Objective: To further study the renal damage of Sjögren's syndrome (SS) and its clinical and pathologic characteristics with biopsy and recent technology.
Methods: 84 patients of SS with renal impairment from 1993 to 1999 were analyzed by routine, immunoassay, tubular function and biopsy examination.
Results: 55 of the 84 cases presented with renal tubular acidosis (RTA), 5 with diabetes insipidus and 3 with hypokalemic paralysis. Glomerulopathy occurred in 22 cases (nephrotic syndrome 12, glomerulonephritis 10) and mild renal failure (RF) was found in 14. 69.1% of the patients had hypergamma-globulinemia. 64.3% and 44.1% of the patients showed positive anti SS-A and anti SS-B. In 37 renal biopsy specimens 21 showed chronic interstitial nephritis (CIN) with extensive lymphoplasmic cell infiltration and tubular atrophy. 10 of the 37 specimens revealed lupus nephritis (LN, type III and IV) and 5 mesangial proliferative glomerulonephritis (MsPGN). With immunofluorescence tests, no positive findings were seen in most of the specimens, but deposition of IgA, IgM or C(3) was seen in some patients. IgG deposits in the interstitial lymphoplasmic cells were found in 1 patient. 25 patients were treated with prednisone combined with cytoxan (CTX). In 14 patients with renal failure, serum creatinine level returned to normal after treatment.
Conclusion: Renal impairment may be the presenting or predominant feature in SS. The major clinical manifestations are RTA and GN. Treatment with prednisone may decrease the infiltration of lymphoplasmic cells in the interstitium, improve the renal function and correct RTA.