020
Historique:
received:
12
12
2019
accepted:
16
04
2020
revised:
04
04
2020
pubmed:
22
5
2020
medline:
15
5
2021
entrez:
22
5
2020
Statut:
ppublish
Résumé
This study aimed to analyse the clinical and laboratory characteristics of different pathologic classifications of lupus nephritis (LN) patients in terms of age at systemic lupus erythematosus (SLE) diagnosis and nephritis onset. Clinical, laboratory, and pathological data of 710 LN patients diagnosed by renal biopsy at our institution between 2000 and 2018 were retrospectively analysed. Patients were divided into the different pathological classification groups; childhood-, adult- and elderly-onset SLE groups and early- and late-onset LN groups. Class IV occurred most frequently and had the lowest complement C3 level. There was an obvious increase in active index in class IV and class V + IV. Patients with class VI showed some clinical characteristics similar to end-stage renal disease. Patients with proliferative nephritis were younger at SLE diagnosis and had higher blood pressure, higher frequency of proteinuria and urinary erythrocyte and lower haemoglobin and complement C3. Pathologic classification between childhood-, adult- and elderly-onset SLE patients or between early- and late-onset LN patients was not significantly different. Elderly-onset SLE patients had the highest chronic index (CI), IgA, IgG and Sjögren's syndrome A antibodies and Sjögren's syndrome B antibodies rates, whereas late-onset LN patients showed significantly higher CI, haemoglobin, complement C3 and C4 but lower uric acid, IgM and IgG. LN patients present with different clinical and laboratory characteristics according to pathological classification, age at SLE diagnosis and nephritis onset. These results might be valuable for estimating the pathology and guiding treatment and prognosis. Key Points • Patients with proliferative nephritis have more severe immune disorders, worse renal function and stronger inflammatory state. • The elderly-onset SLE patients showed a poorer condition. • The late-onset LN patients might have a more stable status.
Identifiants
pubmed: 32435895
doi: 10.1007/s10067-020-05115-2
pii: 10.1007/s10067-020-05115-2
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
3353-3363Subventions
Organisme : National Natural Science Foundation of China
ID : 81830019
Références
Lisnevskaia L, Murphy G, Isenberg D (2014) Systemic lupus erythematosus. Lancet 384(9957):1878–1888. https://doi.org/10.1016/S0140-6736(14)60128-8
doi: 10.1016/S0140-6736(14)60128-8
pubmed: 24881804
Lessard CJ, Sajuthi S, Zhao J, Kim K, Ice JA, Li H, Ainsworth H, Rasmussen A, Kelly JA, Marion M, Bang SY, Joo YB, Choi J, Lee HS, Kang YM, Suh CH, Chung WT, Lee SK, Choe JY, Shim SC, Oh JH, Kim YJ, Han BG, Shen N, Howe HS, Wakeland EK, Li QZ, Song YW, Gaffney PM, Alarcon-Riquelme ME, Criswell LA, Jacob CO, Kimberly RP, Vyse TJ, Harley JB, Sivils KL, Bae SC, Langefeld CD, Tsao BP (2016) Identification of a systemic lupus erythematosus risk locus spanning ATG16L2, FCHSD2, and P2RY2 in Koreans. Arthritis Rheumatol 68(5):1197–1209. https://doi.org/10.1002/art.39548
doi: 10.1002/art.39548
pubmed: 26663301
pmcid: 4981330
Niu Z, Zhang P, Tong Y (2015) Value of HLA-DR genotype in systemic lupus erythematosus and lupus nephritis: a meta-analysis. Int J Rheum Dis 18(1):17–28. https://doi.org/10.1111/1756-185X.12528
