Renal manifestations of rheumatic autoimmune diseases

doi:10.16138/j.1673-6087.2025.05.12

Abstract

Abstract:

Rheumatic autoimmune diseases are characterized by the involvement of multiple systems and organs, and the kidney is a common and critical target. The clinical manifestations of kidney diseases caused by different rheumatic diseases are diverse, ranging from asymptomatic hematuria and proteinuria to rapidly progressive glomerulonephritis and renal failure, and vary in severity. The treatment strategies and prognosis differ depending on the specific clinical manifestation. This article reviews relevant domestic and international literature, summarizing the renal manifestations associated with common rheumatic diseases. The aim is to improve clinicians’ understanding of the diseases, enabling them to intervene early to improve patient outcomes.

Key words: Rheumatic autoimmune diseases, Tubulointerstitial nephritis, Glomerulonephritis, Epidemiology

CLC Number:

R593.2

ZHANG Xiaoyan, LI Huilin. Renal manifestations of rheumatic autoimmune diseases[J]. Journal of Internal Medicine Concepts & Practice, 2025, 20(05): 410-414.

Figures/Tables 2

Table 1

Table 2

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疾病类型	肾受累率	临床表现	病理表现	ANCA阳性
MPO：髓过氧化物酶（myeloperoxidase）；p-ANCA:核周型ANCA（perinuclear ANCA）；PR3-ANCA: 蛋白酶3ANCA（proteinase 3 ANCA）
MPA	80%	急进性肾小球肾炎、无症状性血尿、不同程度蛋白尿及肾功能不全	寡免疫复合物沉积、轻度局灶节段性肾小球肾炎、弥漫坏死性新月体性肾小球肾炎、间质性肾炎	60%~80%，主要为MPO-ANCA及p-ANCA阳性
GPA	60%~80%	急进性肾小球肾炎、无症状性血尿、不同程度蛋白尿及肾功能不全	寡免疫复合物沉积、轻度局灶节段性肾小球肾炎、弥漫坏死性新月体性肾小球肾炎，偶见肉芽肿	70%~90%为PR3-ANCA阳性，少数为MPO-ANCA阳性
EGPA	20%	急进性肾小球肾炎、无症状性血尿、不同程度蛋白尿及肾功能不全	坏死性新月体性肾小球肾炎、嗜酸性粒细胞性间质性肾炎、膜性肾小球肾炎、局灶节段性肾小球硬化	1/3患者ANCA阳性，多为p-ANCA
大动脉炎	78.1%	高血压、蛋白尿、肾功能不全、ESKD	肾动脉狭窄	/
结节性多动脉炎	不详	急进性肾衰竭，镜下血尿甚至肉眼血尿、细胞管型、蛋白尿、肾性高血压、肾病综合征	缺血性肾病、肾微动脉瘤、输尿管周围组织血管炎及继发纤维化	/

	肾受累率	临床表现	病理表现	鉴别诊断
SSc	35%~40%^[33]	50%的SSc患者表现为轻度蛋白尿、血肌酐升高和(或)高血压, 6%发生硬皮病肾危象^[33]	血管腔狭窄堵塞的内膜增殖和增厚，伴向心性“葱皮样”肥大、血栓性微血管病	其他原因所致的肾功能不全、硬皮病肾危象需要与其他血栓性微血管病相鉴别
MCTD	25%^[34]	肾小球肾炎、肾病综合征、肾小管酸中毒、肾脏浓缩功能受损、肾结石或间质性肾炎^[35]，少数可发生肾危象	膜性肾病、TIN、系膜增生性肾小球肾炎	原发性膜性肾病、其他原因引起的肾小管及肾间质炎
IgG4-RD	7.0%~24.6%^[36]	肾功能不全、尿检异常、尿路梗阻、肾盂占位	TIN、膜性肾病	药物性间质性肾炎、慢性肾盂肾炎、多中心型淋巴结增生症、其他自身免疫性疾病相关间质性肾炎
AS	10%~35%^[37]	尿检异常	非特异性肾小球病、IgA肾病、淀粉样变性	与原发性肾小球病较难鉴别，需从临床表现、全面体检、辅助检查等鉴别
RA	很少直接导致	尿检异常	系膜增生性或膜性肾小球肾炎、淀粉样变性	与原发性肾小球病及药物引起的肾损伤相鉴别，控制RA可改善淀粉样变