Abstract: Ｏｂｊｅｃｔｉｖｅ：We aimed to analyze the clinicalmorphologic features of and risk factors for acute kidney injury(AKI) in patients with lupus podocytopathy, and to assess the impact of AKI on renal prognosis.
Ｍｅｔｈｏｄｏｌｏｇｙ：90 patients with lupus podocytopathy were included and divided into AKI group and nonAKI group. The kidney histological semiquantitative scors of acute／chronic tubuleinterstitial injury (ATI／CTI) were evaluated by light micnoscopy, immumofluorescence and electron microscopy. Kidney endpoint included endstage kidney disease, or a sustained decline in eGFR of at least 50％.
Ｒｅｓｕｌｔｓ：Among 90 lupus podocytopathy patients, 32 patients (356％) had AKI. Compared with patients in nonAKI group, patients in AKI group showed a significantly higher levels of urine protein, urine NAG, urine RBP, ATI score, and higher proportion of podocyte foot process effacement, but a significantly lower blood levels of hemoglobin, serum albumin, C3, and C4. Multivariate analysis indicated that high urine protein (OR=1195, 95％CI 1793～21678, P=0033), and low serum C3 (OR=0015, 95％CI 0001～0225, P=0002) were two independent risk factors for AKI.There was no significant difference in the renal remission between two groups. None of patients reached the kidney endpoint during a median followup of 671 months, but patients in AKI group showed significantly higher kidney relapse rate than patients in nonAKI group (800％ vs 500％, P=0010).
Ｃｏｎｃｌｕｓｉｏｎ：We found that patients with lupus podocytopathy had a high incidence of AKI, and that high proteinuria and low serum C3 level were risk factors for the development of AKI. AKI in lupus podocytopathy patients significantly increased the risk of kidney relapse but showed no effects on longterm renal survival.