Clinical and pathological characteristics of pediatric lupus nephritis with hyperuricemia

doi:10.3877/cma.j.issn.1674-0785.2026.02.002

Abstract

Abstract:

Objective

To analyze the clinical and pathological characteristics of children with lupus nephritis (LN) complicated by hyperuricemia (HUA), and to identify the factors influencing serum uric acid (SUA) levels.

Methods

SUA data of were collected from LN children admitted to the Children's Hospital Affiliated to Nanjing Medical University from January 2017 to December 2024, with healthy children enrolled as the control group. The incidence of HUA was compared between LN children and healthy children. Additionally, LN children were divided into a HUA group and a non-hyperuricemia (NHUA) group. Differences in clinical manifestations, pathological findings, and laboratory indicators between the two groups were compared, and independent factors influencing SUA were identified.

Results

The incidence of HUA was 16.0% (17/106) in healthy children and 50.9% (54/106) in LN children. Compared with the NHUA group, the HUA group had significantly higher SLEDAI-2K scores (P＜0.001) and higher rates of serositis and hypertension (P=0.012 and P＜0.001, respectively) as clinical manifestations; higher acute activity index scores and a greater proportion of renal interstitial inflammatory cell infiltration (P=0.007 and P＜0.001, respectively) as pathological results; and poorer renal function-related indicators (P＜0.001), lower complement C3 levels (P=0.010), and more pronounced proteinuria (P＜0.05) as laboratory indicators. Multivariate Logistic regression analysis incorporating the above variables identified low complement C3 level as an independent factor influencing SUA.

Conclusion

The incidence of HUA is significantly higher in LN children than in healthy children. LN children complicated with HUA present more severe disease manifestations; therefore, SUA levels should be monitored in clinical practice. Furthermore, low complement C3 level is an independent factor influencing SUA, providing a useful reference for identifying high-risk children in the clinical setting.

Key words: Children, Lupus nephritis, Serum uric acid, Renal pathology, Renal function

Shumin He, Qianqian Sheng, Guixia Ding. Clinical and pathological characteristics of pediatric lupus nephritis with hyperuricemia[J]. Chinese Journal of Clinicians(Electronic Edition), 2026, 20(02): 90-96.

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Figures/Tables 7

临床表现	HUA（n=54）	NHUA（n=52）	统计量	P值
浆膜炎	34（63.0）	20（38.5）	6.363	0.012
高血压	22（40.7）	5（9.6）	13.519	＜0.001
SLEDAI-2K（分， $x ¯$ ±s）	19.35±4.853	15.440±6.267	-3.599	＜0.001

临床表现	HUA（n=54）	NHUA（n=52）	统计量	P值
浆膜炎	34（63.0）	20（38.5）	6.363	0.012
高血压	22（40.7）	5（9.6）	13.519	＜0.001
SLEDAI-2K（分， $x ¯$ ±s）	19.35±4.853	15.440±6.267	-3.599	＜0.001

肾活检病理	HUA（n=54）	NHUA（n=52）	χ²值	P值
急性活动指数评分	7（2.75，10）	3（0，6）	2.704	0.007
慢性指数评分	1（0，2）	0（0，1）	1.951	0.051
肾间质炎症细胞浸润[例（%）]	33（61.1）	15（28.8）	11.130	＜0.001

实验室指标	HUA（n=54）	NHUA（n=52）	χ²值	P值
血肌酐（µmol/L）	70.00（47.00，106.50）	46.50（37.77，63.75）	4.093	＜0.001
胱抑素C（mg/L）	1.76（1.29，2.68）	1.27（0.99，1.49）	4.630	＜0.001
尿素（mmol/L）	9.85（5.77，15.75）	5.52（4.35，7.82）	4.788	＜0.001
直接胆红素（µmol/L）	1.76（1.13，2.52）	2.26（1.60，3.48）	-2.491	0.013
间接胆红素（µmol/L）	2.84（1.80，4.20）	3.40（2.42，6.15）	-2.121	0.034
血清白蛋白（g/L， $x ¯$ ±s）	25.567±9.566	34.117±8.724	4.802	＜0.001
血氯（mmol/L， $x ¯$ ±s）	107.083±4.245	104.844±3.682	-2.896	0.005
高密度脂蛋白胆固醇（mmol/L）	0.81（0.62，1.16）	0.96（0.80，1.42）	-2.121	0.034
血沉（mm/h）	53.50（16.25，75.50）	27.50（12.75，50.25）	2.518	0.012
eGFR（ml·min^-1·1.73 m^-2， $x ¯$ ±s）	81.465±41.671	117.789±37.527	4.710	＜0.001
补体C3（g/L）	0.27（0.19，0.38）	0.38（0.23，0.54）	-2.585	0.010
24 h尿蛋白（g/L）	2105.00（958.50，5337.50）	747.00（193.75，1855.00）	3.818	＜0.001
尿蛋白/尿肌酐（mg）	270.50（124.75，721.25）	81.70（32.80，257.00）	4.092	＜0.001

