High-Risk Indicators of Renal Involvement in Primary Sjogren's Syndrome: A Clinical Study of 1002 Cases.

Jing Luo,Jian-Wu Wang,Yu-Wei Huo,Hui Guo

doi:10.1155/2019/3952392

Jing Luo, Jian-Wu Wang + Show 2 more

Open Access

https://doi.org/10.1155/2019/3952392

Copy DOI

Abstract

Objective A retrospective analysis of clinical characteristics and immunological manifestations of primary Sjogren's syndrome (pSS) patients with or without renal involvement was conducted in order to elucidate the potential risk factors of renal damage in pSS and evaluate the condition. Methods A total of 1002 patients, who fulfilled the 2002 classification criteria for pSS from the Second Affiliated Hospital of Shanxi Medical University, were enrolled in the cross-sectional study. Clinical, immunological, and histological characteristics were compared between pSS patients with and without renal involvement, and potential risk factors of renal involvements in pSS patients were examined by multivariate analysis. Results Among these pSS patients, there were 162 cases (16.17%) with and 840 cases (83.83%) without renal damage. Serious edema of both lower limbs, interstitial nephritis, and renal tubular acidosis were found in the pSS with renal damage group. Compared with simple pSS patients, the levels of creatinine, cystatin C, and alpha-1-microglobulin (α1-MG) in the pSS with renal damage group were significantly increased. The difference between the two groups was statistically significant (P < 0.05). The AUC of the combination of creatinine and α1-MG and creatinine, α1-MG, and creatinine was statistically larger than that of creatinine, and the biomarker of the biggest AUC is the combination of creatinine and α1-MG. Conclusion The main clinical manifestations of pSS with renal damage were edema of the lower limbs, interstitial nephritis, and renal tubular acidosis. Creatinine and α1-MG are effective indicators for renal function in pSS, which may provide a better understanding for clinical decision-making.

Highlights

Sjogren’s syndrome (SS) is a chronic progressive autoimmune disorder characterized by lymphocytic infiltration of the exocrine glands, which affects the salivary and lacrimal glands, presenting dryness of the mouth and eyes
Demographic, clinical, histological, immunological, inflammatory feature, and outcome measure data were presented in Tables 1 and 2, collected from -162 primary Sjogren’s syndrome (pSS) patients with and 840 without renal involvement
The pathological features of pSS with renal damage are the lymphocytic infiltration of the renal parenchyma rather than immune complex deposition and renal tubular atrophy that mainly presented interstitial nephritis mediated by an immune mechanism [9,10,11]

Summary

Introduction

Sjogren’s syndrome (SS) is a chronic progressive autoimmune disorder characterized by lymphocytic infiltration of the exocrine glands, which affects the salivary and lacrimal glands, presenting dryness of the mouth and eyes. The majority of infiltrating mononuclear cells are CD4+ T cells [1]. Some patients may present diverse extraglandular impairment such as that in the lungs, kidneys, nervous system, and skin affected by this disorder [2]. Renal involvement is ignored by the physicians because the clinical symptoms are often insidious. Growing evidence suggests that patients with pSS may have greater renal injury risk than the general population and the most common renal disease in SS is tubulointerstitial nephritis, responsible for renal tubular acidosis in 20% [3]. It is still challenging to diagnose renal involvement in pSS patients

Methods

Results

Conclusion