狼疮性肾炎患者重复肾活检的作用(病例报告)

N. Y. Nikishin, E. Aseeva, A. Mesnyankina, S. Soloviev, E. S. Stolyarevich, V. Zelenov, A. Lila
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摘要

35%-60%的系统性红斑狼疮(SLE)患者会出现狼疮性肾炎(LN),通常发生在疾病的早期阶段。LN 是系统性红斑狼疮最严重的表现之一,如果得不到及时有效的治疗,会导致肾功能迅速而严重地丧失。尽管采用了现代药物疗法,但仍有5%-20%的患者在确诊LN后10年内发展为终末期肾衰竭。LN 治疗的主要原则是防止肾功能恶化,但目前尚未就 LN 治疗的结果评估标准和临床相关的短期和长期目标达成共识。越来越多的证据表明,重复肾活检对于评估初期治疗效果和确定肾功能衰竭的长期预后非常重要。我们描述了一个年轻患者的临床病例,该患者患有高度活动性系统性红斑狼疮,形态学确诊为 IV-S 级 LN。重复活组织检查和临床及实验室检查证实,在治疗的背景下,患者的临床和实验室病情均有所缓解。这使得减少甲泼尼龙和细胞抑制药物(霉酚酸酯)的剂量以及停止使用生物疾病调节抗风湿药物(利妥昔单抗)治疗成为可能。
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The role of repeat kidney biopsy in patients with lupus nephritis (case report)
Lupus nephritis (LN) occurs in 35–60% of patients with systemic lupus erythematosus (SLE), often in the early stages of the disease. LN is one of the most severe manifestations of SLE and, if not treated promptly and effectively, can lead to rapid and severe loss of kidney function. Despite modern pharmacotherapy, 5–20% of patients develop end-stage renal failure within 10 years of diagnosis of LN. The main principle of LN therapy is to prevent deterioration of renal function, but a consensus on outcome assessment criteria and clinically relevant short- and long-term goals for LN therapy has not yet been reached. There is increasing evidence of the importance of repeat kidney biopsies to assess the outcomes of the initial phase of therapy and to determine the long-term prognosis of renal failure. It is believed that the information obtained from repeat biopsies can help to make optimal treatment decisions and thus increase the likelihood of achieving a complete renal response in the short term and a more favorable renal prognosis in the long term.We describe a clinical case of a young patient with highly active SLE and morphologically confirmed class IV-S LN. Repeat biopsy and clinical and laboratory examination, had confirmed a clinical and laboratory remission of the disease on the background of the therapy. This made it possible to reduce the dose of methylpednisolone and cytostatic drugs (mycophenolate mofetil) and to discontinue therapy with biologic diseasemodifying antirheumatic drug (rituximab).
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