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1 年时缺乏 EULAR/ERA-EDTA 缓解预测狼疮肾炎患者的长期肾脏预后不良。

Lack of EULAR/ERA-EDTA response at 1 year predicts poor long-term renal outcome in patients with lupus nephritis.

机构信息

Nephrology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy

Division of Rheumatology, Department of Medicine, DIMED, University of Padova, Padova, Italy.

出版信息

Ann Rheum Dis. 2020 Aug;79(8):1077-1083. doi: 10.1136/annrheumdis-2020-216965. Epub 2020 Jun 5.

DOI:10.1136/annrheumdis-2020-216965

PMID:32503858

Abstract

OBJECTIVES

Short-term predictive endpoints of chronic kidney disease (CKD) are needed in lupus nephritis (LN). We tested response to therapy at 1 year.

METHODS

We considered patients with LN who underwent renal biopsy followed by induction therapy between January 1970 and December 2016. LN was assessed using the International Society of Nephrology/Renal Pathology Society (2003) criteria and the National Institute of Health (NIH) activity and chronicity index. The renal outcome was CKD. Response was defined according to EULAR/European League Against Rheumatism/European Renal Association-European Dialysis and Transplant Association (EULAR/ERA-EDTA) recommendations: proteinuria <0.5 g/24 hours, (near) normal estimated glomerular filtration rate (eGFR); ≥50% proteinuria reduction to subnephrotic levels, (near) normal eGFR; and all the other cases. Logistic regression analysis was employed for 12-month response and Cox regression for CKD prediction.

RESULTS

We studied 381 patients (90.5% Caucasians). After 12-month therapy, 58%, 26% and 16% of patients achieved complete, partial and no response, respectively, according to EULAR/ERA-EDTA. During a median follow-up of 10.7 (IQR: 4.97-18.80) years, 53 patients developed CKD. At 15 years, CKD-free survival rate was 95.2%, 87.6% and 55.4% in patients with complete, partial and no response at 12 months, respectively (p<0.0001). CKD-free survival rates did not differ between complete and partial responders (p=0.067). Serum creatinine (HR: 1.485, 95% CI 1.276 to 1.625), eGFR (HR 0.967, 95% CI 0.957 to 0.977) and proteinuria at 12 months (HR 1.234, 95% CI 1.111 to 1.379) were associated with CKD, yet no reliable cut-offs were identified on the receiver operating characteristic curve. In multivariable analysis, no EULAR/ERA-EDTA response at 12 months (HR 5.165, 95% CI 2.770 to 7.628), low C4 (HR 1.053, 95% CI 1.019 to 1.089) and persistent arterial hypertension (HR 3.154, 95% CI 1.500 to 4.547) independently predicted CKD.

CONCLUSIONS

Lack of EULAR/ERA-EDTA response at 12 months predicts CKD.

摘要

目的

狼疮性肾炎（LN）需要短期预测慢性肾脏病（CKD）的终点。我们检测了 1 年后的治疗反应。

方法

我们考虑了 1970 年 1 月至 2016 年 12 月期间接受肾活检和诱导治疗的 LN 患者。LN 采用国际肾脏病学会/肾脏病理学会（2003 年）标准和美国国立卫生研究院（NIH）活动和慢性指数进行评估。肾脏结局为 CKD。根据欧洲抗风湿病联盟/欧洲狼疮协会/欧洲肾脏协会-欧洲透析与移植协会（EULAR/EULAR-ERA-EDTA）的建议定义反应：蛋白尿<0.5 g/24 小时，（接近）正常估算肾小球滤过率（eGFR）；蛋白尿减少≥50%至亚肾病水平，（接近）正常 eGFR；和所有其他情况。12 个月的反应采用逻辑回归分析，CKD 预测采用 Cox 回归。

结果

我们研究了 381 名患者（90.5%为白种人）。根据 EULAR/EULAR-ERA-EDTA 的建议，治疗 12 个月后，分别有 58%、26%和 16%的患者完全、部分和无反应。在中位数为 10.7（IQR：4.97-18.80）年的随访中，53 名患者发生 CKD。在 15 年时，完全、部分和无反应的患者的 CKD 无病生存率分别为 95.2%、87.6%和 55.4%（p<0.0001）。完全和部分反应患者的 CKD 无病生存率无差异（p=0.067）。12 个月时血清肌酐（HR：1.485，95%CI 1.276 至 1.625）、eGFR（HR 0.967，95%CI 0.957 至 0.977）和蛋白尿（HR 1.234，95%CI 1.111 至 1.379）与 CKD 相关，但在受试者工作特征曲线中未确定可靠的截断值。在多变量分析中，12 个月时无 EULAR/EULAR-ERA-EDTA 反应（HR 5.165，95%CI 2.770 至 7.628）、低 C4（HR 1.053，95%CI 1.019 至 1.089）和持续动脉高血压（HR 3.154，95%CI 1.500 至 4.547）独立预测 CKD。