Centro de Ciências da Saúde, Universidade Estadual Do Ceará, Avenida Dr. Silas Munguba, 1700, Itaperi, Fortaleza, Ceará, Brazil.
Hospital Universitário Walter Cantídio, Universidade Federal Do Ceará, Rua Capitão Francisco Pedro 1290, Rodolfo Teófilo, Fortaleza, Ceará, Brazil.
Adv Rheumatol. 2022 Jan 4;62(1):2. doi: 10.1186/s42358-021-00232-1.
Lupus nephritis (LN) is a major source of morbidity and mortality in patients with systemic lupus erythematosus (SLE), with 10-25% of patients progressing to end-stage renal disease (ESRD).
This study aims to elucidate the predictive capabilities of 24-h proteinuria (24PTU) and serum creatinine (sCr) after 12 months of treatment with respect to long-term renal outcomes in LN in a single-center cohort of LN patients.
A retrospective analysis was performed on 214 patients diagnosed with LN followed in our center. Values of 24PTU and sCr were assessed at baseline and after 3, 6 and 12 months, and after 5 years and/or the last evaluation. Chronic kidney disease (CKD) was defined as an estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m for 3 months or longer. End-stage renal disease (ESRD) was defined as the need for permanent dialysis. Receiver operating characteristics curves (ROC) were used to test the best cut-off value of 24PTU and sCr at 12 months who predict bad long-term renal outcomes. RESULTS: The mean follow-up period was 11.2 ± 7.2 years. The best cut-off values for 24PTU and sCr as predictor of CKD were, respectively, 0.9 g/24 h and 0.9 mg/dL. ROC curve for 24PTU had a slightly lower performance than ROC curve for sCr as predictor for CKD (PTU AUC = 0.68; sCr AUC = 0.70), but sensitivity and specificity were better for 24PTU (24PTU: sensitivity = 63.5%, specificity = 71.2%; sCr: sensitivity = 54.8%, specificity = 75.3%). When the outcome was ESRD the best cut-off points were 0.9 g/24hs and 1.3 mg/dL for 24PTU and sCr, respectively, and the curve performance was better for 24PTU (PTU AUC = 0.72; sCr AUC = 0.61).
In this ethnically diverse population with LN followed for a long time (> 10 years), levels of 24PTU > 0.9/day at 12 months was a good predictor of bad long-term renal outcome. The serum creatinine > 0.9 mg/dL and > 1.3 mg/dL at 12 months were also good predictors of CKD and ESRD, respectively. Patients with 24PTU < 0.9 g/day and sCr < 1.3 mg/dL at 12 months are not likely to develop ESRD because of the high negative predictive values (NPV) (93.2% and 82%). 24PTU and sCr are relevant as components for a treat-to-target strategy for LN treatment, since their high NPV corroborates their importance as good predictors of long-term renal outcome.
狼疮肾炎（LN）是系统性红斑狼疮（SLE）患者发病率和死亡率的主要来源，10-25%的患者进展为终末期肾病（ESRD）。
本研究旨在阐明 LN 患者在治疗 12 个月后 24 小时尿蛋白（24PTU）和血清肌酐（sCr）的变化对长期肾脏结局的预测能力，这是在 LN 患者的单中心队列中进行的。
对在我院就诊的 214 例 LN 患者进行回顾性分析。基线时和治疗后 3、6 和 12 个月及 5 年后和/或最后一次评估时评估 24PTU 和 sCr 值。慢性肾脏病（CKD）定义为估计肾小球滤过率（eGFR）<60ml/min/1.73m 持续 3 个月以上。终末期肾病（ESRD）定义为需要永久性透析。使用受试者工作特征曲线（ROC）来测试 12 个月时 24PTU 和 sCr 的最佳截断值，以预测不良的长期肾脏结局。
平均随访时间为 11.2±7.2 年。24PTU 和 sCr 作为 CKD 预测因子的最佳截断值分别为 0.9g/24h 和 0.9mg/dL。24PTU 的 ROC 曲线的性能略低于 sCr 的 ROC 曲线（PTU AUC=0.68；sCr AUC=0.70），但 24PTU 的敏感性和特异性更好（24PTU：敏感性=63.5%，特异性=71.2%；sCr：敏感性=54.8%，特异性=75.3%）。当结局为 ESRD 时，24PTU 和 sCr 的最佳截断值分别为 0.9g/24hs 和 1.3mg/dL，24PTU 的曲线性能更好（PTU AUC=0.72；sCr AUC=0.61）。
在本研究中，在一个种族多样化的 LN 患者群体中（随访时间>10 年），12 个月时 24PTU>0.9 天是不良长期肾脏结局的良好预测因子。12 个月时 sCr>0.9mg/dL 和>1.3mg/dL 也是 CKD 和 ESRD 的良好预测因子，分别为。12 个月时 24PTU<0.9g/天和 sCr<1.3mg/dL 的患者不太可能发展为 ESRD，因为其阴性预测值（NPV）很高（93.2%和 82%）。24PTU 和 sCr 作为治疗靶点策略的治疗成分很重要，因为它们的高 NPV 证实了它们作为长期肾脏结局良好预测因子的重要性。
