肾静脉血栓与肾病综合征

肾静脉血栓常合并肾病综合征,且许多病例肾组织学发现类似膜性肾炎,故曾认为肾静脉血栓是原因,肾病综合征是其结果。本文对36例肾病综合征作了预计性研究,于出院后随诊4～24个月。结果:本组肾静脉血栓12例(占33％)。其中,膜性肾小球肾炎10例,膜性增生性肾小球肾炎2例。无肾静脉血栓的肾病综合征24例。其中,膜性肾小球肾炎10例,膜性增生性肾小球肾炎8例,肾淀粉样变     

84例干燥综合征合并肾脏损害的临床与病理分析

目的 结合肾活检及相关实验室检测结果,进一步探讨干燥综合征（SS）肾脏损害的临床及病理特征。方法 对我科1993－1999年间收住的84例SS肾脏损害患者,进行常规免疫学、肾小管功能及部分肾活检检查。结果 55／84例为肾小管性酸中毒（RTA）,5／55例合并肾性尿崩症,3／55例合并低钾性麻痹;表现为肾病综合征及肾小球肾炎（GN）分别为12及10例;14／84例有轻度肾功能衰竭。69．1％的患者为高γ球蛋白血症,64．3％和44．1％的患者抗SS－A和抗SS－B（＋）。肾活体组织检查37例,光镜下21例为慢性间质性肾炎伴间质大量淋巴、浆细胞浸润及小管萎缩,10／37例为狼疮性肾炎（LN）,5例为系膜增生性肾炎。免疫荧光检查大多阴性,部分标本肾小球有免疫球蛋白和补体沉积,1例IgG肾病患者有间质沉积。25例应用泼尼松及环磷酰胺（CTX）冲击治疗。14例肾功能受损者血清肌酐（Cr）水平基本降低正常。结论 SS肾脏损害常见,以RTA和GN为主要表现,泼尼松治疗可以减少间质淋巴细胞和浆细胞浸润,改善肾功能,纠正RTA。     

抗磷脂综合征100例临床特征分析

目的探讨抗磷脂综合征（APS）的临床特征和血清学特点。方法回顾性分析总结100例APS患者的临床表现和免疫学改变。结果原发性APS（PAPS）37例，继发性APS（SAPS）63例，其中继发于系统性红斑狼疮（SLE）46例、狼疮样综合征14例。80％患者出现血管性血栓形成，其中静脉血栓43例、动脉闭塞18例、静脉血栓和动脉闭塞15例。52％为单一部位，32％有2个部位，15％多个部位血栓。56％单次，25％2次，19％多次血栓形成。血栓事件以下肢深静脉血栓（36％）、肺栓塞（30％）和脑卒中（26％）常见。51％（34／67）女性出现病态妊娠，胎死宫内占37％，习惯性自发性流产13％。血小板减少71例。抗心磷脂抗体（ACL）和狼疮抗凝物（LA）的阳性率分别为84％和58％。SLE继发APS组关节炎、白细胞减少、抗核抗体（ANA）阳性和低补体血症较PAPS多见。男性患者下肢深静脉血栓和LA阳性较多见；而女性白细胞减少、ANA阳性和ACL阳性较多见。结论APS以血栓形成及病态妊娠为特点．高滴度ACL和（或）LA阳性是其免疫学特征。其临床表现受基础疾病（SLE）和性别的影响而有不同。     

抗肾小球基膜肾炎合并膜性肾病

青年男性患者,临床表现急进性肾炎综合征伴大量蛋白尿、低蛋白血症,血清抗肾小球基膜(GBM)抗体阳性,肾活检组织学呈新月体肾炎合并膜性肾病,免疫病理IgG呈线状及颗粒状沉积于血管袢,电镜下见GBM上皮侧电子致密物沉积,最终诊断为抗GBM肾炎合并膜性肾病.     

肾病综合征抗凝治疗的时机和药物选择

肾病综合征(NS)患者体内存在高凝状态,易导致静脉血栓栓塞症(VTE)发生,包括下肢深静脉血栓塞和肾静脉血栓,并可引起肺动脉栓塞(PE),严重威胁患者的生命安全.文献报道NS患者VTE的发生率在7.2％ ～62％.南京军区南京总医院全军肾脏病研究所一项前瞻性研究观察了膜性肾病患者VTE的发生率证实,VTE发生率高达36％,其中肾静脉血栓33％,PE17％,且多数患者并无典型血栓栓塞症状.因此,对于可能发生VTE的患者抗凝治疗显得尤为必要.但长期抗凝治疗可导致患者医疗费用的增加,出血并发症增多,严重者甚至威胁生命.因此,正确把握抗凝治疗的时机,选择合理的抗凝药物,对改善NS患者预后,减少并发症,提高生活质量有重要意义.     