doi: 10.1111/1756-185X.12528
pubmed: 25546242
Bertsias GK, Boumpas DT (2011) Connective tissue diseases: lupus nephritis-winning a few battles but not the war. Nat Rev Rheumatol 7(8):441–442. https://doi.org/10.1038/nrrheum.2011.88
doi: 10.1038/nrrheum.2011.88
pubmed: 21691329
Maroz N, Segal MS (2013) Lupus nephritis and end-stage kidney disease. Am J Med Sci 346(4):319–323. https://doi.org/10.1097/MAJ.0b013e31827f4ee3
doi: 10.1097/MAJ.0b013e31827f4ee3
pubmed: 23370533
Lydia A, Saraswati MH, Dharmeizar D, Saraswati M, Setiati S (2018) Diagnostic determinants of proliferative lupus nephritis based on clinical and laboratory parameters: a diagnostic study. Acta Med Indones 50(2):110–118
pubmed: 29950529
Weening JJ, D'Agati VD, Schwartz MM, Seshan SV, Alpers CE, Appel GB, Balow JE, Bruijn JA, Cook T, Ferrario F, Fogo AB, Ginzler EM, Hebert L, Hill G, Hill P, Jennette JC, Kong NC, Lesavre P, Lockshin M, Looi LM, Makino H, Moura LA, Nagata M, International Society of Nephrology Working Group on the Classification of Lupus N, Renal Pathology Society Working Group on the Classification of Lupus N (2004) The classification of glomerulonephritis in systemic lupus erythematosus revisited. Kidney Int 65(2):521–530. https://doi.org/10.1111/j.1523-1755.2004.00443.x
doi: 10.1111/j.1523-1755.2004.00443.x
pubmed: 14717922
Chen DN, Fan L, Wu YX, Zhou Q, Chen W, Yu XQ (2018) A predictive model for estimation risk of proliferative lupus nephritis. Chin Med J 131(11):1275–1281. https://doi.org/10.4103/0366-6999.232809
doi: 10.4103/0366-6999.232809
pubmed: 29786038
pmcid: 5987496
Tang Y, Zhang W, Zhu M, Zheng L, Xie L, Yao Z, Zhang H, Cao D, Lu B (2018) Lupus nephritis pathology prediction with clinical indices. Sci Rep 8(1):10231. https://doi.org/10.1038/s41598-018-28611-7
doi: 10.1038/s41598-018-28611-7
pubmed: 29980727
pmcid: 6035173
Bomback AS (2018) An update on therapies for proliferative lupus nephritis: how certain can we be about the evidence? Am J Kidney Dis 72(5):758–760. https://doi.org/10.1053/j.ajkd.2018.07.007
doi: 10.1053/j.ajkd.2018.07.007
pubmed: 30343733
Yokoyama H, Wada T, Hara A, Yamahana J, Nakaya I, Kobayashi M, Kitagawa K, Kokubo S, Iwata Y, Yoshimoto K, Shimizu K, Sakai N, Furuichi K, Kanazawa Study Group for Renal D, Hypertension (2004) The outcome and a new ISN/RPS 2003 classification of lupus nephritis in Japanese. Kidney Int 66(6):2382–2388. https://doi.org/10.1111/j.1523-1755.2004.66027.x
doi: 10.1111/j.1523-1755.2004.66027.x
pubmed: 15569330
Schwartz N, Goilav B, Putterman C (2014) The pathogenesis, diagnosis and treatment of lupus nephritis. Curr Opin Rheumatol 26(5):502–509. https://doi.org/10.1097/BOR.0000000000000089
doi: 10.1097/BOR.0000000000000089
pubmed: 25014039
pmcid: 4221732
Antolin J, Amerigo MJ, Cantabrana A, Roces A, Jimenez P (1995) Systemic lupus erythematosus: clinical manifestations and immunological parameters in 194 patients. Subgroup classification of SLE. Clin Rheumatol 14(6):678–685. https://doi.org/10.1007/bf02207936
doi: 10.1007/bf02207936
pubmed: 8608688
Klein-Gitelman M, Reiff A, Silverman ED (2002) Systemic lupus erythematosus in childhood. Rheum Dis Clin N Am 28(3):561–577 vi-vii
doi: 10.1016/S0889-857X(02)00015-7
