儿童Ⅲ~Ⅴ型无症状性狼疮性肾炎的危险因素及预后分析

doi:10.7499/j.issn.1008-8830.2404118

Abstract
Figure/Table
References(32)
Related Citation (15)
Read Tracking
Download Tracking

Download: PDF (623 KB) HTML
Export: BibTeX | EndNote (RIS) Supporting Info

Abstract Objective To study the risk factors and prognostic characteristics of pediatric silent lupus nephritis (SLN) with class Ⅲ to V. Methods A retrospective study was conducted to collect clinical data from 30 children diagnosed with SLN at the Department of Pediatrics, Second Xiangya Hospital, Central South University, from May 2007 to April 2023. Based on renal pathological classification, the patients were divided into a class Ⅱ group (12 cases) and a class Ⅲ to Ⅴ group (18 cases). The risk factors for the occurrence of class Ⅲ to Ⅴ SLN were analyzed, and the prognostic characteristics were summarized. Results Among the 30 SLN patients, the median follow-up time was 61.50 months. There were no statistically significant differences in the proportions of patients who discontinued glucocorticoids or achieved low disease activity status, nor in the annual decline rate of estimated glomerular filtration rate (eGFR) between the class Ⅱ and class Ⅲ to V groups (P>0.05). However, three patients in the class Ⅱ group progressed to stage 1 chronic kidney disease (CKD), while eight patients in the class III to V group reached stage 1 CKD, and four patients reached stage 2 CKD. Among the 26 female SLN patients, serum complement C3 levels in the class III to V group were lower than those in the class Ⅱ group (P<0.05). Serum C3 levels in SLN patients, as well as in female SLN patients, were negatively correlated with the fluorescence intensity of IgA, IgG, and C3 immune complexes in the kidneys (P<0.05). Additionally, serum C3 levels in female SLN patients were negatively correlated with the renal pathological activity index (P<0.05). Binary logistic regression analysis indicated that being female and having low serum complement C3 levels were risk factors for the occurrence of class Ⅲ to V SLN in children (P<0.05). Conclusions Class Ⅲ to V SLN is not uncommon among SLN children, and there remains a risk of long-term renal function progression. Being female and having low serum complement C3 levels are identified as risk factors for class Ⅲ to V SLN in children.

	Service

	E-mail this article
	Add to my bookshelf
	Add to citation manager
	E-mail Alert
	RSS
	Articles by authors
	SHEN Tian
	HE Qing-Nan
	ZHANG Qin
	CAO Yan
	DANG Xi-Qiang
	WU Xiao-Chuan
	LI Xiao-Yan

Key words： Silent lupus nephritis Complement C3 Risk factor Prognosis Child

Received: 18 April 2024

Corresponding Authors: Li X-Y Email：lixiaoyan001@csu.edu.cn。 E-mail: lixiaoyan001@csu.edu.cn

Cite this article:

SHEN Tian,HE Qing-Nan,ZHANG Qin et al. Risk factors and prognosis of pediatric silent lupus nephritis with class Ⅲ to Ⅴ[J]. CJCP, 2024, 26(9): 914-920.

URL:

http://www.zgddek.com/EN/10.7499/j.issn.1008-8830.2404118 OR http://www.zgddek.com/EN/Y2024/V26/I9/914

