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Renal Involvement and Followup of 130 Patients with Primary Sjögren's Syndrome
HON REN, WEI-MING WANG, XIAO-NONG CHEN, WEN ZHANG, XIAO-XIA PAN, XIANG-LING WANG, YING LIN, SU ZHANG, and NAN CHEN
ABSTRACT. Methods. All patients with pSS and renal involvement who were admitted to Ruijin Hospital from April 1993 to December 2006 were included. All the data of clinical features and pathological changes were retrospectively analyzed. Forty-one patients underwent renal biopsies. Results. Our study included 130 patients with pSS: 122 women and 8 men. Ages ranged from 16 to 68 years (mean 44.1 ± 11.52). Ninety-five patients (73.1%) developed renal tubular acidosis (RTA); 91 were found to have distal RTA. Nine patients presented with hypokalemic paralysis. Four patients developed Fanconi syndrome and 3 were proved to have nephrogenic diabetes insipidus. Twenty-seven of 130 patients (20.8%) developed tubular proteinuria and 18/130 (13.8%) presented glomerular involvement. Thirty-five patients (27.7%) developed renal failure (serum creatinine > 115 µmol/l). Most patients (70.8%) had increased serum IgG levels. The incidence of chronic interstitial nephritis was 80.5% among all the biopsy materials. Immunofluorescent staining was negative in most renal tissue. Ninety-six patients were treated with corticosteroids and/or immunosuppressant. Eighteen recovered renal function. Conclusion. Patients with pSS commonly present with renal impairment, mainly from renal tubular dysfunction. The combination of corticosteroids and immunosuppressors significantly improves the renal function of patients with pSS. There is a correlation between hypergammaglobulinemia and distal RTA. The renal acidification capacity for patients with hypergammaglobulinemia should be monitored. (First Release Dec 15 2007; J Rheumatol 2008;35:278-84) Key Indexing Terms:
SJÖGREN'S SYNDROME
From the Department of Nephrology, Ruijin Hospital affiliated to Shanghai Jiaotong University, School of Medicine, Shanghai, P.R. China. Supported by grants from the National Natural Science Foundation of China (No. 30670814), the Leading Academic Discipline Project of Shanghai Health Bureau (No. 05III001), and the Shanghai Leading Academic Discipline Project (No. T0201). H. Ren, MD; W-M. Wang, MD; X-N. Chen, MD; W. Zhang, MD; X-X. Pan, MD; X-L. Wang, MD; Y. Lin, MD; S. Zhang, MD; N. Chen, MD, Department of Nephrology, Shanghai Ruijin Hospital affiliated to Shanghai Jiaotong University, School of Medicine (formerly Shanghai Second Medical University). Address reprint requests to Prof. N. Chen, Department of Nephrology, No. 197 Ruijin Er Road, Shanghai Ruijin Hospital affiliated to Shanghai Jiaotong University, School of Medicine (formerly Shanghai Second Medical University), Shanghai 200025, PR China. E-mail: chen-nan@medmail.com.cn Accepted for publication September 2, 2007. |
