Gatto Mariele, Frontini Giulia, Calatroni Marta, Reggiani Francesco, Depascale Roberto, Cruciani Claudio, Quaglini Silvana, Sacchi Lucia, Trezzi Barbara, Bonelli Grazia Dea, L'Imperio Vincenzo, Vaglio Augusto, Furlan Claudia, Zen Margherita, Iaccarino Luca, Sinico Renato Alberto, Doria Andrea, Moroni Gabriella
Academic Rheumatology Centre, Department of Clinical and Biological Sciences, University of Turin, Mauriziano Hospital, Turin, Italy.
Rheumatology Unit, Department of Medicine, University of Padua, Italy.
Kidney Int Rep. 2024 Jan 19;9(4):1047-1056. doi: 10.1016/j.ekir.2024.01.016. eCollection 2024 Apr.
This retrospective study on patients with biopsy-proven lupus nephritis (LN) aimed to assess the probability of sustained clinical remission (sCR) and to investigate sCR effects on disease flares and impaired kidney function (IKF).
sCR was defined as clinical-Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K) = 0 and estimated glomerular filtration rate (eGFR) >60 ml/min per 1.73 m lasting ≥1 year; IKF: eGFR <60 ml/min per 1.73 m for >3 months. We analyzed the probability of achieving and maintaining sCR, and the yearly risk of flare. Cox models were used to identify predictors of sCR and IKF with variables analyzed as time-dependent covariates when appropriate.
Of 303 patients followed-up with for 14.8 (interquartile range: 9.8-22) years, 257 (84.8%) achieved sCR. The probability of achieving sCR progressively increased over time reaching 90% at 15 years. Baseline age (hazard ratio [HR]: 1.017; 95% confidence interval [CI]: 0.005-1.029; = 0.004), hydroxychloroquine intake (HR: 1.385; 95% CI: 1.051-1.825; = 0.021), and absence of arterial hypertension (HR: 0.699; 95% CI: 0.532-0.921; = 0.011) were independent predictors of sCR. Among patients who achieved sCR, 142 (55.3%) developed a lupus flare after a median time of 3.6 (2.3-5.9) years. In the remaining 115 patients, sCR persisted for 9.5 (5.8-14.5) years. The probability of sCR to persist at 15 years was 38%. SLE flare risk decreased to 10%, 5%, and 2% in patients with sCR lasting <5, 5 to 10, and >10 years, respectively. At the last observation, 57 patients (18.81%) had IKF. sCR achievement (HR: 0.18, < 0.001) and its duration (HR: 0.83, < 0.001) were protective against IKF.
sCR is an achievable target in LN management and protects against IKF. The longer the sCR, the higher the chance of its persistence and the lower the risk of SLE flares.
这项针对经活检证实的狼疮性肾炎（LN）患者的回顾性研究旨在评估持续临床缓解（sCR）的概率，并研究sCR对疾病复发和肾功能受损（IKF）的影响。
sCR定义为临床系统性红斑狼疮疾病活动指数2000（SLEDAI - 2K）= 0且估计肾小球滤过率（eGFR）>60 ml/（min·1.73 m²）持续≥1年；IKF定义为eGFR<60 ml/（min·1.73 m²）超过3个月。我们分析了实现并维持sCR的概率以及每年的复发风险。Cox模型用于确定sCR和IKF的预测因素，在适当情况下将变量作为时间依赖性协变量进行分析。
在303例随访14.8（四分位间距：9.8 - 22）年的患者中，有257例（84.8%）实现了sCR。实现sCR的概率随时间逐渐增加，在15年时达到90%。基线年龄（风险比[HR]：1.017；95%置信区间[CI]：0.005 - 1.029；P = 0.004）、服用羟氯喹（HR：1.385；95%CI：1.051 - 1.825；P = 0.021）以及无动脉高血压（HR：0.699；95%CI：0.532 - 0.921；P = 0.011）是sCR的独立预测因素。在实现sCR的患者中，142例（55.3%）在中位时间3.6（2.3 - 5.9）年后出现狼疮复发。在其余115例患者中，sCR持续了9.5（5.8 - 14.5）年。sCR在15年时持续存在的概率为38%。sCR持续时间<5年、5至10年和>10年的患者中，狼疮复发风险分别降至10%、5%和2%。在最后一次观察时，57例患者（18.81%）出现IKF。实现sCR（HR：0.18，P < 0.001）及其持续时间（HR：0.83，P < 0.001）对IKF具有保护作用。
sCR是LN管理中可实现的目标，并可预防IKF。sCR持续时间越长，其持续存在的机会越高，SLE复发风险越低。