	Levy DM, Kamphuis S. Systemic lupus erythematosus in children and adolescents[J]. Pediatr Clin North Am, 2012, 59(2): 345-364. PMID: 22560574. PMCID: PMC3348509. DOI: 10.1016/j.pcl.2012.03.007.
	Chan EY, Yap DY, Wong WT, et al. Long-term outcomes of children and adolescents with biopsy-proven childhood-onset lupus nephritis[J]. Kidney Int Rep, 2023, 8(1): 141-150. PMID: 36644360. PMCID: PMC9831948. DOI: 10.1016/j.ekir.2022.10.014.
	Couture J, Silverman ED. Update on the pathogenesis and treatment of childhood-onset systemic lupus erythematosus[J]. Curr Opin Rheumatol, 2016, 28(5): 488-496. PMID: 27341622. DOI: 10.1097/BOR.0000000000000317.
	Groot N, Shaikhani D, Teng YKO, et al. Long-term clinical outcomes in a cohort of adults with childhood-onset systemic lupus erythematosus[J]. Arthritis Rheumatol, 2019, 71(2): 290-301. PMID: 30152151. PMCID: PMC6590133. DOI: 10.1002/art.40697.
	Zabaleta-Lanz ME, Mu?oz LE, Tapanes FJ, et al. Further description of early clinically silent lupus nephritis[J]. Lupus, 2006, 15(12): 845-851. PMID: 17211989. DOI: 10.1177/0961203306070002.
	Gonzalez-Crespo MR, Lopez-Fernandez JI, Usera G, et al. Outcome of silent lupus nephritis[J]. Semin Arthritis Rheum, 1996, 26(1): 468-476. PMID: 8870114. DOI: 10.1016/s0049-0172(96)80027-8.
	Wada Y, Ito S, Ueno M, et al. Renal outcome and predictors of clinical renal involvement in patients with silent lupus nephritis[J]. Nephron Clin Pract, 2004, 98(4): c105-c111. PMID: 15627787. DOI: 10.1159/000081551.
	Ishizaki J, Saito K, Nawata M, et al. Low complements and high titre of anti-Sm antibody as predictors of histopathologically proven silent lupus nephritis without abnormal urinalysis in patients with systemic lupus erythematosus[J]. Rheumatology (Oxford), 2015, 54(3): 405-412. PMID: 25183834. DOI: 10.1093/rheumatology/keu343.
	Zabaleta-Lanz M, Vargas-Arenas RE, Tápanes F, et al. Silent nephritis in systemic lupus erythematosus[J]. Lupus, 2003, 12(1): 26-30. PMID: 12587823. DOI: 10.1191/0961203303lu259oa.
	Cruchaud A, Chenais F, Fournié GJ, et al. Immune complex deposits in systemic lupus erythematosus kidney without histological or functional alterations[J]. Eur J Clin Invest, 1975, 5(3): 297-309. PMID: 1149788. DOI: 10.1111/j.1365-2362.1975.tb00458.x.
	Wakiguchi H, Takei S, Kubota T, et al. Treatable renal disease in children with silent lupus nephritis detected by baseline biopsy: association with serum C3 levels[J]. Clin Rheumatol, 2017, 36(2): 433-437. PMID: 27900491. DOI: 10.1007/s10067-016-3491-7.
	Mannemuddhu SS, Shoemaker LR, Bozorgmehri S, et al. Does kidney biopsy in pediatric lupus patients "complement" the management and outcomes of silent lupus nephritis? Lessons learned from a pediatric cohort[J]. Pediatr Nephrol, 2023, 38(8): 2669-2678. PMID: 36688943. PMCID: PMC10393877. DOI: 10.1007/s00467-022-05859-w.
	13 潘海英. 尿常规正常的儿童狼疮性肾炎1例[J]. 实用儿科临床杂志, 2001, 16(1): 15. DOI: 10.3969/j.issn.1003-515X.2001.01.039.
	14 刘虹, 彭佑铭, 刘伏友, 等. 无肾脏临床表现的Ⅲ+Ⅴ型狼疮性肾炎一例报道[J]. 医学临床研究, 2007, 24(10): 1824-1825. DOI: 10.3969/j.issn.1671-7171.2007.10.083.
	Weening JJ, D'Agati VD, Schwartz MM, et al. The classification of glomerulonephritis in systemic lupus erythematosus revisited[J]. Kidney Int, 2004, 65(2): 521-530. PMID: 14717922. DOI: 10.1111/j.1523-1755.2004.00443.x.
	Pennesi M, Benvenuto S. Lupus nephritis in children: novel perspectives[J]. Medicina (Kaunas), 2023, 59(10): 1841. PMID: 37893559. PMCID: PMC10607957. DOI: 10.3390/medicina59101841.
	中华医学会儿科学分会免疫学组, 中华儿科杂志编辑委员会. 中国儿童系统性红斑狼疮诊断与治疗指南[J]. 中华儿科杂志, 2021, 59(12): 1009-1024. PMID: 34856659. DOI: 10.3760/cma.j.cn112140-20210905-00743.
