90%系统性红斑狼疮患者会伤及肾脏，红斑狼疮患者的肾脏一般都会增大，其表面光滑，有点状出血。光镜检査，有60%到70%患者肾脏有病变，而用电子显微镜和免疫荧光检査(包括活组织检査)98%以上肾脏均为异常。可先后损伤肾小球、肾小管、肾间质及血管等。
肾小球
肾小球病变纷歧。常见病变包含有基膜增厚、线圈样病变、类纤维病变、球丛细胞显着很多增生和坏死、通明物质栓塞、纤维上皮细胞半月体构成、肾小球毛细血管发作纤维蛋白变性或局灶性坏死(内有通明血栓以及苏木素小体)，其间线圈样病变为SLE肾脏病变的特征性体现，它是因为免疫复合物的沉积使SLE患者肾脏安排中基膜增厚，局部有很多嗜酸性细胞滋润，相似曲折线圈，圈袢由内皮细胞和上皮细胞之间的类纤维物质组成。病变晚期，肾小球可与囊壁粘连，跟着纤维安排增多，肾小球可发作纤维化，纤锥安排通明变性呈玻璃样小体。
肾小管病变
常见肾小管变性，肾小管细胞肿胀，而且经常有含有PAS糖原染色阳性颗粒，调集管可见到萎缩，并伴有核固缩，基底膜增厚及萎缩。肾小管可发作显着扩张，炎症损害严重者亦可见肾小管萎缩及坏死。免疫荧光检査可见70%的肾小管免疫荧光阳性。
肾间质病变
肾间质的病变表现为间质水肿，并将肾小管彼此分隔，缓慢者可发现有散在性斑驳状散布的纤维化安排，病程越长纤维化则越显着，间质及纤维化安排中有淋巴细胞、浆细胞及安排细胞散在滋润。
血管病变
SLE肾脏血管病变部位为小动脉，可呈坏死性动脉炎现象的类纤维化变性，伴轻度血管周围细胞滋润，这是本病特征性的血管壁硬化病变。如果呈现坏死性血管炎的病变者，首要损伤肾小动脉及部分叶间动脉，其特征为血管壁无细胞坏死，有蛋白栓子阻塞管腔，管壁很少或无白细胞滋润。
中枢神经系统病理变化
中枢神经系统病理变化，主要是在大脑皮质，尤其是沟前区灰白质的血管易于遭到损害。体现有细小堵塞，血管壁部分坏死，多少不等的颅内出血;脊髓血管受损严重者可导致脊髓梗死。此外在脑部病变的血管内可见类纤维素性坏死和内膜增生性的变化，有内皮细胞增殖和淋巴细胞滋润，有弥漫性神经细胞削减，并可见到纤维蛋白栓塞和血管壁细胞的炎症性反应，可有广泛的细小血栓和局限性软化灶等。免疫荧光检査:在脑组织以及头绪膜丛能够见到免疫球蛋白IgG、IgM,补体Cs和免疫复合物冷静。脑脊液检査，可出现DNA-抗DNA复合物。
郑康忠中医工作室
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