Tomic-Lucic A, Petrovic R, Radak-Perovic M, Milovanovic D, Milovanovic J, Zivanovic S, Pantovic S, Veselinovic M (2013) Late-onset systemic lupus erythematosus: clinical features, course, and prognosis. Clin Rheumatol 32(7):1053–1058. https://doi.org/10.1007/s10067-013-2238-y
doi: 10.1007/s10067-013-2238-y
pubmed: 23515605
das Chagas Medeiros MM, Bezerra MC, Braga FN, da Justa Feijao MR, Gois AC, Reboucas VC, de Carvalho TM, Carvalho LN, Ribeiro AM (2016) Clinical and immunological aspects and outcome of a Brazilian cohort of 414 patients with systemic lupus erythematosus (SLE): comparison between childhood-onset, adult-onset, and late-onset SLE. Lupus 25(4):355–363. https://doi.org/10.1177/0961203315606983
doi: 10.1177/0961203315606983
pubmed: 26405022
Seligman VA, Lum RF, Olson JL, Li H, Criswell LA (2002) Demographic differences in the development of lupus nephritis: a retrospective analysis. Am J Med 112(9):726–729. https://doi.org/10.1016/s0002-9343(02)01118-x
doi: 10.1016/s0002-9343(02)01118-x
pubmed: 12079714
Kang JH, Park DJ, Lee KE, Lee JS, Choi YD, Lee SS (2017) Comparison of clinical, serological, and prognostic differences among juvenile-, adult-, and late-onset lupus nephritis in Korean patients. Clin Rheumatol 36(6):1289–1295. https://doi.org/10.1007/s10067-017-3641-6
doi: 10.1007/s10067-017-3641-6
pubmed: 28444577
Varela DC, Quintana G, Somers EC, Rojas-Villarraga A, Espinosa G, Hincapie ME, McCune WJ, Cervera R, Anaya JM (2008) Delayed lupus nephritis. Ann Rheum Dis 67(7):1044–1046. https://doi.org/10.1136/ard.2008.088740
doi: 10.1136/ard.2008.088740
pubmed: 18413438
Ugolini-Lopes MR, Santos LPS, Stagnaro C, Seguro LPC, Mosca M, Bonfa E (2019) Late-onset biopsy-proven lupus nephritis without other associated autoimmune diseases: severity and long-term outcome. Lupus 28(1):123–128. https://doi.org/10.1177/0961203318811603
doi: 10.1177/0961203318811603
pubmed: 30442061
Guo Q, Lu X, Miao L, Wu M, Lu S, Luo P (2010) Analysis of clinical manifestations and pathology of lupus nephritis: a retrospective review of 82 cases. Clin Rheumatol 29(10):1175–1180. https://doi.org/10.1007/s10067-010-1517-0
doi: 10.1007/s10067-010-1517-0
pubmed: 20556453
Shariati-Sarabi Z, Ranjbar A, Monzavi SM, Esmaily H, Farzadnia M, Zeraati AA (2013) Analysis of clinicopathologic correlations in Iranian patients with lupus nephritis. Int J Rheum Dis 16(6):731–738. https://doi.org/10.1111/1756-185X.12059
doi: 10.1111/1756-185X.12059
pubmed: 24382282
Satirapoj B, Tasanavipas P, Supasyndh O (2015) Clinicopathological correlation in Asian patients with biopsy-proven lupus nephritis. Int J Nephrol 2015:857316–857316. https://doi.org/10.1155/2015/857316
doi: 10.1155/2015/857316
pubmed: 25874130
pmcid: 4383344
Silva CA, Avcin T, Brunner HI (2012) Taxonomy for systemic lupus erythematosus with onset before adulthood. Arthritis Care Res 64(12):1787–1793. https://doi.org/10.1002/acr.21757
doi: 10.1002/acr.21757
Schwartz GJ, Munoz A, Schneider MF, Mak RH, Kaskel F, Warady BA, Furth SL (2009) New equations to estimate GFR in children with CKD. J Am Soc Nephrol 20(3):629–637. https://doi.org/10.1681/ASN.2008030287
doi: 10.1681/ASN.2008030287
pubmed: 19158356
pmcid: 2653687
Stevens LA, Claybon MA, Schmid CH, Chen J, Horio M, Imai E, Nelson RG, Van Deventer M, Wang HY, Zuo L, Zhang YL, Levey AS (2011) Evaluation of the chronic kidney disease epidemiology collaboration equation for estimating the glomerular filtration rate in multiple ethnicities. Kidney Int 79(5):555–562. https://doi.org/10.1038/ki.2010.462
