Objective To evaluate the risk of end-stage kidney disease (ESKD) in lupus nephritis (LN) patients using tubulointerstitial lesion scores. Methods Clinical profiles and histopathological presentations of 151 biopsy-proven LN patients were retrospectively examined. Risk factors of ESKD based on characteristics and scoring of their tubulointerstitial lesions (e.g. interstitial inflammation [II], tubular atrophy [TA], and interstitial fibrosis [IF]) were analyzed. Results The mean age of 151 LN patients was 36 years old, and 136 (90.1%) were female. The LN cases examined included: class I/II (n = 3, 2%), class III/IV (n = 119, 78.8%), class V (n = 23, 15.2%), and class VI (n = 6, 4.0%). The mean serum creatinine level was 1.4 mg/dl. Tubulointerstitial lesions were recorded in 120 (79.5%) patients. Prior to receiving renal biopsy, 9 (6.0%) patients developed ESKD. During the follow-up period (mean, 58 months), an additional 47 patients (31.1%) progressed to ESKD. Multivariate analyses identified serum creatinine (hazard ratio [HR]: 1.7, 95% confidence interval [CI]: 1.42–2.03, p < 0.001) and IF (HR: 3.2, 95% CI: 1.58–6.49, p = 0.001) as independent risk factors of ESKD. Kaplan-Meier analysis further confirmed a heightened risk of ESKD associated with IF. Conclusion Tubulointerstitial involvement is commonly observed in histopathological presentation of LN. However, IF, rather than II, or TA, was found to increase the risk of ESKD in our cohort. Therefore, to predict renal outcome in LN patients prior to adjusting immunosuppressive treatment, degree of IF should be reviewed.

中文翻译：

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间质纤维化增加狼疮性肾炎患者患终末期肾病的风险

目的 利用肾小管间质病变评分评估狼疮性肾炎 (LN) 患者患终末期肾脏病 (ESKD) 的风险。方法回顾性分析151例经活检证实的LN患者的临床资料和组织病理学表现。根据肾小管间质病变的特征和评分（例如间质炎症[II]、肾小管萎缩[TA]和间质纤维化[IF]）分析ESKD的危险因素。结果 151例LN患者平均年龄36岁，其中女性136例（90.1%）。检查的 LN 病例包括：I/II 级（n = 3，2%）、III/IV 级（n = 119，78.8%）、V 级（n = 23，15.2%）和 VI 级（n = 6） ，4.0%）。平均血清肌酐水平为 1.4 mg/dl。 120 名 (79.5%) 患者出现肾小管间质病变。在接受肾活检之前，9 名 (6.0%) 患者出现 ESKD。在随访期间（平均 58 个月），另有 47 名患者 (31.1%) 进展为 ESKD。多变量分析确定了血清肌酐（风险比 [HR]：1.7，95% 置信区间 [CI]：1.42–2.03，p < 0.001）和 IF（HR：3.2，95% CI：1.58–6.49，p = 0.001）作为ESKD的独立危险因素。 Kaplan-Meier 分析进一步证实了与 IF 相关的 ESKD 风险增加。结论 LN 的组织病理学表现中常见肾小管间质受累。然而，在我们的队列中，发现 IF 而不是 II 或 TA 会增加 ESKD 的风险。因此，为了在调整免疫抑制治疗之前预测 LN 患者的肾脏结局，应审查 IF 的程度。