狼疮肾炎终末期肾病患者尸体肾移植疗效观察

目的：探讨系统性红斑狼疮肾炎终末期肾病（LN-ESRD）患者肾移植的时机、疗效及术后狼疮活动情况。方法：回顾性分析16例LN-ESRD患者,女性14例,男性2例。年龄20～47岁,平均34.4岁。术前、术后狼疮活动指数（SLEDAI）,移植时机,移植后免疫抑制剂使用,人/肾存活情况。结果：16例患者术后10d内肾功能恢复正常。术后6个月内发生急性排斥3例（18.8%）,用甲泼尼龙（MP）冲击治疗后逆转。术前高血压10例,术后3个月后高血压7例,1例术后4个月因高血压脑出血死亡,当时无狼疮活动（SLEDAI〈10分）。15例至今仍存活,存活时间3～156个月,平均80.3个月）,其中有4例出现慢性移植肾肾病（1例重返透析治疗,3例肾功能不全,氮质血症期）,1例移植肾新发肾炎（病理检查为局灶、节段性硬化）,伴肾功能不全,氮质血症期。10例肾功能正常,其中1例出现少量蛋白尿。术前SLEDAI〈10分15例,SLEDAI〉10分1例（12分）,术后6个月后均无狼疮活动（SLEDAI〈10分）。本组患者定期追踪复查SLEDAI〈10分。结论：肾移植是治疗LN-ESRD有效的方法。狼疮无活动时,肾移植后系统性红斑狼疮复发率低。     

老年慢性阻塞性肺疾病急性加重病人发生静脉血栓栓塞症的临床特征和危险因素分析

目的探讨老年慢性阻塞性肺疾病急性加重(acute exacerbation of chronic obstructive pulmonary disease,AECOPD)病人发生静脉血栓栓塞症(venous thromboembolism,VTE)的临床特征和危险因素。方法纳入2016年1月至2019年12月在我院确诊的老年AECOPD病人208例为研究对象,根据是否发生VTE分为AECOPD+VTE组(49例)和AECOPD组(159例),收集临床资料、实验室检查指标,比较2组临床特征,并分析发生VTE的危险因素。结果AECOPD+VTE组肌间静脉的栓塞发生率最高,在年龄<80岁和≥80岁的病人中分别为64.0%和91.7%。2组年龄、静脉血栓病史、近3 d制动或卧床史、不对称下肢水肿、合并冠心病、肺功能GOLD严重程度分级、血清白蛋白和D-二聚体水平差异有统计学意义(P<0.05)。多因素Logistic回归分析显示,深静脉血栓病史、合并冠心病、D-二聚体升高是老年AECOPD病人发生VTE的独立危险因素。结论老年AECOPD病人发生VTE时,下肢肌间静脉血栓的发生率高;深静脉血栓病史、合并冠心病、D-二聚体升高是老年AECOPD病人发生VTE的独立危险因素。     

老年肾病综合征的临床表现和病理类型分析

目的：进一步了解老年肾病综合征的临床表现和病理特点。方法：对北京协和医院1980－1999年底住院老年肾病综合征病人进行临床表现和病理类型分析。结果：住院成人肾病综合征病人共513例,其中老年肾病综合征61例,占11．9％,原发病为原发性肾小球肾炎者49例,占80．3％,糖尿病肾病者7例,占11．5％。临床表现以浮肿、血尿为主,贫血的发生率为54．1％,慢性肾功能不全（CRF）为32．8％。肾活检发现,在非糖尿病肾病综合征病人用激素或激素加免疫抑制剂治疗的缓解率为47．85,有效率为30．4％,未缓解率为21．7％,一般激素或激素加免疫抑制剂效果较好,其临床表现与年轻人的肾病综合征相似,但合并贫血、急性肾功能不全（ARF）、CRF和感染的比例较高,最常见的病因是慢性肾小球肾炎,其病理类型以系膜增殖型肾小球肾炎最常见,其次是局灶增殖型肾小球肾炎,老年肾病综合征患者对激素或激素加免疫抑制剂治疗的反应尚可。     

