狼疮性肾炎的肾活检指征
- Authors
- Ronald J Falk, MD
Ronald J Falk, MD
- Nan and Hugh Cullman Eminent Professor of Nephrology
- Chair, Department of Medicine
- Director, UNC Kidney Center
- University of North Carolina-Chapel Hill
- Maria Dall'Era, MD
Maria Dall'Era, MD
- Professor of Medicine
- University of California, San Francisco
- Gerald B Appel, MD
Gerald B Appel, MD
- Section Editor — Glomerular Diseases
- Professor of Medicine
- Columbia University College of Physicians and Surgeons
- Section Editors
- Richard J Glassock, MD, MACP
Richard J Glassock, MD, MACP
- Editor-in-Chief — Nephrology
- Section Editor — Glomerular Diseases
- Emeritus Professor
- The David Geffen School of Medicine at UCLA
- Brad H Rovin, MD
Brad H Rovin, MD
- Section Editor — Glomerular Diseases
- Professor of Medicine and Pathology
- The Ohio State University College of Medicine
- Deputy Editor
- John P Forman, MD, MSc
John P Forman, MD, MSc
- Senior Deputy Editor — UpToDate
- Deputy Editor — Nephrology
- Assistant Professor of Medicine
- Harvard Medical School
- Translators
- 刘峰, 副主任医师
刘峰, 副主任医师
- 上海东方医院肾内科
引言
大约60%的系统性红斑狼疮(systemic lupus erythematosus, SLE)患者会出现肾脏受累，这是该类患者的一个重要并发症[1]。狼疮性肾炎(lupus nephritis, LN)有多种组织学亚型，不同亚型的最佳治疗方案不同[2]。尽管临床表现、尿液分析和肾功能估计值可能提示某种特定亚型，但仍需肾活检来确定正确的类别或分类。
本专题将总结已确诊SLE患者的肾活检指征。LN的各种类型和分类、治疗以及终末期肾病(end-stage renal disease, ESRD)患者的管理将单独讨论。 (参见“系统性红斑狼疮患者肾脏疾病的诊断及分型”和“弥漫性或局灶性增生性狼疮性肾炎的治疗”和“膜性狼疮性肾病的临床特征和治疗”和“狼疮性肾炎导致的终末期肾病”)
分类和临床表现
国际肾脏病学会(international society of nephrology, ISN)的LN病理学分类方案将在别处详细讨论，但会在此进行总结。被广泛使用的ISN分类是对世界卫生组织(world health organization, WHO)制定的旧分类系统的改良。 (参见“系统性红斑狼疮患者肾脏疾病的诊断及分型”，关于‘分型’一节)
ISN分类将狼疮相关肾小球病变分为6种不同的主要类型或模式，根据光学显微镜下病变的活动性和慢性程度又分为许多亚类[3]。虽然这些病变往往具有独特的组织学、临床和预后特征，但是不同类型之间又有很多重合之处，这种情况部分是由采样差异造成的。此外，相当一部分患者会自发地或在治疗后从一种类型演变为另一种类型。例如，在一项较早的病例系列研究中，在10年时患者从膜性LN转变成膜性增生性LN的概率为35%[4]。这一观察结果并不令人意外，因为不同的LN组织学类型代表对免疫复合物沉积的非特异性反应。 (参见“膜性狼疮性肾病的临床特征和治疗”，关于‘预后’一节)
轻微系膜性LN(Ⅰ型) — 轻微系膜性LN是肾小球受累最早和最轻的病变类型。光镜下肾小球表现正常，但是免疫荧光和电镜下可见系膜区免疫复合物沉积。受累患者的尿液分析和血清肌酐浓度通常正常，因此一般不会进行肾活检，故通常也就不能确诊。
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To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:Literature review current through: 2017-06 . | This topic last updated: 2015-10-06.The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.References- Beck LH Jr, Salant DJ. Treatment of membranous lupus nephritis: where are we now? J Am Soc Nephrol 2009; 20:690.
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