Tian S, Li J, Wang L, Liu T, Liu H, Cheng G, Liu D, Deng Y, Gou R, Wan Y, Jia J, Chen C
Department of Nephrology, Renmin Hospital of Yunyang Medical College, Shiyan, 442000, Hubei province, PR China.
Inflamm Res. 2007 Jul;56(7):304-10. doi: 10.1007/s00011-007-6147-x.
To explore a new predictor of renal flares after successful inductive treatment for diffuse proliferative glomerulonephritis(DPGN) in patients with lupus nephritis.
A cohort of patents with SLE DPGN who were treated initially with prednisone and cyclophosphamide were studied. Those who responded to inductive treatment were followed up for the occurrence of renal flares. Urinary levels of RANTES, MCP-1 and M-CSF were measured by ELISA. Other clinical and laboratory data were collected. The predictors and outcome of renal flare were analyzed.
Seventy-three qualified patients with SLE DPGN were investigated. After a mean follow-up of 24.5 +/- 6.4 months, 22 patients experienced renal flares. The median time to relapse was 14.1 +/- 4.1 months. The patients experiencing renal flare showed higher urinary RANTES, MCP-1 and M-CSF. However, independent predictors of renal flares were increased urinary RANTES and M-CSF. Eight patents developed doubling of the serum creatinine (CRX2) level. The occurrence of renal flares was the only predictor of CRX2.
Persistently increased urinary levels of RANTES and M-CSF after initial remission are predictors of renal flare in patients with SLE DPGN. Our results indicate monitoring urinary pro-inflammatory factors may direct us in managing those patients.
探索狼疮性肾炎患者弥漫性增殖性肾小球肾炎（DPGN）诱导治疗成功后肾复发的新预测指标。
研究一组最初接受泼尼松和环磷酰胺治疗的系统性红斑狼疮（SLE）合并DPGN患者。对诱导治疗有反应的患者随访肾复发情况。采用酶联免疫吸附测定法（ELISA）检测尿液中调节激活正常T细胞表达和分泌因子（RANTES）、单核细胞趋化蛋白-1（MCP-1）和巨噬细胞集落刺激因子（M-CSF）水平。收集其他临床和实验室数据。分析肾复发的预测指标和结局。
对73例符合条件的SLE合并DPGN患者进行了研究。平均随访24.5±6.4个月后，22例患者出现肾复发。复发的中位时间为14.1±4.1个月。出现肾复发的患者尿液RANTES、MCP-1和M-CSF水平较高。然而，肾复发的独立预测指标是尿液RANTES和M-CSF升高。8例患者血清肌酐（CRX2）水平翻倍。肾复发是CRX2的唯一预测指标。
初始缓解后尿液RANTES和M-CSF水平持续升高是SLE合并DPGN患者肾复发的预测指标。我们的结果表明，监测尿液促炎因子可能有助于指导我们对这些患者的管理。
