狼疮性肾炎在终末期肾衰竭时肾脏替代治疗的特点

目的 探讨狼疮性肾炎（lupus nephritis，LN）患者在尿毒症阶段行肾脏替代治疗的特点。方法 收集上海交通大学医学院附属仁济医院肾脏科近年LN患者尿毒症阶段的临床资料，包括完整的病史、病情演变、临床症状、实验室检查等随访资料，总结分析LN患者行肾脏替代治疗（renal replacement therapy，RRT）的特点。结果 入选规律性肾脏替代治疗的LN患者共23例，8例男性（35％），15例女性（65％）。其中10例（43．5％）首选血液透析（HD），13例（56．5％）首选腹膜透析（PD）。随访时间为6～211个月。随访中有4例患者死亡，2例（50％）死于心血管疾病（cardiovasculardisease，CVD），5年生存率为85．0％。皿患者中有4例（40％）在开始透析治疗后一年内肾功能部分恢复。PD患者中有2例（15．0％）在透析第一年后残肾Kt／V有上升。HD患者中有2例（20．0％）因心房纤颤、腕管综合征和瘘管功能不良改为PD。PD患者中有5例（38．5％）因腹水感染而改为HD。透析后第一年有14例（60．996）发生感染，有6例（21．6％）发生肾外狼疮活动。结论 进入肾脏替代治疗的LN患者的预后较好。部分患者在开始透析一年内肾功能可有不同程度恢复，CVD是LN终末期肾衰竭患者的主要死因。

Features of renal replacement therapy in the renal failure stage of lupus nephritis

Objective To investigate the features of renal replacement therapy in patients with end- stage renal disease of lupus nephritis. Methods Clinical features of renal replacement therapy for lupus nephritis patients treated in this hospital were analyzed retrospectively. Results We observed 23 patients who had lupus nephritis at the uremia stage and were regularly treated with renal replacement therapy. The ratio of male to female was 1: 1.9. Renal replacement therapy selected at the beginning was hemodialysis in 10 patients (43.5%) and peritoneal dialysis in 13 patients (56.5%). Their following-up period lasted for 6~211 months. In this period, 4 patients died, in which 2 were died of cardiovascular diseases. The five-year survival rate was 85%. Partial improvement of renal function was found in 4 of the 10 cases on hemodialysis for one year, and the residual renal Kt/V increased in 2 of the 13 cases on peritoneal dialysis for one year. Hemodialysis was changed to peritoneal dialysis in 2 cases (20%) due to atrial fibrillation, carpal tunnel syndrome or A-V fistula dysfunction, and peritoneal dialysis was replaced by hemodialysis in 5 cases (38.5%) due to peritonitis. In the first year of the dialysis therapy, 14 cases (60.9%) were complicated with infections, and 6 cases (21.6%) developed extrarenal manifestations of systemic lupus erythematosus. Conclusion The uremia stage of lupus nephritis treated with renal replacement therapy will have a relatively better prognosis. Partial improvement of renal function may be found in some of the patients after one year of the treatment. Cardiovascular involvement is the major cause of death.