摘要（台湾） 背景：本研究的目的是探讨系统性红斑狼疮肾受累的患者早期行肾活检的意义。

方法：我们对本医学中心自2000.1至2009.12行肾活检的狼疮病人进行回顾性分析。要求入组的病人行肾活检的时间必须在首次出现肾病表现的3个月之内。

结果：研究对象共纳入131例。以急性肾衰竭为表现的病人中，91%为增生性狼疮性肾炎（IV型，Ⅴ+Ⅲ混合型），9%为非增生性狼疮性肾炎（单纯Ⅴ型）。以肾性蛋白尿且尿蛋白量达肾病综合征为表现的病人中，增生性狼疮性肾炎（Ⅲ型，Ⅳ型，Ⅴ+Ⅲ混合型）及非增生性狼疮性肾炎（Ⅱ型，单纯Ⅴ型）分别占55%和36%，另外还有9%的患者没有狼疮性肾炎病理表现。在本组患者中，除了抗ds-DNA抗体在增生性狼疮性肾炎患者中更常见外（p=0.043），其余临床特点均不能预测肾脏受累的类型。有蛋白尿但尿蛋白量未达肾病综合征的患者中，49%为增生性狼疮性肾炎（Ⅲ型，Ⅳ型，Ⅴ+Ⅲ混合型），51%为非增生性狼疮性肾炎（Ⅱ型，单纯Ⅴ型）。在本组中，增生性狼疮性肾炎患者的补体C4水平下降更为普遍（p=0.031）。在以孤立性血尿为表现的病人中，所有患者均无活动性肾病表现。29%的急性肾衰竭患者，43%的肾病综合征范围的蛋白尿患者及53%的低于肾病综合征范围的蛋白尿患者因其肾活检的发现而增强了其免疫抑制剂治疗。

结论：我们的数据提示相似的临床肾病表现可能具有截然不同的病理类型。临床医生倾向于对于严重的狼疮性肾炎的患者，待其病理结果汇报后再开始免疫抑制剂治疗，以免过强的免疫抑制剂治疗给患者带来潜在的风险。因此，SLE具有临床肾病表现的患者，早期的肾活检对于制定治疗方案是非常有益的。

附原文：Abstract Background: The goal of this study is to determine the value of early renal biopsy as a therapeutic guide in systemic lupus erythematosus (SLE) patients presenting with renal involvement. Methods: We retrospectively analyzed renal biopsies findings in SLE patients between January 2000 and December 2009 encountered at a medical center in Taiwan. An additional criterion for inclusion in this study was kidney biopsy done within 3 months of the first detection of sign(s) of renal disease.Results: There were 131 patients enrolled in this study. In patients presenting with acute renal failure, 91% of patients had proliferative lupus nephritis (Class IV, mixed Class V+III) and 9% had non-proliferative lupus nephropathy (pure Class V). In patients presenting with nephrotic range proteinuria, proliferative lupus nephritis (Class III, IV, mixed Class V+III) and non-proliferative lupus nephropathy (Class II, pure Class V) accounted for 55% and 36% of patients, respectively; and 9% had non-lupus nephropathy. In this group, except that elevated anti-double-stranded DNA antibody levels were more common in proliferative lupus nephritis (p = 0.043), no clinical findings could predict the renal morphology. In patients presenting with subnephrotic proteinuria, 49% of patients had proliferative lupus nephritis (Class III, IV, mixed Class V+III) and 51% had non-proliferative lupus nephropathy (Class II, pure Class V), and decreased C4 levels were more common in patients with proliferative lupus nephritis (p = 0.031). In patients presenting with isolated hematuria, all were not active forms of nephropathy. Immunosuppressive therapy was intensified because of biopsy findings in 29% of patients presenting with acute renal failure, 43% with nephrotic range proteinuria, and 53% with sub-nephrotic proteinuria. Conclusions: Our data suggested that similar clinical renal manifestations may be observed despite very different classes of lupus nephritis. Clinicians tended to wait for histological identification of severe lupus nephritis before initiating potential harmful treatment with aggressive immunosuppressive therapy. Therefore, in SLE patients with clinical sign(s) of renal disease, early renal biopsy may be helpful in planning treatment.

引自：Hsieh YP, Wen YK, Chen ML. The value of early renal biopsy in systemic lupus erythematosus patients presenting with renal involvement. Clin Nephrol 2012 Jan;77(1):18-24.