Zavala-Miranda María Fernanda, Perez-Arias Abril Alicia, Márquez-Macedo Sofía E, Comunidad-Bonilla Roque A, Romero-Diaz Juanita, Morales-Buenrostro Luis E, Mejía-Vilet Juan M
Department of Nephrology and Mineral Metabolism.
Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
Rheumatology (Oxford). 2023 Mar 1;62(3):1136-1144. doi: 10.1093/rheumatology/keac407.
To characterize the clinical presentation and outcomes of LN in a Hispanic cohort from Mexico.
We studied 440 subjects with systemic lupus erythematosus and biopsy-proven LN followed for >36 months. We obtained demographic, clinical, laboratory, histopathological and treatment variables. All outcomes were analysed by survival analysis and included response to therapy, renal relapses, progression of kidney disease (decline in eGFR ≥ 30%, doubling of serum creatinine, end-stage kidney disease) and patient survival.
The median age of the study cohort was 29 years (IQR 23-37) and 96% were female. The median eGFR at inclusion was 81 mL/min/1.73m2 (IQR 48-118) and 24 h-uPCR was 3.4 g/g (IQR 1.9-5.6). Mixed class LN (III/IV+V) was the most frequently observed (69%). Over a median follow-up of 79 months, complete response rates were 22.3%, 40.5% and 51.6%, at 6, 12 and 24 months, respectively. Renal relapse rates were 32.3% and 50.6% at 3 and 5 years. By 3 and 5 years, 20.7% and 31.4% had decline in eGFR ≥30%, 14.4% and 22.5% doubled their serum creatinine, and 9.1% and 17.7% progressed to ESKD. The factors associated with loss of kidney function were age, eGFR at presentation, the histologic chronicity index in the kidney biopsy, and the type of response to therapy. Patient survival was 98.2% and 97.1% at 3 and 5 years.
Although the response to treatment and patient survival in this Latin American cohort is comparable to that observed in other regions, there is still a high rate of renal relapses and progression to decline in kidney function.
描述来自墨西哥的西班牙裔队列中狼疮性肾炎（LN）的临床表现和结局。
我们研究了440例系统性红斑狼疮且经活检证实为LN的受试者，随访时间超过36个月。我们获取了人口统计学、临床、实验室、组织病理学和治疗变量。所有结局均通过生存分析进行分析，包括对治疗的反应、肾脏复发、肾脏疾病进展（估算肾小球滤过率[eGFR]下降≥30%、血清肌酐翻倍、终末期肾病）和患者生存率。
研究队列的中位年龄为29岁（四分位间距[IQR] 23 - 37），96%为女性。纳入时的中位eGFR为81 mL/min/1.73m²（IQR 48 - 118），24小时尿蛋白肌酐比值（uPCR）为3.4 g/g（IQR 1.9 - 5.6）。混合性LN（III/IV + V型）最为常见（69%）。在中位随访79个月期间，6个月、12个月和24个月时的完全缓解率分别为22.3%、40.5%和51.6%。3年和5年时的肾脏复发率分别为32.3%和50.6%。到3年和5年时，20.7%和31.4%的患者eGFR下降≥30%，14.4%和22.5%的患者血清肌酐翻倍，9.1%和17.7%的患者进展至终末期肾病（ESKD）。与肾功能丧失相关的因素有年龄、就诊时的eGFR、肾脏活检的组织学慢性指数以及对治疗的反应类型。3年和5年时的患者生存率分别为98.2%和97.1%。
尽管该拉丁美洲队列对治疗的反应和患者生存率与其他地区观察到的情况相当，但肾脏复发率和肾功能下降进展率仍然很高。