肾病综合征相关静脉血栓栓塞症的发病机制及防治研究进展

静脉血栓栓塞症（VTE）是肾病综合征（NS）常见、多发的严重并发症,包括深静脉血栓形成（DVT）和肺血栓栓塞症（PTE）。NS患者长期处于“血栓形成倾向”状态,其VTE发病率逐年增高。对于疑诊PTE患者,可先应用临床可能性评分进行临床评估,并联合D-二聚体检测进一步筛查,PTE的确诊检查包括CT肺动脉造影、核素肺通气/灌注显像、磁共振肺动脉造影、肺动脉造影等;DVT确诊影像学检查包括加压静脉超声、CT静脉造影、核素静脉显像、静脉造影等。NS患者常存在肾功能不全,需临床医师谨慎选择适合的检查方式。NS相关VTE的治疗通常包括肝素、华法林,需根据不同患者制定个体化治疗方案,未确诊VTE的NS患者是否常规预防性抗凝存在争议。     

肾病综合征及其高凝状态的治疗

本文报告肾病综合征及其高凝状态的治疗结果。在病程中，膜性肾小球肾炎、膜增殖性肾小球肾炎和微小病变易出现肾病综合征。发生率分别为２９．８％，２８．８％，１９．２％。治疗前病人的白陶土部分凝血活酶（ＫＰＴＴ）试验缩短（Ｐ＜０．０５），肾上腺素诱导的血小板凝集力显著增高（Ｐ＜０．０１），ＡＴⅢ显著降低（Ｐ＜０．０１）及血纤维蛋白原显著增高（Ｐ＜０．０１），促使血液凝固，血管内形成血栓。给严重的肾病综合征而无高血压的病人多次输注血浆后，达到了平均动脉压（Ｐ＜０．０１）。应用肝素和／或尿激酶治疗后改善了高凝参数和肾功能，显著减少了尿蛋白。     

降钙素原用于系统性红斑狼疮活动和细菌性感染快速鉴别

目的探讨血清降钙素原(procalcitonin,PCT)水平对系统性红斑狼疮(systemic lupus erythematosus,SLE)患者病情活动和细菌性感染的鉴别诊断作用。方法前瞻性对2010年4月至2013年4月发热(体温≥38.3℃)或符合全身炎性反应综合征(或脓毒症)标准的SLE患者行PCT、C-反应蛋白(C-reactive protein,CRP)、补体3(C3)及病原学等检测及比较;依据SLE疾病活动指数(SLE diease activity index,SLEDAI)及临床感染证据等,分为细菌性血流感染,细菌性局部感染、SLE病情活动3组。另外纳入缓解期无发热SLE患者作为对照组。血流感染组在使用抗感染药物1周后再次测定血清PCT、CRP水平。结果血流感染组22例,局部感染组28例,SLE活动组27例,对照组20例。血流感染组PCT[11.00(8.80,16.84)μg/L]和CRP[78.86(62.04,89.37)mg/L]明显高于局部感染组[2.22(1.65,2.56)μg/L和23.48(20.20,27.55)mg/L]、活动组[0.19(0.16,0.22)μg/L和19.34(15.98,19.78)mg/L]和对照组[0.11(0.07,0.12)μg/L和4.30(3.83,4.98)mg/L],差异均有统计学意义(P=0.000);局部感染组PCT较活动组和对照组增高,差异有统计学意义(P=0.034,P=0.016);PCT浓度在SLE对照组和活动组差异无显著性意义(P=0.950)。革兰阴性杆菌血流感染的PCT值[14.10(10.13,20.63)μg/L]明显高于革兰阳性菌[1.00(0.70,9.44)μg/L,Z=-2.900,P=0.004]。动态监测血流感染组发现,在抗菌药物治疗1周后血清PCT可快速下降,由11.00(8.80,16.84)μg/L降至0.38(0.28,0.48)μg/L,P=0.000。结论 PCT在SLE缓解期和病情活动时基本正常,在SLE合并细菌性血流感染时显著升高;革兰阴性杆菌血流感染的PCT值较革兰阳性菌更高;提示PCT有可能作为SLE细菌感染的一项快速鉴别指标,与SLE细菌感染的严重程度相关。     

Symptomatic thrombotic events among Egyptian patients with systemic lupus erythematosus: special consideration for renal vein thrombosis

