Park D J, Kang J H, Lee J W, Lee K E, Kim T J, Park Y W, Lee J S, Choi Y D, Lee S S
1 Division of Rheumatology, Chonnam National University Medical School & Hospital, Gwangju, Republic of Korea.
2 Department of Pathology, Chonnam National University Hospital & Medical School, Gwangju, Republic of Korea.
Lupus. 2017 Oct;26(11):1139-1148. doi: 10.1177/0961203317694257. Epub 2017 Mar 8.
Objectives We analyzed the clinical follow-up results of 88 lupus nephritis patients to find prognostic factors for the development of chronic kidney disease in ethnically homogeneous Korean patients with biopsy-proven lupus nephritis. Methods Sociodemographic, clinical, laboratory, and treatment-related data at the time of kidney biopsy and during follow-up were obtained. Renal biopsy specimens were reclassified according to the International Society of Pathology/Renal Pathology Society classification, separately, by two renal pathologists blinded to the previous classification. Univariate and multivariate analyses were performed using the Cox proportional hazard regression model to identify independent risk factors for chronic kidney disease in lupus nephritis patients. Results Eighteen of 88 patients (20.5%) developed chronic kidney disease during a mean follow-up of 47.6 months (range: 12-96 months). Patients who developed chronic kidney disease were older at onset of lupus nephritis, had less education, and were more likely to have hypertension; they had lower serum albumin levels, lower platelet levels, higher serum creatinine levels, lower estimated glomerular filtration rate, higher chronicity index, and lower frequency of anti-ribosomal P antibodies, and they were less likely to be in complete remission in the first year. In stepwise multivariable analyses, hypertension, lower glomerular filtration rate, and failure to achieve complete remission in the first year of treatment were significant predictors of the development of chronic kidney disease in lupus nephritis patients. Conclusions These findings suggest that patients with hypertension and decreased kidney function at the onset of lupus nephritis and showing a poor response to immunosuppressive drugs in the first year should be monitored carefully and managed aggressively to avoid deterioration of kidney function.
目的 我们分析了88例狼疮性肾炎患者的临床随访结果，以寻找在种族同质的经活检证实为狼疮性肾炎的韩国患者中慢性肾脏病发生的预后因素。方法 获取肾活检时及随访期间的社会人口统计学、临床、实验室和治疗相关数据。两名对先前分类不知情的肾脏病理学家分别根据国际病理学会/肾脏病理学会分类对肾活检标本进行重新分类。使用Cox比例风险回归模型进行单因素和多因素分析，以确定狼疮性肾炎患者慢性肾脏病的独立危险因素。结果 88例患者中有18例（20.5%）在平均47.6个月（范围：12 - 96个月）的随访期间发生了慢性肾脏病。发生慢性肾脏病的患者狼疮性肾炎起病时年龄较大、受教育程度较低，且更易患高血压；他们的血清白蛋白水平较低、血小板水平较低、血清肌酐水平较高、估计肾小球滤过率较低、慢性指数较高、抗核糖体P抗体频率较低，且在第一年完全缓解的可能性较小。在逐步多变量分析中，高血压、较低的肾小球滤过率以及治疗第一年未实现完全缓解是狼疮性肾炎患者发生慢性肾脏病的显著预测因素。结论 这些发现表明，狼疮性肾炎起病时患有高血压且肾功能下降以及在第一年对免疫抑制药物反应不佳的患者应进行密切监测并积极管理，以避免肾功能恶化。
