Repeat renal biopsy findings in 82 lupus nephritis patients: a clinicopathological study.

IF 0.9 Q4 ONCOLOGY
International journal of clinical and experimental pathology Pub Date : 2025-07-15 eCollection Date: 2025-01-01 DOI:10.62347/VFGO9374
Sixing Li, Kun Yang, Cheng Zhao, Fei Dong, Wen Zeng, Jiale Wen, Zhendong He, Wenjing Huang, Fang Qin
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引用次数: 0

Abstract

Objective: Lupus nephritis (LN) is among the most severe complications of systemic lupus erythematosus and is associated with increased mortality. The aim of this study was to explore the value and clinical utility of repeat renal biopsies in patients with LN.

Methods: We conducted a retrospective study of patients with biopsy-proven LN who had undergone at least two renal biopsies at First Affiliated Hospital of Guangxi Medical University from June 1, 2012 to March 31, 2024. A comparative analysis was conducted on the clinical data obtained from both renal biopsies, including demographic information, clinical manifestations, laboratory results, and pathological findings collected at the time of each biopsy. Paired sample T-test and chi-square test were used for statistical analysis.

Results: A total of 82 patients met the inclusion criteria. The male-to-female ratio of our study cohort was 1:5.83. At the first biopsy, the predominant pathological types were class IV (23.2%) and class III+V (24.4%) lupus nephritis (LN). In contrast, at the repeat biopsy, class IV (25.6%) and class IV+V (24.4%) were the most common types. Among the 82 patients included in the study, 51 (62.2%) exhibited worsening pathological types, while 24 (29.3%) showed no improvement. Compared with results obtained at the first biopsy, the prevalence of crescents increased significantly from 19.5% to 45.1%, the prevalence rates of proteinuria, pyuria, and cellular casts, as well as pathological findings of global sclerosis, tubular atrophy, interstitial fibrosis, and inflammatory cell infiltration were increased at the second biopsy (P<0.05). Estimated glomerular filtration rates were lower at the second than those at the first biopsy (P<0.05).

Conclusion: Renal biopsy should be repeated in patients with LN who have undergone treatment if urinalysis results and renal function worsen or do not improve to determine whether the pathological class of LN has changed and whether LN is in the active phase. Repeat renal biopsies show increased chronicity, the pathological types are predominantly non-remitting or worsening, with a considerable proportion of patients also presenting with crescentic glomerulonephritis. Repeat renal biopsy is necessary for the diagnosis of LN patients and may inform the design of subsequent treatment plans.

82例狼疮性肾炎患者重复肾活检结果:临床病理研究。
目的:狼疮肾炎(LN)是系统性红斑狼疮最严重的并发症之一,与死亡率增加有关。本研究的目的是探讨重复肾活检在LN患者中的价值和临床应用。方法:回顾性研究2012年6月1日至2024年3月31日在广西医科大学第一附属医院接受过两次以上肾活检的经活检证实的LN患者。对两组肾活检的临床资料进行比较分析,包括人口统计学信息、临床表现、实验室结果和每次活检时的病理结果。采用配对样本t检验和卡方检验进行统计分析。结果:共有82例患者符合纳入标准。本研究队列的男女比例为1:5.83。第一次活检时,主要病理类型为IV级(23.2%)和III+V级(24.4%)狼疮性肾炎(LN)。相比之下,在重复活检中,IV型(25.6%)和IV+V型(24.4%)是最常见的类型。纳入研究的82例患者中,51例(62.2%)病理类型恶化,24例(29.3%)无改善。与第一次活检结果相比,新月状病变的患病率从19.5%显著上升至45.1%,蛋白尿、脓尿、细胞型铸造的患病率,以及全球硬化症、小管萎缩、间质纤维化和炎症细胞浸润的病理表现在第二次活检中有所增加(p)。对于接受过治疗的LN患者,如果尿液分析结果和肾功能恶化或没有改善,应重复进行肾活检,以确定LN的病理类型是否发生变化以及LN是否处于活动期。重复肾活检显示慢性加重,病理类型以不缓解或恶化为主,相当比例的患者还表现为新月形肾小球肾炎。重复肾活检对于LN患者的诊断是必要的,并且可以为后续治疗计划的设计提供信息。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
自引率
0.00%
发文量
42
审稿时长
1 months
期刊介绍: The International Journal of Clinical and Experimental Pathology (IJCEP, ISSN 1936-2625) is a peer reviewed, open access online journal. It was founded in 2008 by an international group of academic pathologists and scientists who are devoted to the scientific exploration of human disease and the rapid dissemination of original data. Unlike most other open access online journals, IJCEP will keep all the traditional features of paper print that we are all familiar with, such as continuous volume and issue numbers, as well as continuous page numbers to keep our warm feelings towards an academic journal. Unlike most other open access online journals, IJCEP will keep all the traditional features of paper print that we are all familiar with, such as continuous volume and issue numbers, as well as continuous page numbers to keep our warm feelings towards an academic journal.
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