OBJECTIVE: To evaluate the prevalence of symptomatic thrombotic events among Egyptian patients with systemic lupus erythematosus (SLE), and to evaluate the frequency and the risk factors associated with renal vein thrombosis in those patients. METHODS: Fifty-four patients with SLE, 51 (94.4%) females, were involved in this study. All of them were submitted for abdominal sonography, chest X-ray, echocardiography, and Doppler of renal, abdominal and lower limb veins, with examination of data on clinical and laboratory profile. Abdominal CT, brain MRI, MRI both hips, CT chest and pulmonary scintigraphy were used when needed. RESULTS: Sixteen patients (29.6%) were diagnosed with symptomatic thrombotic events. Eight patients had more than one type of thrombosis. Two patients (3.7%) were diagnosed by Doppler as having renal vein thrombosis (RVT). This was confirmed by abdominal CT. One of them presented with nephrotic syndrome, graded by renal biopsy as World Health Organization (WHO) class V, and had positive anticardiolipin antibodies (ACL). The other patient had RVT and inferior vena cava (IVC) thrombosis, nephrotic syndrome, positive ACL, and died before renal biopsy was performed. Both of them were without history of peripheral thrombotic events. One patient was diagnosed with IVC thrombosis, lupus nephritis grade II, positive ACL, and diagnosed by abdominal CT. One patient was diagnosed with portal vein thrombosis and had positive ACL. One patient with retinal vessel thrombosis and positive ACL. Four patients had deep vein thrombosis (DVT). Recurrent miscarriages were reported in 4 patients (7.4%), skin ulcerations in 3 (5.6%), avascular necrosis of the hips in 4 (7.4%), stroke in 1 (1.9%), and pulmonary hypertension in 2 patients (3.7%). CONCLUSION: Sixteen SLE patients (29.6%) were diagnosed with symptomatic thrombotic events. RVT was detected in 2 patients representing 3.7% of all patients, and 12.5% of patients with thrombosis. Both patients with RVT presented with nephrotic syndrome.     

Lupus nephritis: Clinical course as related to morphologic forms and their transitions

An intensive study of the course of lupus nephritis has been undertaken in 88 patients in whom strict morphologic criteria were utilized in classification. All were treated with steroid, and 17 received cytotoxic drugs in addition. Focal proliferative lupus nephritis generally follows a benign course except in the occasional instances when transition to the diffuse proliferative or membranous forms occurs. Membranous lupus nephritis, when characterized by persistent nephrotic syndrome, leads slowly to renal failure, but this progression is aborted in the one-third in whom remission of the nephrotic syndrome can be achieved. A fatal outcome occurs within five years in the majority of those with diffuse proliferative lupus nephritis and the nephrotic syndrome, often in association with necrotizing renal vasculitis, severe hypertension and accelerated renal failure. A small number with the diffuse proliferative form have a remission and then show only mesangial abnormalities, usually, however, with the appearance of glomerular sclerosis. Progressive glomerular sclerosis is observed in some patients and may be a sequel of the remission of the diffuse or focal proliferative lesions, or it may represent still another form of lupus nephritis. Mesangial immune deposits with or without proliferation, at times in the absence of clinical renal disease, are observed early in the course of systemic lupus erythematosus (SLE) and may proceed to the diffuse proliferative or membranous forms.     

Lupus nephritis: 211 cases

PURPOSE: Renal involvement is one of the most severe and frequent manifestations of systemic lupus erythematosus. Prognosis factors are variable in the different studies. We analyze in 211 patients clinical, biological and histologic characteristics of lupus nephritis and the different prognosis factors. METHODS: It's a retrospective study in 211 with lupus nephritis followed-up between 1975 and 2003. RESULTS: There were 195 women and 16 men aged meanly of 28,8 years. At first presentation, we noted hypertension in 32,3% of cases, nephrotic syndrome in 47,7% of cases and renal failure in 51,6% of cases. histologic examination of kidney revealed class III in 59 cases, class IV in 97 cases and class V in 33 cases. Two hundred and five patients were treated by corticosteriods associated with immunosupressive agents in 95 cases. After a mean follow-up of 103 months (2-289 months), we obtained remission in 55,3% deterioration of renal function in 34,8% with end stage renal failure in 14,7% and relapses occurred in 51% of cases. Thirty-three patients died. Age <24 years, hypertension, nephrotic syndrome and initial renal failure were statistically associated with deterioration of renal function. CONCLUSION: Lupus nephritis is severe in our patients with predominance of proliferative forms. Age <24 years, hypertension, nephrotic syndrome and initial renal failure were statistically associated with deterioration of renal function.     

