Division of Nephrology, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas 75390-8856, USA.
Am J Med Sci. 2011 Dec;342(6):467-73. doi: 10.1097/MAJ.0b013e3182199214.
Lupus nephritis (LN) is an ominous complication of systemic lupus erythematosus, and the risk factors for the disease progression are not well characterized.
In a retrospective study, the authors evaluated the mode of presentation and outcomes of 163 consecutive patients with biopsy-proven LN, who presented to the center between January 1999 and September 2008. Using stepwise logistic regression analysis, the authors assessed risk factors independently associated with response to treatment and to progression to end-stage renal disease (ESRD) in proliferative LN (PLN).
Ninety percent of the patients belonged to minority population. Among 122 patients with class III and IV LN (PLN), 76 patients received intravenous cyclophosphamide and 38 patients received mycophenolate for induction, whereas 34 patients received intravenous cyclophosphamide and 63 patients received mycophenolate for maintenance. Thirty-six (30%) patients with PLN progressed to ESRD, and 3 patients died over a mean follow-up of 37.5 months. In multivariate analysis, chronicity index (CI) (P = 0.0007) and hypertension (P = 0.042) positively correlated with progression to ESRD and death, and CI was associated with increased probability of nonresponse to treatment (P = 0.001). In addition, mycophenolate as maintenance agent was associated with increased likelihood of sustained complete remission and partial remission (P = 0.045).
In patients with LN, hypertension and a high CI are independent risk factors for progression to ESRD or death. Furthermore, a high CI is associated with poor response, and mycophenolate as a maintenance agent may improve the response to treatment.
狼疮肾炎（LN）是系统性红斑狼疮的一种严重并发症，其疾病进展的危险因素尚不清楚。
在一项回顾性研究中，作者评估了 1999 年 1 月至 2008 年 9 月期间在该中心就诊的 163 例经活检证实的 LN 患者的发病方式和结局。作者采用逐步逻辑回归分析，评估与增生性 LN（PLN）对治疗的反应和进展至终末期肾病（ESRD）相关的独立危险因素。
90%的患者属于少数民族。在 122 例 III 级和 IV 级 LN（PLN）患者中，76 例接受静脉注射环磷酰胺和 38 例接受霉酚酸酯诱导，而 34 例接受静脉注射环磷酰胺和 63 例接受霉酚酸酯维持治疗。36 例（30%）PLN 患者进展为 ESRD，3 例患者在平均 37.5 个月的随访中死亡。多变量分析显示，慢性指数（CI）（P=0.0007）和高血压（P=0.042）与进展为 ESRD 和死亡呈正相关，CI 与治疗反应不良的概率增加相关（P=0.001）。此外，霉酚酸酯作为维持剂与持续完全缓解和部分缓解的可能性增加相关（P=0.045）。
在 LN 患者中，高血压和高 CI 是进展为 ESRD 或死亡的独立危险因素。此外，CI 较高与反应不良相关，霉酚酸酯作为维持剂可能改善治疗反应。