doi: 10.1038/ki.2010.462
pubmed: 21107446
Gupta R, Aggarwal A, Sinha S, Rajasekhar L, Yadav A, Gaur P, Misra R, Negi VS (2016) Urinary osteoprotegerin: a potential biomarker of lupus nephritis disease activity. Lupus 25(11):1230–1236. https://doi.org/10.1177/0961203316636470
doi: 10.1177/0961203316636470
pubmed: 26936893
Hiromura K, Ikeuchi H, Kayakabe K, Sugiyama H, Nagata M, Sato H, Yokoyama H, Nojima Y (2017) Clinical and histological features of lupus nephritis in Japan: a cross-sectional analysis of the Japan Renal Biopsy Registry (J-RBR). Nephrology (Carlton) 22(11):885–891. https://doi.org/10.1111/nep.12863
doi: 10.1111/nep.12863
Nossent J, Raymond W, Kang A, Wong D, Ognjenovic M, Chakera A (2018) The current role for clinical and renal histological findings as predictor for outcome in Australian patients with lupus nephritis. Lupus 27(11):1838–1846. https://doi.org/10.1177/0961203318792361
doi: 10.1177/0961203318792361
pubmed: 30092734
Restrepo-Escobar M, Granda-Carvajal PA, Jaimes F (2019) Development and internal validation of a prediction model to estimate the probability of needing aggressive immunosuppressive therapy with cytostatics in de novo lupus nephritis patients. Reumatol Clin 15(1):27–33. https://doi.org/10.1016/j.reuma.2017.05.010
doi: 10.1016/j.reuma.2017.05.010
pubmed: 28732643
Mitjavila F, Pac V, Moga I, Poveda R, Vidaller A, Carrera M, Pujol R (1997) Clinicopathological correlations and prognostic factors in lupus nephritis. Clin Exp Rheumatol 15(6):625–631
pubmed: 9444418
Okpechi IG, Swanepoel CR, Tiffin N, Duffield M, Rayner BL (2012) Clinicopathological insights into lupus nephritis in South Africans: a study of 251 patients. Lupus 21(9):1017–1024. https://doi.org/10.1177/0961203312441981
doi: 10.1177/0961203312441981
pubmed: 22451603
Xu YX, Tan Y, Yu F, Zhao MH (2011) Late onset lupus nephritis in Chinese patients: classified by the 2003 International Society of Nephrology and Renal Pathology Society system. Lupus 20(8):801–808. https://doi.org/10.1177/0961203310397563
doi: 10.1177/0961203310397563
pubmed: 21543512
Tang Z, Chen D, Yang S, Zhang H, Hu W, Liu Z, Li L (2011) Late onset lupus nephritis: analysis of clinical manifestations and renal pathological features in Chinese patients. Rheumatol Int 31(12):1625–1629. https://doi.org/10.1007/s00296-010-1536-9
doi: 10.1007/s00296-010-1536-9
pubmed: 20535471
Denic A, Glassock RJ, Rule AD (2016) Structural and functional changes with the aging kidney. Adv Chronic Kidney Dis 23(1):19–28. https://doi.org/10.1053/j.ackd.2015.08.004
doi: 10.1053/j.ackd.2015.08.004
pubmed: 26709059
pmcid: 4693148
Ruacho G, Kvarnstrom M, Zickert A, Oke V, Ronnelid J, Eketjall S, Elvin K, Gunnarsson I, Svenungsson E (2019) Sjogren's syndrome in systemic lupus erythematosus - a subset characterized by a systemic inflammatory state. J Rheumatol jrheum.190250. https://doi.org/10.3899/jrheum.190250
Choi JH, Park DJ, Kang JH, Yim YR, Lee KE, Lee JW, Wen L, Kim TJ, Park YW, Lee JK, Lee SS (2015) Comparison of clinical and serological differences among juvenile-, adult-, and late-onset systemic lupus erythematosus in Korean patients. Lupus 24(12):1342–1349. https://doi.org/10.1177/0961203315591024
doi: 10.1177/0961203315591024
pubmed: 26085595