Department of Medicine, Division of Nephrology, King Saud University, King Khalid University Hospital, Riyadh, Saudi Arabia.
Nephrol Dial Transplant. 2012 Feb;27(2):627-32. doi: 10.1093/ndt/gfr327. Epub 2011 Jul 18.
Despite recent advances in the management of lupus nephritis (LN), these unfortunate patients are at a higher risk of developing chronic kidney disease (CKD). Concomitant chronic hepatitis C virus (HCV) infection is associated with adverse outcome in patients with LN and further compounds the risk as some of these patients choose to undergo kidney transplantation in the near future. Objectives. The aim of the present study is to evaluate the long-term impact of chronic HCV infection in patients with underlying Class IV LN on renal function, progression to end-stage renal disease (ESRD) and patient survival.
Retrospective analysis of the medical records of 134 nondialysis-dependent patients with biopsy-proven World Health Organization Class IV LN with chronic HCV infection was done from January 1995 to January 2008 at King Khalid University Hospital, Riyadh, Saudi Arabia. Primary and the secondary end points were death or the development of ESRD. The patients were followed over a period of 6.7 ± 3.3 (1-14.4) years.
From a total of 134 biopsy-proven Class IV LN patients, 15 (11.2%) patients were HCV positive of which 2 (13.3%) patients were male and 13 (86.7%) patients were female. One hundred and nineteen (88.8%) patients were HCV negative of which 17 (14.3%) were male and 102 (85.7%) were female. The mean age was 32.47 ± 11.8 years. Eight (53.3%) patients in the HCV-positive group versus 19 (22.6%) patients in the HCV-negative group progressed to severe renal impairment with serum creatinine >350 μmol/L (P = 0.024). A total of 8 (53.3%) patients in the HCV-positive group versus 18 (17.3%) in HCV-negative group progressed to ESRD (P = 0.005). The mean creatinine clearance was higher (43.3 ± 33 mL/min) in the HCV-negative LN group at last follow-up than in the HCV-positive patients (25 ± 34.9 mL/min) with a statistically significant P-value of 0.0463. Five patients (33.3%) with HCV-positive LN died in comparison to eight (7.6%) patients who were HCV negative P = 0.03; however, the cause of hospital mortality was mainly cardiovascular disease (CVD) and infection and none of the patients died of chronic liver disease, although there was significant deterioration of the liver function at the end of the study. Kaplan-Meier survival estimates showed a significantly inferior renal function and rapid deterioration to ESRD in LN patients with concomitant HCV infection, with a dialysis free survival of 95 and 80% for the HCV-negative group and 90 and 65% for the HCV-positive groups at the end of 5 and 10 years respectively, with a highly significant P-value of <0.05 at the end of 10 years.
The present study highlights that concomitant HCV infection in patients with LN is associated with worse renal outcome, higher rate of progression to ESRD and reduced patient survival.
尽管狼疮肾炎（LN）的治疗近年来取得了进展，但这些不幸的患者仍面临着更高的发展为慢性肾脏病（CKD）的风险。合并慢性丙型肝炎病毒（HCV）感染与 LN 患者的不良预后相关，并且由于一些患者选择在不久的将来进行肾移植，因此风险进一步增加。目的：本研究旨在评估合并基础 IV 型 LN 的慢性 HCV 感染对肾功能、进展为终末期肾病（ESRD）和患者生存的长期影响。
对 1995 年 1 月至 2008 年 1 月在沙特阿拉伯利雅得的哈立德国王大学医院接受活检证实的世界卫生组织（WHO）IV 型 LN 合并慢性 HCV 感染的 134 例非透析依赖患者的病历进行回顾性分析。主要和次要终点分别为死亡或发展为 ESRD。患者随访时间为 6.7±3.3（1-14.4）年。
在总共 134 例活检证实的 IV 型 LN 患者中，15 例（11.2%）患者 HCV 阳性，其中 2 例（13.3%）为男性，13 例（86.7%）为女性。119 例（88.8%）患者 HCV 阴性，其中 17 例（14.3%）为男性，102 例（85.7%）为女性。平均年龄为 32.47±11.8 岁。HCV 阳性组中有 8 例（53.3%）患者进展为严重肾功能损害，血清肌酐>350μmol/L，而 HCV 阴性组中只有 19 例（22.6%）患者进展为严重肾功能损害（P=0.024）。HCV 阳性组中有 8 例（53.3%）患者进展为 ESRD，而 HCV 阴性组中只有 18 例（17.3%）患者进展为 ESRD（P=0.005）。在最后一次随访时，HCV 阴性 LN 组的肌酐清除率（43.3±33 mL/min）明显高于 HCV 阳性患者（25±34.9 mL/min），P 值为 0.0463。5 例（33.3%）HCV 阳性 LN 患者死亡，8 例（7.6%）HCV 阴性患者死亡（P=0.03）；然而，医院死亡的主要原因是心血管疾病（CVD）和感染，没有患者死于慢性肝病，尽管在研究结束时肝功能明显恶化。Kaplan-Meier 生存估计显示，合并 HCV 感染的 LN 患者肾功能迅速恶化，进展为 ESRD 的风险更高，HCV 阴性组的透析无生存时间为 95%和 80%，HCV 阳性组分别为 90%和 65%，在 10 年时具有显著的 P 值<0.05。
本研究强调，LN 合并 HCV 感染与更差的肾脏预后、更高的 ESRD 进展率和降低的患者生存率相关。
