Clinical characteristics of tubulointerstitial lesions and their impacts on prognosis of lupus nephritis

doi:10.3877/cma.j.issn.2095-3216.2017.02.003

Abstract

Abstract:

Objective

To investigate the clinical characteristics of tubulointerstitial lesions (TIL) and their impacts on prognosis of lupus nephritis.

Methods

Three hundred and nine patients with lupus nephrits from the Department of Nephrology, Chinese PLA General Hospital, were confirmed by renal biopsy. Clinical and pathological parameters of this cohort were collected. All patients were reviewed and reclassified according to the 2003 Classification System of International Society of Nephrology (ISN)/Renal Pathology Society (RPS). Semiquantitative score was used to assess the severity of renal injury. Kaplan-Meier curve was used to analyze the outcomes of patients with different TIL.

Results

The percentages of interstitial inflammatory cells infiltration, tubular atrophy, interstitial fibrosis, and tubular epithelial cell degeneration were 86.5%, 66.5%, 66.9%, and 55.1%, respectively. Class Ⅱ, Ⅲ, Ⅳ, and Ⅴ lupus nephritis were different from each other in the interstitial inflammatory cells infiltration, tubular atrophy, interstitial fibrosis, and tubular epithelial cell degeneration (all P<0.05). The severity of TIL in class Ⅲ and Ⅳ lupus nephritis were more severe than those in class Ⅱ and Ⅴ (χ² =13.857, P﹤0.001). 47 patients with class Ⅳ lupus nephritis received repeat-biopsies, among whom 14 cases transformed to class Ⅱ, but the differences in interstitial inflammatory cells infiltration, tubular atrophy, interstitial fibrosis, and tubular epithelial cell degeneration were not significant (all P>0.05). The interstitial inflammatory cells infiltration, tubular atrophy, and interstitial fibrosis were associated with the patients′ prognosis: the more severe TILs, the poorer prognosis (all P<0.001).

Conclusions

The incidence of TILs in lupus nephritis was high. TILs in different classes of lupus nephritis were different from each other. The degree of TILs did not affect the pathological transformation of class IV lupus nephritis, and the changes of TILs before and after pathological transformation were not obvious. TILs may predict the renal outcomes: the more severe TILs, the poorer prognosis.

Key words: Lupus nephritis, Tubulointerstitial lesions, Prognosis

Yan Zhang, Guangyan Cai, Shuwen Liu, Xueguang Zhang, Jia Kou, Pu Chen, Jie Wu, Jinling Meng, Zhong Yin, Li Zhang, Xiangmei Chen. Clinical characteristics of tubulointerstitial lesions and their impacts on prognosis of lupus nephritis[J]. Chinese Journal of Kidney Disease Investigation(Electronic Edition), 2017, 06(02): 58-63.

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Figures/Tables 6

References 20

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项目	例数(%)或(±s)
女性	242(78.32)
年龄(岁)	31.18±11.72
高血压	120(38.83)
大量蛋白尿	141(45.63)
血尿	226(73.14)
贫血	232(75.08)
血小板减少	50(16.18)
白细胞减少	70(22.65)
血清肌酐升高	110(35.60)
高脂血症	224(72.49)
低补体	267(86.41)
抗核抗体阳性率^a	239/289(82.70)
抗ds-DNA抗体阳性率^b	127/251(50.60)
活动性指数	6.09±3.89
慢性化指数	3.00±2.70
细胞增殖	1.94±0.86
肾小球白细胞浸润	0.84±0.81
袢坏死和(或)核碎裂	0.90±1.35
微血栓	0.19±0.51
细胞性新月体	1.05±1.65
球性硬化	0.66±0.85
纤维性新月体	0.21±0.53
间质炎细胞浸润	1.40±0.89
肾小管上皮细胞变性	0.33±0.52
肾小管萎缩	1.04±0.98
间质纤维化	1.06±0.98
血管壁增厚	0.64±0.99
透明样变	0.06±0.27
纤维素样坏死	0.03±0.25

