Clinical characteristics of tubulointerstitial lesions and their impacts on prognosis of lupus nephritis

Abstract

Objective To investigate the clinical characteristics of tubulointerstitial lesions (TIL) and their impacts on prognosis of lupus nephritis. Methods Three hundred and nine patients with lupus nephrits from the Department of Nephrology, Chinese PLA General Hospital, were confirmed by renal biopsy. Clinical and pathological parameters of this cohort were collected. All patients were reviewed and reclassified according to the 2003 Classification System of International Society of Nephrology (ISN)/Renal Pathology Society (RPS). Semiquantitative score was used to assess the severity of renal injury. Kaplan-Meier curve was used to analyze the outcomes of patients with different TIL. Results The percentages of interstitial inflammatory cells infiltration, tubular atrophy, interstitial fibrosis, and tubular epithelial cell degeneration were 86.5%, 66.5%, 66.9%, and 55.1%, respectively. Class Ⅱ, Ⅲ, Ⅳ, and Ⅴ lupus nephritis were different from each other in the interstitial inflammatory cells infiltration, tubular atrophy, interstitial fibrosis, and tubular epithelial cell degeneration (all P 0.05). The interstitial inflammatory cells infiltration, tubular atrophy, and interstitial fibrosis were associated with the patients′ prognosis: the more severe TILs, the poorer prognosis (all P<0.001). Conclusions The incidence of TILs in lupus nephritis was high. TILs in different classes of lupus nephritis were different from each other. The degree of TILs did not affect the pathological transformation of class IV lupus nephritis, and the changes of TILs before and after pathological transformation were not obvious. TILs may predict the renal outcomes: the more severe TILs, the poorer prognosis. Key words: Lupus nephritis; Tubulointerstitial lesions; Prognosis