Korean Journal of Nephrology 1994;13(3):533-546.

낭창성 신염의 임상 및 병리학적 연구 : 예후인자들에 관한 연관성 분석

김지훈 , 강경원 , 강종명 , 박문향

Abstract

Renal disease is a major cause of morbidity and mortality in patient with systemic lupus erythematosus (SLE). The renal pathology of SLE as demonstrated by renal biopsy, is related to patient survival and preservation of renal function. Although semiquantitative indices of nephron loss (Chronicity Index = CI) and acute potentially reversible inflammation (Activity Index= AI) are reported by some to have separate values from WHO classification as predictors of outcome and therapeutic guides, this point remains controversial. We have studied renal biopsies from 67 patients with SLE by light microscopy (LM), immunofluorescent (IF) electron microscopy (EM) and classified according to WHO classification. Semiquantitative scores of histologic features (AI & CI) identified each group. The interrelationships between tubulointerstitial immune deposits (TID), activity index (AI) and chronicity index (CI), renal function, response to treatment and prognosis were assessed in the renal boipsies from 67 patients with lupus nephritis. The prevalence of TID was 73.8%. By IF and 43.1% by EM. The highest mean AI was 13.1±3.2/24 in Class IV and then in Class V+IV and Class III in order of decreasing score. In Class V (1.9±1.3) and Class Iib (2.5±0.6) the mean Ais were significantly lower than that of focal or diffuse proliferative lesions ranging from. 6.1±2.3 to 13. 1±3.2/24. The number of patients with AI greater than 10 were 3 (42.9%) in Class II, 3 (60%.) in Class V+IV and 20 (87%) in Class IV. Mean Cis of Class Iib (1.3± 1.0) and Class V (1.5±1.9) were significantly lower than that of focal or diffuse proliferative lesions ranging from 3.0± 3.5 to 3.6±2.5/12. The incidence of patients with CI more than 3 were less than 23.1% in Class llib and V, but more than 40% upto 66.7% in focal or diffuse proliferative lesions. Among 34 patients with available follow-up information, improved group was 15 cases, stationary group being 11 cases, and aggragated group was 8 cases. There was no significant difference among these 3 groups in activity index, chronictiy index, and age. Aiso there was no significant difference between improved or stationary group and aggravated group in AI, CI, and age. Eight cases (50%) among 16 cases were improved by steroid single therapy and 7 cases (43.8%) among 16 cases were improved with combination therapy. Three cases (18.8%) among 16 cases were aggravated by steroid single therapy and 3 cases (18.8%) among 16 cases were aggravated by combination therapy. There was no significant difference between steroid single therapy and combination therapy.