Division of Rheumatology, Department of Internal Medicine, Chonnam National University Medical School & Hospital, Gwangju, Republic of Korea.
Department of Pathology, Chonnam National University Medical School & Hospital, Gwangju, Republic of Korea.
Clin Exp Rheumatol. 2021 Sep-Oct;39(5):947-954. doi: 10.55563/clinexprheumatol/k4rdi7. Epub 2020 Oct 6.
Little is known regarding the effect of hyperuricaemia on the progression of kidney function in patients with lupus nephritis (LN). Thus, we investigated the effect of uric acid (UA) on the long-term outcome of patients with biopsy-proven LN.
Data were obtained from KORNET, a prospective longitudinal systemic lupus erythematosus registry in the Republic of Korea. All 137 patients with LN included in this study had undergone a kidney biopsy and were subsequently treated with immunosuppressants. The patients were divided into two groups: UA ≤7 mg/dL and >7 mg/dL; their sociodemographic, clinical, treatment-related data, and outcomes were compared. Cox-proportional regression analyses were performed to identify independent predictors of renal outcome in patients with LN.
Among the 137 patients, 37 (27.0%) had UA >7 mg/dL. This higher UA group included fewer women, but more patients with hypertension, proliferative type LN, and a chronicity index >12. The 24-h urinary protein excretion and the creatinine level were higher in this group; haemoglobin, platelet, and albumin levels were lower. During 85.0 months of follow-up, complete remission at 1 year was less frequent in the higher UA group, whereas chronic kidney disease (CKD) and end-stage renal disease were more prevalent. In the Cox proportional hazards regression analysis, UA >7 mg/dL was a signi cant predictor of progression to CKD in patients with LN (hazard ratio=2.437; p=0.020).
Our findings suggest that hyperuricaemia at LN onset is an independent risk factor that predicts the development of CKD in patients with LN.
关于高尿酸血症对狼疮肾炎（LN）患者肾功能进展的影响知之甚少。因此，我们研究了尿酸（UA）对经肾活检证实的 LN 患者长期预后的影响。
数据来自韩国的 KORNET，这是一个前瞻性纵向系统性红斑狼疮登记处。本研究纳入的所有 137 例 LN 患者均接受了肾活检，并随后接受免疫抑制剂治疗。患者被分为两组：UA≤7mg/dL 和>7mg/dL；比较两组的社会人口统计学、临床、治疗相关数据和结局。进行 Cox 比例风险回归分析，以确定 LN 患者肾脏结局的独立预测因素。
在 137 例患者中，37 例（27.0%）UA>7mg/dL。UA 较高组的女性较少，但高血压、增生性 LN 和慢性指数>12 的患者更多。该组的 24 小时尿蛋白排泄和肌酐水平更高；血红蛋白、血小板和白蛋白水平较低。在 85.0 个月的随访中，较高 UA 组的 1 年完全缓解率较低，而慢性肾脏病（CKD）和终末期肾病更为常见。在 Cox 比例风险回归分析中，UA>7mg/dL 是 LN 患者进展为 CKD 的独立预测因素（风险比=2.437；p=0.020）。
我们的研究结果表明，LN 发病时的高尿酸血症是预测 LN 患者 CKD 发展的独立危险因素。
