Rheumatology and Rehabilitation Department, Kasr Alainy Faculty of Medicine, Cairo University, Cairo, Egypt.
Pediatric Rheumatology Department, Kasr Alainy Faculty of Medicine, Cairo University, Cairo, Egypt.
Saudi J Kidney Dis Transpl. 2022 Jan-Feb;33(1):90-105. doi: 10.4103/1319-2442.367830.
The study aimed to evaluate the association of demographic, clinical, and histopathologic characteristics with renal and disease outcomes. Persistent lack of partial or complete remission despite sequential induction therapy, chronic kidney disease (CKD) or endstage renal disease (ESRD), and/or mortality were determined as poor renal outcomes. Disease damage was investigated through the Systemic Lupus International Collaborating Clinics/ American College of Rheumatology Damage Index (SDI). Of 201 biopsy-proven lupus nephritis patients, a poor outcome was present in 56 (27.9%) patients, with nine (4.5%), 22 (10.9%), and 29 (14.4%) patients demonstrating lack of response, CKD, and ESRD, respectively, and the prevalence of mortality was 5.5% (11/201). The outcome was poor among males [29/201 (14.4%)] [P = 0.008; odds ratio (OR): 2.8; 95% confidence interval (CI): 1.2-6.4], yet comparable between adult- and juvenile-onset patients [80/201 (39.8%) (≤16 years)] (P = 0.6; OR: 0.8; 95% CI: 0.4-1.6). Hypertension (P <0.001; OR: 6.3; 95% CI: 2.6-14.9), elevated creatinine (P <0.001; OR: 5.2; 95% CI: 2.6-10.3), and hematuria (P <0.001; OR: 3.7; 95% CI: 1.9-7.5) at presentation, and fibrinoid necrosis [P <0.001; odds ratio (OR): 4.1; 95% confidence interval (CI): 2.1-8.1], wire loops (P = 0.006; OR: 2.4; 95% CI: 1.2-4.6), crescents (P <0.001; OR: 5.4 95% CI: 2.8-10.5), interstitial fibrosis (P = 0.001; OR: 2.7; 95% CI: 1.4-5.1), and acute vascular lesions (P = 0.004; OR: 3.6; 95% CI: 1.4-9.4) on biopsy were associated with a poor outcome. Chronic glomerular (P = 0.003) and acute vascular lesions (P <0.001), and a higher chronicity index (r = 0.1; P = 0.006) on biopsy, and frequent renal (r = 0.3; P <0.001) and extra-renal flares (r = 0.2; P <0.001) were associated with higher SDI scores. Among the studied renal and extra-renal parameters, independent predictors of higher disease damage solely included frequent renal flares (ᵝ= 1; P <0.001). To conclude, a poor renal outcome (27.9%) was associated with distinct features. Disease damage was associated with frequent renal flares.
本研究旨在评估人口统计学、临床和组织病理学特征与肾脏和疾病结局的关联。尽管进行了连续诱导治疗，但仍持续缺乏部分或完全缓解、慢性肾脏病（CKD）或终末期肾病（ESRD）和/或死亡被确定为不良肾脏结局。通过系统性红斑狼疮国际协作诊所/美国风湿病学会损伤指数（SDI）来研究疾病损伤。在 201 例经活检证实的狼疮肾炎患者中，56 例（27.9%）患者预后不良，分别有 9 例（4.5%）、22 例（10.9%）和 29 例（14.4%）患者出现无反应、CKD 和 ESRD，死亡率为 5.5%（11/201）。男性的预后不良[29/201（14.4%）] [P = 0.008；比值比（OR）：2.8；95%置信区间（CI）：1.2-6.4]，但与成人和青少年发病患者之间无差异[80/201（39.8%）（≤16 岁）] （P = 0.6；OR：0.8；95% CI：0.4-1.6）。高血压（P <0.001；OR：6.3；95% CI：2.6-14.9）、肌酐升高（P <0.001；OR：5.2；95% CI：2.6-10.3）和血尿（P <0.001；OR：3.7；95% CI：1.9-7.5），以及纤维蛋白样坏死[P <0.001；比值比（OR）：4.1；95%置信区间（CI）：2.1-8.1]、线状环（P = 0.006；OR：2.4；95% CI：1.2-4.6）、新月体（P <0.001；OR：5.4；95% CI：2.8-10.5）、间质纤维化（P = 0.001；OR：2.7；95% CI：1.4-5.1）和急性血管病变（P = 0.004；OR：3.6；95% CI：1.4-9.4）与不良预后相关。慢性肾小球病变（P = 0.003）和急性血管病变（P <0.001）、活检时的慢性指数（r = 0.1；P = 0.006）和频繁的肾脏（r = 0.3；P <0.001）和肾脏外发作（r = 0.2；P <0.001）与较高的 SDI 评分相关。在所研究的肾脏和肾脏外参数中，仅频繁的肾脏发作（ᵝ= 1；P <0.001）是疾病损伤的独立预测因素。总之，不良肾脏结局（27.9%）与特定特征相关。疾病损伤与频繁的肾脏发作相关。
