From the Department of Nephrology, Peking Union Medical College Hospital; Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China.
C. Yue, MD, Department of Nephrology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College; G. Li, MD, Department of Nephrology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College; Y. Wen, MD, Department of Nephrology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College; X. Li, MD, Department of Nephrology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College; R. Gao, MD, Department of Nephrology, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College. C. Yue and G. Li contributed equally to this manuscript.
J Rheumatol. 2018 May;45(5):655-662. doi: 10.3899/jrheum.170561. Epub 2018 Feb 15.
To investigate the renal protective effects of early renin-angiotensin-aldosterone system (RAAS) blockade with renin-angiotensin system inhibitors (RASI) in systemic lupus erythematosus (SLE) patients with antiphospholipid-associated nephropathy (aPLN).
Medical data of 57 SLE patients with biopsy-proven aPLN were analyzed. Early RAAS blockade was defined as administration of RASI within 3 months after kidney biopsy and continued for ≥ 12 months.
There was no significant difference in demographic data, laboratory findings, and renal histology by the time of kidney biopsy, except that the RASI group had higher proteinuria levels vs the non-RASI group [5.2 (2.8-8.8) vs 1.9 (0.6-2.8) g/d, p = 0.005, respectively] and higher prevalence of hypertension (75% vs 29%, p = 0.001, respectively). No significant difference between the 2 groups was observed in estimated glomerular filtration rate (eGFR), mean arterial pressure, and proteinuria level at 12 months after kidney biopsy. The improvement ratio of eGFR at 12 months was significantly higher in the RASI group versus the non-RASI group [26% (-5 to 86) vs -2% (-20 to 20), p = 0.028, respectively], and the rate of change in eGFR beyond 12 months was similar between the 2 groups. During a mean followup of 80 months, 4 (23%) patients in the non-RASI group and 3 (8%) patients in the RASI group developed kidney disease progression. Early RAAS blockade significantly decreased the risk of kidney disease progression [HR = 0.11 (0.02-0.59); p = 0.010]. Proteinuria and hypertension controls were similar between the 2 groups.
Early RAAS blockade improved the short-term and longterm renal outcomes in SLE patients with aPLN. The renal protective effect of RASI was independent of its antihypertensive and antiproteinuric effects.
研究在伴有抗磷脂抗体相关性肾损害（aPLN）的系统性红斑狼疮（SLE）患者中，早期肾素-血管紧张素-醛固酮系统（RAAS）阻断治疗（使用肾素-血管紧张素系统抑制剂（RASI））对肾脏的保护作用。
分析了 57 例经肾活检证实为 aPLN 的 SLE 患者的临床资料。早期 RAAS 阻断定义为肾活检后 3 个月内开始使用 RASI，且持续使用≥12 个月。
两组患者的人口统计学资料、实验室检查结果和肾脏病理表现，除了 RASI 组的蛋白尿水平明显高于非 RASI 组[5.2（2.8-8.8）比 1.9（0.6-2.8）g/d，p=0.005]和高血压患病率更高[75%比 29%，p=0.001]外，并无明显差异。两组患者在肾活检后 12 个月时的估算肾小球滤过率（eGFR）、平均动脉压和蛋白尿水平无明显差异。RASI 组的 eGFR 改善率明显高于非 RASI 组[26%（-5 至 86）比-2%（-20 至 20），p=0.028]，两组在 12 个月后 eGFR 的变化率相似。在平均 80 个月的随访期间，非 RASI 组有 4 例（23%）和 RASI 组有 3 例（8%）患者发生肾脏疾病进展。早期 RAAS 阻断可显著降低肾脏疾病进展的风险[风险比（HR）=0.11（0.02-0.59）；p=0.010]。两组的蛋白尿和高血压控制情况相似。
早期 RAAS 阻断可改善伴有抗磷脂抗体相关性肾损害的系统性红斑狼疮患者的短期和长期肾脏预后。RASI 的肾脏保护作用与其降压和降蛋白尿作用无关。