项目	例数(%)或(±s)
女性	242(78.32)
年龄(岁)	31.18±11.72
高血压	120(38.83)
大量蛋白尿	141(45.63)
血尿	226(73.14)
贫血	232(75.08)
血小板减少	50(16.18)
白细胞减少	70(22.65)
血清肌酐升高	110(35.60)
高脂血症	224(72.49)
低补体	267(86.41)
抗核抗体阳性率^a	239/289(82.70)
抗ds-DNA抗体阳性率^b	127/251(50.60)
活动性指数	6.09±3.89
慢性化指数	3.00±2.70
细胞增殖	1.94±0.86
肾小球白细胞浸润	0.84±0.81
袢坏死和(或)核碎裂	0.90±1.35
微血栓	0.19±0.51
细胞性新月体	1.05±1.65
球性硬化	0.66±0.85
纤维性新月体	0.21±0.53
间质炎细胞浸润	1.40±0.89
肾小管上皮细胞变性	0.33±0.52
肾小管萎缩	1.04±0.98
间质纤维化	1.06±0.98
血管壁增厚	0.64±0.99
透明样变	0.06±0.27
纤维素样坏死	0.03±0.25

项目	间质炎细胞浸润	肾小管萎缩	间质纤维化	肾小管上皮细胞变性
Ⅱ型	0.70±0.59	0.45±0.56	0.42±0.61	0.36±0.60
Ⅲ型	1.28±0.65	1.21±0.62	1.07±0.75	0.69±0.76
Ⅳ型	1.66±0.92	1.22±1.08	1.27±1.05	0.91±0.93
Ⅴ型	0.96±0.51	0.64±0.68	0.64±0.62	0.71±0.71
t值	41.30	40.27	25.99	11.60
P值	<0.001	0.003	<0.001	0.018

项目	间质炎细胞浸润	肾小管萎缩	间质纤维化	肾小管上皮细胞变性
Ⅱ型	0.70±0.59	0.45±0.56	0.42±0.61	0.36±0.60
Ⅲ型	1.28±0.65	1.21±0.62	1.07±0.75	0.69±0.76
Ⅳ型	1.66±0.92	1.22±1.08	1.27±1.05	0.91±0.93
Ⅴ型	0.96±0.51	0.64±0.68	0.64±0.62	0.71±0.71
t值	41.30	40.27	25.99	11.60
P值	<0.001	0.003	<0.001	0.018

组别	例数	转为Ⅱ型的患者
组别	例数	间质炎细胞浸润	肾小管萎缩	间质纤维化	肾小管上皮细胞变性	AI	CI
首次	14	1.33±0.72	0.73±0.80	0.93±0.70	1.00±0.76	8.67±4.01	2.27±2.15
重复	14	1.00±0.65	0.93±0.59	0.93±0.59	2.53±0.92	2.53±0.92	2.53±1.60
t值	?	1.810	0.966	0.287	1.164	3.904	1.149
P值	?	0.096	0.317	0.799	0.291	0.002	0.250
组别	例数	维持Ⅳ型或转为Ⅲ型的患者
组别	例数	间质炎细胞浸润	肾小管萎缩	间质纤维化	肾小管上皮细胞变性	AI	CI
首次	33	1.81±0.79	1.17±0.90	1.25±0.94	1.24±0.92	9.31±3.69	3.33±2.45
重复	33	1.61±0.87	1.47±0.91	1.56±0.91	1.09±0.90	5.36±2.74	4.83±0.91
t值	?	0.736	0.810	1.160	0.345	4.460	2.17
P值	?	0.469	0.418	0.246	0.730	﹤0.001	0.03
t值₁	?	1.726	1.312	0.987	0.692	0.312	1.022
P值₁	?	0.073	0.171	0.324	0.531	0.604	0.235

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