Department of Rheumatology and Clinical Immunology, University Medical Center Groningen, University of Groningen, The Netherlands.
Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen, University of Groningen, The Netherlands.
Clin Exp Rheumatol. 2022 Jan;40(1):33-38. doi: 10.55563/clinexprheumatol/c58c39. Epub 2021 Mar 30.
To describe renal outcomes of the lupus nephritis (LN) population of the University Medical Centre Groningen (UMCG) in the Netherlands and to identify predictors for renal flares and long-term renal outcome in daily clinical practice.
A retrospective analysis of biopsy-proven LN patients with induction and maintenance treatment in the UMCG between 1982 and 2016 was performed. Data were collected at time of diagnosis, after 6 months and every year up to 10 years after diagnosis. Outcome measures were renal relapse (biopsy proven), progression to chronic kidney disease (CKD) stage 3 or 4 and chronic renal replacement therapy. The ability of serum creatinine, proteinuria, creatinine clearance, serum anti-double stranded DNA (anti-dsDNA) antibodies, serum complement 3 (C3) and serum complement 4 (C4), as well as biographic data and histopathological class to predict long-term renal outcome was assessed.
Seventy-one patients were included, with median follow-up of 120 months (IQR 48-120 months). During follow-up - up to 10 years - twenty-one (30%) patients experienced at least one relapse. Eleven (15%) patients had CKD stage 3 or 4, of whom eight showed persistent CKD since baseline and two (3%) patients required chronic renal replacement therapy. At baseline, low levels of serum C3 were a significant predictor of renal relapse. Low levels of C3 and C4 at 6 and 12 and proteinuria and high levels of anti-dsDNA at 12 months were significant predictors of renal relapse. At baseline, 6 months and 12 months serum creatinine and creatinine clearance were significant predictors for persistent or newly developed CKD 3 or 4, and need for chronic renal replacement therapy.
Almost one-third of LN patients experience at least one renal relapse during long-term follow up, but only 3% need chronic renal replacement therapy. Our data suggests that early serological remission is associated with a low risk of renal relapse. Decreased renal function at onset and the first year after diagnosis is predictive for decreased renal function at a later stage.
描述荷兰格罗宁根大学医学中心（UMCG）狼疮肾炎（LN）患者的肾脏结局，并确定日常临床实践中肾脏发作和长期肾脏结局的预测因素。
对 1982 年至 2016 年间在 UMCG 接受诱导和维持治疗的活检证实为 LN 的患者进行回顾性分析。在诊断时、6 个月后以及诊断后 10 年内每年收集数据。结局指标为肾脏复发（活检证实）、进展为慢性肾脏病（CKD）3 或 4 期和慢性肾脏替代治疗。评估血清肌酐、蛋白尿、肌酐清除率、血清抗双链 DNA（抗-dsDNA）抗体、血清补体 3（C3）和血清补体 4（C4）以及生物统计学数据和组织病理学分类预测长期肾脏结局的能力。
共纳入 71 例患者，中位随访时间为 120 个月（IQR 48-120 个月）。在随访期间-长达 10 年-21 例（30%）患者至少发生过一次复发。11 例（15%）患者出现 CKD 3 或 4 期，其中 8 例自基线以来持续存在 CKD，2 例（3%）患者需要慢性肾脏替代治疗。基线时，血清 C3 水平低是肾脏复发的显著预测因素。6 个月和 12 个月时的 C3 和 C4 水平低、12 个月时的蛋白尿和抗-dsDNA 水平高是肾脏复发的显著预测因素。基线、6 个月和 12 个月时的血清肌酐和肌酐清除率是持续性或新发 CKD 3 或 4 以及需要慢性肾脏替代治疗的显著预测因素。
近三分之一的 LN 患者在长期随访期间至少经历过一次肾脏复发，但只有 3%需要慢性肾脏替代治疗。我们的数据表明，早期血清学缓解与肾脏复发风险降低相关。发病时和诊断后第一年的肾功能下降是以后阶段肾功能下降的预测因素。
