Toronto Western Hospital, Centre for Prognosis Studies in the Rheumatic Diseases, University of Toronto Lupus Clinic, Toronto, ON, Canada.
Biomed Res Int. 2017;2017:5312960. doi: 10.1155/2017/5312960. Epub 2017 Aug 21.
This study aims to elucidate the predictive capabilities of proteinuria, serum creatinine (Cr), and urine RBCs (uRBCs) with respect to long-term renal outcomes in lupus nephritis (LN) in patients followed in clinic. . A retrospective analysis was performed on patients with LN. We evaluated the ability of proteinuria, serum Cr, and uRBCs at 12 months to predict good long-term renal outcomes defined as serum Cr ≤ 100 mmol/L and kidney transplant/dialysis-free at the 7th year. Receiver operator characteristic curves were generated for proteinuria, serum Cr, and uRBCs to study their ability to predict good long-term outcomes and to identify their best cut-off. Descriptive statistics studied the pattern of change of proteinuria and serum Cr. . Proteinuria of 0.6 g/d and Cr of 83 mmol/L performed independently moderately well in predicting good long-term renal outcomes while uRBC was less accurate. Combining serum Cr to proteinuria gave a small increase in positive predictive value with a trade-off in sensitivity. Proteinuria changed within the first year whereas serum Cr changed until the 7th year. . Both proteinuria and Cr predict good long-term renal outcomes in LN. Proteinuria's ability to change faster at 12 months makes it a favorable endpoint for clinical trials and research studies.
本研究旨在阐明蛋白尿、血清肌酐(Cr)和尿红细胞(uRBC)在临床随访的狼疮肾炎(LN)患者中的长期肾脏结局预测能力。对 LN 患者进行了回顾性分析。我们评估了蛋白尿、血清 Cr 和 uRBC 在 12 个月时预测良好长期肾脏结局(定义为第 7 年时血清 Cr≤100mmol/L 且无肾移植/透析)的能力。生成了蛋白尿、血清 Cr 和 uRBC 的受试者工作特征曲线,以研究它们预测良好长期结局的能力,并确定其最佳截断值。描述性统计分析了蛋白尿和血清 Cr 的变化模式。蛋白尿 0.6g/d 和 Cr 83mmol/L 独立预测良好长期肾脏结局的效果中等,而 uRBC 准确性较低。将血清 Cr 与蛋白尿结合使用可略微提高阳性预测值,但代价是敏感性降低。蛋白尿在第 1 年内发生变化,而血清 Cr 则在第 7 年内发生变化。蛋白尿和 Cr 均可预测 LN 的良好长期肾脏结局。蛋白尿在 12 个月时更快地发生变化,使其成为临床试验和研究的理想终点。