Korean Journal of Nephrology 1988;7(2):329-337.

낭창성 신염 환자에서 단백뇨의 임상적의의

정동균 , 이호영 , 함영환 , 김미림 , 최규헌 , 한대석

Abstract

Among 188 SLE patients who were admitted to Yonsei University Severance hospital from January 1979 to April 1988 meeting the diagnostic criteria proposed by American Rheumatism Association in 1982, 95 patients showing proteinuria more than 300 mg per day were studied. We evaluated the relationship between the severity of proteinuria and both clinical and pathologic features after dividing the patients into three groups according to the degree of proteinuria. 1) The mean ages of the patients were not different among 3 groups (group 1 25.6±9.5, group 2 28.9±11.9, group 3 29.1±8.9, respectively) and most of the patients were in the range between 20 and 40 yrs, The male to female ratio was 1:12.5 in group 1 and 1:5.8, 1:4.4 in group 2 and 3, respectively. 2) Heavy proteinuria was associated with higher fre- quency of hypertenion and 13 of 27 patients (49.1%) in group 3 had hypertension, as compared to 4 of 27 (14.8%) in group 1 and 19 of 41 (46.3%) in group 2. 3) Lymphocytopenia and thrombocytopenia was ob- served more frequently in group 3 than other groups and initial serum creatinine level was significantly higher in group 2 and group 3 suggesting higher incidence of renal functional impairment in severe proteinuric patients. 4) In 56 patients who were followed for more than 3 months, both the initial and the final serum creatinine level were significantly higher in group 3 than other groups but the rate of increase in serum creatinine during this period was not statistically different among 3 groups. 5) Diffuse proliferative glomerulonephritis was the most frequent pathologic type found in all 3 groups and membranous type was most frequently seen in group 3. 6) Mortality had occurred in 14 patients during follow-up and 5 patients died of sepsis, 4 patients of CNS involvement. Based on these results, patients initially presenting with heavy proteinuria in lupus nephritis had an in- creasd frequency of renal insufficiency and hyperten- sion. However, futher prospective study may be needed to verify the usefulness of proteinuria as a prognostic indicator in lupus nephritis.