韩国狼疮肾炎患者的慢性肾脏病：单中心 35 年经验。
Chronic kidney disease in Korean patients with lupus nephritis: over a 35-year period at a single center.
机构信息
Division of Rheumatology, Department of Internal Medicine, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Cheonbo-ro, 271, Uijeongbu-si, Gyeonggi-do, Republic of Korea.
Division of Rheumatology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, 06591, Republic of Korea.
出版信息
Clin Rheumatol. 2022 Jun;41(6):1665-1674. doi: 10.1007/s10067-021-06030-w. Epub 2022 Feb 18.
INTRODUCTION
Chronic kidney disease (CKD) is a major risk factor for overall morbidity and mortality even in lupus nephritis (LN) patients. However, less attention has been paid to the development of CKD in patients with LN. The objective of this study was to identify predictors for CKD with 35-year experience depending on newly revised guidelines for patients with LN.
METHODS
We conducted a retrospective cohort study for 401 patients who visited Seoul St. Mary's Hospital between January 1985 and December 2019. We analyzed clinical and laboratory indices, treatment response, the final renal function, and biopsy findings. The timing and cumulative risk of developing CKD were identified by Kaplan-Meier methods. Independent risk factors for developing CKD were examined by Cox proportional hazard regression analyses.
RESULTS
The median follow-up time after the diagnosis of LN was 131 months. CKD occurred in 15.5% of patients within 10 years after the diagnosis of LN. The development of CKD was associated with delayed-onset LN, acute renal dysfunction at onset of LN, and failure to reach complete response (CR) at 6 or 12 months rather than histopathological findings or the severity of proteinuria at onset of LN. Cumulative incidence of progression to CKD was significantly higher in patients with the three predictors mentioned above.
CONCLUSION
Ten-year cumulative incidence of CKD was about 15%. Our results showed that delayed-onset LN, acute renal dysfunction at the onset of LN, and inadequate treatment response assessed at 6 or 12 months after treatment were predictors for the development of CKD in LN. Key Points • CKD is a major risk factor for overall morbidity and mortality in LN patients. • Ten-year cumulative incidence of CKD was about 15% • Delayed-onset LN, acute renal dysfunction at the onset of LN, and inadequate treatment response assessed at 6 or 12 months after treatment were predictors for the development of CKD in LN.
简介
慢性肾脏病（CKD）是影响整体发病率和死亡率的一个主要危险因素，即使在狼疮肾炎（LN）患者中也是如此。然而，对于 LN 患者 CKD 的发展，人们关注较少。本研究的目的是根据 LN 患者新修订的指南，用 35 年的经验来确定 CKD 的预测因素。
方法
我们对 1985 年 1 月至 2019 年 12 月期间在首尔圣玛丽医院就诊的 401 名患者进行了回顾性队列研究。我们分析了临床和实验室指标、治疗反应、最终肾功能和活检结果。通过 Kaplan-Meier 方法确定 CKD 的发生时间和累积风险。通过 Cox 比例风险回归分析检查发生 CKD 的独立危险因素。
结果
LN 诊断后中位随访时间为 131 个月。LN 诊断后 10 年内，15.5%的患者发生 CKD。CKD 的发生与迟发性 LN、LN 发病时急性肾功能障碍以及在 6 或 12 个月时未能达到完全缓解（CR）有关，而与组织病理学发现或 LN 发病时蛋白尿的严重程度无关。上述三种预测因素患者的 CKD 进展累积发生率显著更高。
结论
10 年 CKD 的累积发生率约为 15%。我们的结果表明，LN 发病时迟发性、急性肾功能障碍和治疗后 6 或 12 个月评估的治疗反应不足是 LN 患者 CKD 发展的预测因素。
关键点
CKD 是 LN 患者整体发病率和死亡率的一个主要危险因素。
10 年 CKD 的累积发生率约为 15%。
LN 发病时迟发性、急性肾功能障碍和治疗后 6 或 12 个月评估的治疗反应不足是 LN 患者 CKD 发展的预测因素。
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