【前沿】男性狼疮肾炎患者肾活检预后不佳的预测指标是什么？

摘要：介绍：由于系统性红斑狼疮性狼疮肾炎（LN）在男性中罕见，因此其特点所知甚少。我们的目的是分析男性组织学证实的系统性红斑狼疮和LN的临床表现和病程，并确定进展为终末期肾病的危险因素。方法：总计50例患者纳入研究。他们均来自自西班牙和乌拉圭2个队列。我们对其进行回顾性分析。同时并与一个年龄和疾病特征相匹配的女性队列进行比较。结果：研究对象的肾活检时间的中位年龄为27岁（范围8-79岁）。50例患者中有26例（52％）为肾病综合征，34例为IV级LN（68％）。治疗后21例（45.6％）达到完全缓解。随访期间12例患者需要肾脏替代治疗，3例患者死于感染。将需要肾脏替代疗法的患者与不需要肾脏替代疗法的患者相比较，发现估计的肾小球滤过率<60ml / min、高血压、低白蛋白血症和伴随内脏受累（神经，心血管和/或肺部）在肾活检时显示出显着差异（P <0.05）。在多变量分析中只有估计的肾小球滤过率<60 ml /min仍然是进展为终末期肾病的危险因素。与女性LN患者队列相比，缓解或肾脏生存率无显着差异。结论：男性LN通常表现为肾病综合征、Ⅳ型LN。 肾活检时肾小球滤过率<60 ml / min与肾脏远期预后不佳相关。与女性LN患者队列相比，男性LN缓解或进展无差异。

附原文:

Abstract：Because of their rarity in men,systemiclupuserythematous and lupusnephritis (LN) are poorly understood in men. Our aim was toanalyze the clinical presentation and course ofhistology-provensystemiclupuserythematous and LN in males and todetermine the risk factors for progression to end-stage renal disease.METHODS:Fifty patients from 2 historical cohorts in Spain(Hospital 12 de Octubre) and Uruguay were retrospectively analyzed and comparedwith a female cohort matched for age and diseasecharacteristics.RESULTS:The median age at the time of renal biopsy was 27years (range, 8-79 years). The main forms of presentation were nephrotic syndromein 26 of 50 patients (52%), and class IV LN in 34 of 50 (68%). After treatment,21 patients (45.6%) achieved complete renal remission. During follow-up, 12patients required renal replacement therapy, and 3 patients died of infectiouscauses. When patients who required renal replacement therapy were compared withthose who did not require it, several parameters showed significant differences(P< 0.05) at the time of renal biopsy: estimated glomerular filtrationrate< 60 ml/min, hypertension, hypoalbuminemia, and concomitantvisceral involvement (neurologic, cardiovascular, and/or pulmonary). In themultivariate analysis, only estimated glomerular filtration rate< 60ml/min persisted as a risk factor for progression to end-stage renal disease. Whencompared with a cohort of female patients with LN, there were no significantdifferences in remission or renal survival.DISCUSSION:LN in males usuallypresents as nephrotic syndrome, and type IV LN is the most frequent form. Anestimated glomerular filtration rate< 60 ml/min at the time of renalbiopsy is associated with poor renal outcomes. There were no differences inremission or progression of LN in males when compared with a cohort of femalepatients with LN.

引自:

Urrestarazú A,Otatti G,Silvariño R,Garau M,Coitiño R,Alvarez A,Gonzalez E,Gadola L,Praga M,Noboa O.LupusNephritisin Males: Clinical Features, Course, and Prognostic Factors for End-Stage RenalDisease.

Kidney Int Rep.2017 Jun 16;2(5):905-912.doi: 10.1016/j.ekir.2017.05.011.