Abstract:

Ｏｂｊｅｃｔｉｖｅ：To compare the differences of clinical and immunological features, renal morphology and outcomes of mesangial proliferative lupus nephritis (LN) with or without podocytopathy.
Ｍｅｔｈｏｄｏｌｏｇｙ：one hundred and eight biopsies from 3 750 SLE patients who showed mesangial immune deposits with mesangial proliferation were included. They were divided into two groups according to the extent of foot process effacement (FPE) and proteinuria: podocytopathy group (FPE>50%, with nephrotic syndrome, n=28) and mesangial group (PFE≤50%, n=80). Mesangial proliferation and tubularinterstitial lesion were semiquantitatively scored.
Ｒｅｓｕｌｔｓ：The median FPE were 825%（70%，85%）in podocytopathy group and 15%（10%，25%）in mesangial group (P<0001). To compare with mesangial group, the incidence of renal onset (607％ vs 238％), nephrotic syndrome, acute kidney injury (250% vs 25%), severe tubular interstitial lesion, and urinary NAG were much higher, while incidence of arthritis, fever, serum positive APL, low serum C4, hematuria was much lower in podocytopathy group. The rate of sever acute tubularinterstitial lesion and tubular immune deposition, renal relapse rate (536％ vs 290％) were significant higher in podocytopathy group than that in mesangial group. No patients died or developed ESRD during followup in both two groups.
Ｃｏｎｃｌｕｓｉｏｎ：Mesangial proliferative lupus nephritis with podocytopathy should be differentiated from mesangial proliferative lupus nephritis without podocytopathy, and the classification of lupus nephritis should be reclassified.