Renal vein thrombosis and inferior vena cava thrombosis in systemic lupus erythematosus

Phlebography of the inferior vena cava with selective study of the renal veins was performed in 43 patients with systemic lupus erythematosus (SLE). Inferior vena cava thrombosis (IVCT) or renal vein thrombosis (RVT) was found in 3 of 11 patients (27%) with nephrotic syndrome, in 8 of 13 (61.5%) with previous thrombophlebitis, and in 3 of 4 (75%) with suggestive acute clinical picture. In contrast, none of the 20 control patients with SLE had IVCT or RVT. These results show that SLE patients with thrombophlebitis have a very high risk of developing IVCT or RVT; patients with nephrotic syndrome have a smaller risk. Neither IVCT nor RVT was found in SLE patients without antecedent thrombophlebitis or nephrotic syndrome.     

C反应蛋白与系统性红斑狼疮的相关性

目的分析系统性红斑狼疮(systemic lupus erythemotosus,SLE)患者血清C反应蛋白(C-reactive protein,CRP)水平,了解SLE患者CRP与狼疮本身及合并感染的关系。方法对2009年1月至2011年5月北京大学第一医院住院SLE患者的病历进行回顾分析,研究SLE患者血清CRP水平与狼疮疾病活动度、器官受累的关系;并结合合并感染SLE患者血清CRP水平,探讨CRP对判定感染的敏感性及特异性。结果共入组283例SLE患者。在不合并感染的239例SLE患者中,血清CRP中位值为2.6 mgL,94.6%的患者CRP20.0 mgL。血液系统受累患者CRP水平高于无血液系统受累患者(3.2 mgL vs.2.0 mgL,P0.05),但合并浆膜炎、肾脏受累、关节炎的患者CRP水平与不合并上述表现的患者之间无显著性差异。在不同疾病活动度患者之间,CRP水平无显著差异(P0.05);但随着免疫抑制治疗患者疾病活动度降低,CRP、ESR水平均下降(P0.05)。合并感染SLE患者血清CRP水平明显高于不合并感染患者,差别具有统计学意义(13.6 mgL vs.2.6 mgL,P0.05),CRP21.3 mgL对于判断感染的特异性可达95.0%。结论不合并感染的SLE患者CRP水平多正常或轻度升高,免疫抑制治疗可以使患者CRP水平随病情改善而下降;血液系统受累患者CRP水平高于无血液系统受累患者。SLE患者合并感染时CRP水平可显著升高,故CRP可能作为临床上鉴别狼疮活动与感染的指标之一。     

急性冠脉综合征预后与其支架术前CRP、Fib、D-二聚体水平的关系

目的:探讨急性冠脉综合征(ACS)预后与其支架术前C反应蛋白(CRP)、纤维蛋白原(Fib)、D-二聚体水平的关系。方法:分别选择110例健康体检者(健康对照组)和110例接受冠脉支架术治疗的ACS患者(ACS组),测定两组患者CRP、Fib和D-二聚体的水平。6个月后对ACS组患者进行心血管事件评定,根据是否发生心血管事件分为事件组(35例)和非事件组两组(75例)。结果:与健康对照组比较,ACS组患者CRP[(2.02±1.17)mg/L比(11.15±3.12)mg/L]、Fib[(2.65±1.07)g/L比(4.03±1.19)g/L]、D-二聚体[(193.97±18.13)μg/L比(632.15±21.72)μg/L]的水平明显升高(P<0.05);与非事件组患者比较,事件组CRP[(9.69±3.14)mg/L比(14.28±3.32)mg/L]、Fib[(3.88±1.09)g/L比(4.36±1.23)g/L]、D-二聚体[(509.13±21.57)μg/L比(895.77±25.03)μg/L]的水平明显升高(P<0.05),直线相关分析显示,事件组患者CRP与Fib(r=0.41,P<0.05)、D-二聚体(r=0.54,P<0.01)水平呈正相关,Fib与D-二聚体亦呈正相关(r=0.39,P<0.05)。结论:急性冠脉综合征患者C反应蛋白、纤维蛋白原和D-二聚体的水平较健康体检者升高,急性冠脉综合征支架术前C反应蛋白、纤维蛋白原、D-二聚体水平越高,其预后越差。     