	Fanouriakis A, Kostopoulou M, Cheema K, et al. 2019 Update of the Joint European League Against Rheumatism and European Renal Association-European Dialysis and Transplant Association (EULAR/ERA-EDTA) recommendations for the management of lupus nephritis[J]. Ann Rheum Dis, 2020, 79(6): 713-723. PMID: 32220834. DOI: 10.1136/annrheumdis-2020-216924.
	Kidney Disease: Improving Global Outcomes (KDIGO) Glomerular Diseases Work Group. KDIGO 2021 clinical practice guideline for the management of glomerular diseases[J]. Kidney Int, 2021, 100(4S): S1-S276. PMID: 34556256. DOI: 10.1016/j.kint.2021.05.021.
	Petri M, Orbai AM, Alarcón GS, et al. Derivation and validation of the systemic lupus international collaborating clinics classification criteria for systemic lupus erythematosus[J]. Arthritis Rheum, 2012, 64(8): 2677-2686. PMID: 22553077. PMCID: PMC3409311. DOI: 10.1002/art.34473.
	Bajema IM, Wilhelmus S, Alpers CE, et al. Revision of the International Society of Nephrology/Renal Pathology Society classification for lupus nephritis: clarification of definitions, and modified National Institutes of Health activity and chronicity indices[J]. Kidney Int, 2018, 93(4): 789-796. PMID: 29459092. DOI: 10.1016/j.kint.2017.11.023.
	Franklyn K, Lau CS, Navarra SV, et al. Definition and initial validation of a lupus low disease activity state (LLDAS)[J]. Ann Rheum Dis, 2016, 75(9): 1615-1621. PMID: 26458737. DOI: 10.1136/annrheumdis-2015-207726.
	Mahajan SK, Ordó?ez NG, Feitelson PJ, et al. Lupus nephropathy without clinical renal involvement[J]. Medicine (Baltimore), 1977, 56(6): 493-501. PMID: 335188. DOI: 10.1097/00005792-197711000-00004.
	Miyata M. Clinical and pathological study of lupus nephritis without clinical renal involvement[J]. Nihon Jinzo Gakkai Shi, 1993, 35(9): 1051-1058. PMID: 8230815.
	Bennett WM, Bardana EJ, Norman DJ, et al. Natural history of "silent" lupus nephritis[J]. Am J Kidney Dis, 1982, 1(6): 359-363. PMID: 7091151. DOI: 10.1016/s0272-6386(82)80007-3.
	Fish AJ, Blau EB, Westberg NG, et al. Systemic lupus erythematosus within the first two decades of life[J]. Am J Med, 1977, 62(1): 99-117. PMID: 835595. DOI: 10.1016/0002-9343(77)90355-2.
	Weinstein A, Alexander RV, Zack DJ. A review of complement activation in SLE[J]. Curr Rheumatol Rep, 2021, 23(3): 16. PMID: 33569681. PMCID: PMC7875837. DOI: 10.1007/s11926-021-00984-1.
	Bruschi M, Angeletti A, Prunotto M, et al. A critical view on autoantibodies in lupus nephritis: concrete knowledge based on evidence[J]. Autoimmun Rev, 2024, 23(5): 103535. PMID: 38552995. DOI: 10.1016/j.autrev.2024.103535.
	Gouda W, Abd Elaziz Alsaid A, Abbas AS, et al. Silent lupus nephritis: renal histopathological profile and early detection with urinary monocyte chemotactic protein 1[J]. Open Access Rheumatol, 2022, 14: 161-170. PMID: 36133925. PMCID: PMC9482965. DOI: 10.2147/OARRR.S373589.
	Ma Y, Ding X, Shao M, et al. Association of serum complement C1q and C3 level with age-related macular degeneration in women[J]. J Inflamm Res, 2022, 15: 285-294. PMID: 35058703. PMCID: PMC8765539. DOI: 10.2147/JIR.S348539.
	Kamitaki N, Sekar A, Handsaker RE, et al. Complement genes contribute sex-biased vulnerability in diverse disorders[J]. Nature, 2020, 582(7813): 577-581. PMID: 32499649. PMCID: PMC7319891. DOI: 10.1038/s41586-020-2277-x.
	Renaudineau Y, Brooks W, Belliere J. Lupus nephritis risk factors and biomarkers: an update[J]. Int J Mol Sci, 2023, 24(19): 14526. PMID: 37833974. PMCID: PMC10572905. DOI: 10.3390/ijms241914526.