实验室指标	HUA（n=54）	NHUA（n=52）	χ²值	P值
血肌酐（µmol/L）	70.00（47.00，106.50）	46.50（37.77，63.75）	4.093	＜0.001
胱抑素C（mg/L）	1.76（1.29，2.68）	1.27（0.99，1.49）	4.630	＜0.001
尿素（mmol/L）	9.85（5.77，15.75）	5.52（4.35，7.82）	4.788	＜0.001
直接胆红素（µmol/L）	1.76（1.13，2.52）	2.26（1.60，3.48）	-2.491	0.013
间接胆红素（µmol/L）	2.84（1.80，4.20）	3.40（2.42，6.15）	-2.121	0.034
血清白蛋白（g/L， $x ¯$ ±s）	25.567±9.566	34.117±8.724	4.802	＜0.001
血氯（mmol/L， $x ¯$ ±s）	107.083±4.245	104.844±3.682	-2.896	0.005
高密度脂蛋白胆固醇（mmol/L）	0.81（0.62，1.16）	0.96（0.80，1.42）	-2.121	0.034
血沉（mm/h）	53.50（16.25，75.50）	27.50（12.75，50.25）	2.518	0.012
eGFR（ml·min^-1·1.73 m^-2， $x ¯$ ±s）	81.465±41.671	117.789±37.527	4.710	＜0.001
补体C3（g/L）	0.27（0.19，0.38）	0.38（0.23，0.54）	-2.585	0.010
24 h尿蛋白（g/L）	2105.00（958.50，5337.50）	747.00（193.75，1855.00）	3.818	＜0.001
尿蛋白/尿肌酐（mg）	270.50（124.75，721.25）	81.70（32.80，257.00）	4.092	＜0.001

自身抗体	HUA（n=54）	NHUA（n=52）	χ²值	P值
均质性抗核抗体	44（81.5）	38（73.1）	1.068	0.357
斑点型自身抗体	27（50.0）	19（36.5）	1.954	0.176
抗SSA	25（46.3）	14（26.9）	4.275	0.046
抗SM抗体	12（22.2）	12（22.2）	0.011	0.916
抗n-RNP抗体	18（33.3）	10（19.2）	2.710	0.125
抗Ro-52抗体	22（40.7）	16（30.8）	1.145	0.316
抗双链DNA抗体	32（59.3）	38（73.1）	2.255	0.155
抗心磷脂抗体	4（7.4）	5（9.6）	0.004	0.953

细胞免疫	HUA（n=54）	NHUA（n=52）	χ²值	P值
T淋巴细胞	73.33（65.90，80.07）	74.10（65.26，80.76）	-0.514	0.607
B淋巴细胞	16.04（11.35，24.32）	14.14（10.35，24.00）	0.742	0.458
NK细胞	6.21（4.30，8.75）	6.61（4.16，10.04）	-0.468	0.639

变量	单因素			多因素
变量	OR值	95%CI	P值	OR值	95%CI	P值
浆膜炎[例（%）]	2.720	1.240~5.967	0.013	2.596	0.284~23.730	0.398
高血压[例（%）]	6.462	2.217~18.839	0.001	5.521	0.429~70.978	0.190
SLEDAI-2K（分）	1.137	1.052~1.229	0.001	0.971	0.852~1.107	0.659
急性活动指数评分（分）	1.150	1.038~1.275	0.007	1.168	0.934~1.462	0.173
慢性活动指数评分（分）	1.514	1.045~2.192	0.028	0.565	0.205~1.559	0.270
肾间质炎症细胞浸润[例（%）]	3.876	1.721~8.730	0.001	2.644	0.412~16.986	0.306
血肌酐（μmol/L）	1.031	1.014~1.049	0.001	1.012	0.964~1.063	0.467
胱抑素C（mg/L）	7.647	2.692~21.723	0.001	1.290	0.188~8.832	0.795
尿素（mmol/L）	1.308	1.150~1.488	0.001	1.222	0.883~1.690	0.227
直接胆红素（μmol/L）	0.654	0.470~0.911	0.012	0.512	0.162~1.613	0.253
间接胆红素（μmol/L）	0.835	0.705~0.987	0.035	1.018	0.616~1.682	0.946
白蛋白（g/L）	0.902	0.857~0.948	0.001	0.916	0.825~1.016	0.096
血氯（mmol/L）	1.155	1.041~1.282	0.007	0.797	0.585~1.087	0.151
高密度脂蛋白胆固醇（mmol/L）	0.420	0.198~0.891	0.024	0.354	0.064-1.962	0.235
血沉（mm/h）	1.019	1.004~1.033	0.010	0.995	0.967~1.023	0.714
eGFR（ml·min^-1·1.73 m^-2）	0.977	0.966~0.988	0.001	1.037	0.997~1.079	0.070
补体C3（g/L）	0.027	0.002~0.321	0.004	0.001	0.010~0.214	0.016
24 h尿蛋白（g/L）	1.527	1.181~1.975	0.001	1.263	1.390~0.609	0.434
尿蛋白/尿肌酐（mg）	1.210	1.001~1.462	0.049	0.886	0.556~1.411	0.610

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