Objective: To investigate the clinicopathological characteristics and prognosis of patients with lupus nephritis (LN) presenting with acute kidney disease (AKD). Methods: A retrospective study was conducted on 1 136 patients diagnosed with LN via renal biopsy at the First Affiliated Hospital of Zhengzhou University between January 1, 2012, and May 31, 2019. Clinicopathological features, treatment regimens, and prognosis were compared between the AKD group and the non-AKD group among LN patients. Propensity score matching (1∶1 ratio, caliper=0.03) was used to balance differences in sex, age, Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) score, and LN pathological class. Kaplan-Meier survival analysis and multivariate COX regression models were applied to evaluate the impact of AKD on patient prognosis. Additionally, a subgroup analysis was performed among the LN patients with AKD to assess the effect of renal recovery at the 6-month follow-up on long-term prognosis. Results: The incidence of AKD among LN patients was 19.19% (218/1 136). In the LN with AKD group, 171 patients (78.44%) were female, and the median age was 29 (23, 43) years. Compared with patients without AKD, those with AKD exhibited a significantly higher prevalence of hypertension [52.75% (115/218) vs. 26.90% (247/918)], higher SLEDAI scores [8 (5, 12) vs. 5 (4, 10)], higher serum creatinine [153 (126, 210) μmol/L vs. 62 (51, 76) μmol/L], and higher 24-hour urine protein [3.96 (2.35, 6.70) g vs. 2.66 (1.35, 4.99) g, all P<0.05]. Patients with AKD also displayed higher renal pathological Activity Index [9 (5, 13) vs. 5 (2, 8)] and Chronicity Index scores [1 (0, 4) vs. 0 (0, 1)], alongside higher utilization rates of induction-phase glucocorticoid pulse therapy [5.96% (13/218) vs. 0.76% (7/918)], hemodialysis [1.83% (4/218) vs. 0.11% (1/918)], and plasma exchange [1.83% (4/218) vs. 0.22% (2/918)] (all P<0.05). After propensity score matching (205 patients per group), survival analysis showed that patients with AKD had lower short-term (6-month) and long-term survival rates than those without AKD (short-term: log-rank test χ2=31.64, P<0.001; long-term: log-rank test χ2=12.61, P<0.001). Multivariate COX regression analysis revealed that AKD was an independent risk factor for both poor short-term prognosis (HR=4.84, 95%CI 1.05-22.22, P=0.043) and poor long-term prognosis (HR=4.68, 95%CI 2.25-9.72, P<0.001) in patients with LN. Among patients with AKD, those who achieved renal recovery at the 6-month follow-up experienced a higher long-term survival rate than those who did not (log-rank test χ2=51.61, P<0.001). Conclusions: The incidence of AKD is relatively high among patients with LN. Moreover, LN patients presenting with AKD exhibit more severe clinical and pathological manifestations, resulting in worse short-term and long-term prognoses. Early renal recovery contributes to improved long-term outcomes in this population. 目的： 探讨合并急性肾脏病（AKD）的狼疮性肾炎（LN）患者的临床病理特征及预后。 方法： 回顾性纳入2012年1月1日至2019年5月31日于郑州大学第一附属医院行肾穿刺活检术确诊为LN的1 136例患者，按是否合并AKD分为两组，比较两组患者的临床病理特征、治疗方案及预后。采用倾向性评分匹配法（1∶1匹配，卡钳值0.03）均衡两组在性别、年龄、系统性红斑狼疮疾病活动度指数（SLEDAI）及LN病理分型上的差异。进一步通过Kaplan-Meier生存分析及多因素Cox回归模型评估合并AKD对患者预后的影响，并在合并AKD的LN患者中进行亚组分析，评估随访6个月时肾功能恢复情况对长期预后的影响。 结果： LN患者中AKD的发生率为19.19%（218/1 136）。合并AKD组中女性171例（78.44%），中位年龄为29（23，43）岁。与不合并AKD组相比，合并AKD组患者高血压比例［52.75%（115/218）比26.90%（247/918）］、SLEDAI评分［8（5，12）分比5（4，10）分］、血肌酐［153（126，210）μmol/L比62（51，76）μmol/L］、24 h尿蛋白总量［3.96（2.35，6.70）g比2.66（1.35，4.99）g］更高，LN病理活动性指数评分［9（5，13）分比5（2，8）分］及慢性指数评分［1（0，4）分比0（0，1）分］更高，且诱导期糖皮质激素冲击［5.96%（13/218）比0.76%（7/918）］、血液透析［1.83%（4/218）比0.11%（1/918）］、血浆置换［1.83%（4/218）比0.22%（2/918）］的使用率更高（均P<0.05）。倾向性评分匹配后生存分析显示，合并AKD组短期（6个月）及长期生存率均低于不合并AKD组（每组205例，log-rank检验，χ2=31.64、12.61，均P<0.001）。多因素Cox回归分析显示，合并AKD是LN患者短期不良预后的危险因素（HR=4.84，95%CI 1.05~22.22，P=0.043），亦是长期不良预后的危险因素（HR=4.68，95%CI 2.25~9.72，P<0.001）。在合并AKD组中，随访6个月时肾功能恢复患者的长期生存率高于未恢复者（log-rank检验χ2=51.61，P<0.001）。 结论： LN患者中AKD发生率较高。合并AKD的LN患者临床及病理表现均更重，短期及长期预后更差；早期肾功能恢复有助于改善其长期预后。.
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PubMed · 2026-05-01
PubMed · 2026-07-01
PubMed · 2026-07-01