Lupus erythematosus in the 1980s: a survey of 570 patients

Five hundred seventy lupus erythematosus patients observed in a private practice between 1980 and 1989 were surveyed. Fifty-five percent were diagnosed after 1980. Five hundred three fulfilled criteria for systemic lupus erythematosus ( [SLE]; 464 idiopathic, 23 overlap, 16 drug-induced) and 67 had biopsy-documented cutaneous (discoid) lupus. In the idiopathic SLE group, symptoms began at a mean age of 31 years and patients were observed for a mean of 6 years. Findings in idiopathic SLE patients were (1) 27% have a family history of autoimmune disease; (2) nephritis patients without nephrotic syndrome rarely develop renal failure (4%); (3) nephrotic syndrome patients are relatively cyclophosphamide-resistant; (4) organ-threatening disease is present in 54%; and (5) 13% of women who become pregnant are recurrent aborters and 26% never conceive. In an analysis of cohort data, 5- and 10-year survivals were 97% +/- 2% and 93% +/- 3%, respectively. Additionally, men and patients with renal disease or thrombocytopenia had a poorer prognosis. Blacks had similar clinical findings and survival to whites. Approximately 50% of deaths were from active disease and 50% from complications of therapy. Prolonged survival has resulted from new diagnostic procedures and serologic tests, and improved antibiotics and antihypertensive agents, as well as more efficacious treatment modalities.     

D-二聚体水平在系统性红斑狼疮的临床意义

目的 了解系统性红斑狼疮(SLE)患者D-二聚体水平及其临床意义.方法 选北京大学人民医院住院的261例SLE患者,收集临床及实验室资料,分析D-二聚体水平及其与SLE患者临床特征及实验室检查指标的相关性.结果 (1)除外合并肾功能不全、严重感染、弥漫性血管内凝血(DIC)、肝功能异常、妊娠及外伤等可能影响D-二聚体水平的因素,261例SLE患者中入选205例,其中D-二聚体水平升高者达69.3%(142/205).(2)D-二聚体水平升高与SLE疾病活动指数(SLEDAI)评分呈正相关(r=0.598,P=0.000),并与抗双链DNA抗体阳性、C反应蛋白(GRP)升高、补体C3、补体C4降低等有一定相关性.(3)D-二聚体水平升高者脏器损伤比例增加,狼疮性肾炎(58.5%比38.1%)、神经精神性狼疮的发生率(18.3%比4.8%)明显高于D-二聚体水平正常者.(4)伴有血栓形成的SLE患者均有D-二聚体水平升高,但不合并血栓形成者D-二聚体水平升高或正常.结论 D-二聚体水平升高可见于SLE活动期及有重要脏器损伤者,并不必然提示血栓形成.但是,伴发血栓形成的SLE患者均有D-二聚体升高.     

The clinical and epidemiologic features in 140 patients with lupus nephritis in a predominantly black population from one center in Kingston, Jamaica

BACKGROUND: Lupus nephritis has emerged as a major factor in the overall survival of patients and may help to explain the poor prognosis associated with systemic lupus erythematosus (SLE) in black patients. METHODS: The authors reviewed the clinical and epidemiologic features of lupus nephritis in 130 women and 10 men who were mainly of African descent. RESULTS: The mean (standard deviation) age at diagnosis of SLE was 27.9 (10.3) years. The majority of patients (75%) developed renal involvement within 1 year of presentation with SLE. The most frequent extrarenal manifestations were arthritis (67%), malar rash (44%), serositis (41%), and neurologic disorders (30%). Class IV nephritis was the most common glomerular lesion, accounting for 49% of the biopsies, with class II accounting for a further 23%. Proteinuria was a common feature at presentation in all classes. Nephrotic range proteinuria was most common in classes III and IV. Prevalence of nephrotic range proteinuria was similar in classes II (23%) and V (19%). Hematuria occurred in more than one half of the patients with classes II, IV, and V disease. Fifty-nine percent of the patients had renal impairment at the time of renal biopsy. The prevalence of hypertension, the nephritic syndrome, and renal impairment was significantly higher in class IV patients compared with all the other groups. Factors that were significantly associated with classes III and IV disease compared with the other classes on univariate analysis were renal impairment, proteinuria (but not in nephrotic range), low C3 levels, and anemia. CONCLUSIONS: The clinical features of the study patients were similar to those of patients belonging to other ethnic groups, but a high proportion of the study patients had renal impairment at the time of renal biopsy.