Kharouf Fadi, Li Qixuan, Whittall Garcia Laura P, Jauhal Arenn, Gladman Dafna D, Touma Zahi
Division of Rheumatology, University of Toronto Lupus Clinic, Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, ON, Canada.
Division of Nephrology, University of Toronto, Toronto, ON, Canada.
Rheumatology (Oxford). 2025 Apr 1;64(4):1912-1922. doi: 10.1093/rheumatology/keae436.
Membranous LN (MLN) is thought to have a more benign course than proliferative LN (PLN). We aimed to determine the differences in short- and long-term outcomes between patients with MLN and PLN.
We included patients with first biopsy-proven MLN and PLN. Short-term outcomes included complete proteinuria recovery (CPR), complete renal response (CRR) and primary efficacy renal response (PERR). Long-term outcomes included a sustained ≥40% reduction in baseline estimated glomerular filtration rate, end-stage kidney disease (ESKD), cardiovascular (CV) events, ≥2 increase in SLICC/ACR Damage Index and death. Univariable and multivariable Cox proportional hazard models were used to examine the effect of baseline characteristics on long-term outcomes.
Of 215 patients, 51 had pure MLN and 164 had PLN. We found no significant differences between the two groups in achieving CPR, CRR and PERR at 1 and 2 years. Median time to outcomes was slightly, but insignificantly, longer in the MLN group. For long-term outcomes, PLN was associated with worse renal and non-renal outcomes, but this was not statistically significant. In the multivariable Cox proportional hazard models, ESKD was associated with the following baseline variables: younger age [hazard ratio (HR) 0.92, 95% confidence interval (CI) 0.87-0.97], higher creatinine (HR 1.01, 95% CI 1.01-1.02), low complement (HR 4.0, 95% CI 1.04-11.10) and higher chronicity index (HR 1.28, 95% CI 1.08-1.51).
The resolution of proteinuria in LN is slow. MLN is not a benign disease and may be associated with deterioration of renal function, ESKD, damage, CV events and death.
膜性狼疮性肾炎（MLN）被认为病程比增殖性狼疮性肾炎（PLN）更为良性。我们旨在确定MLN和PLN患者短期和长期结局的差异。
我们纳入了首次经活检证实为MLN和PLN的患者。短期结局包括蛋白尿完全缓解（CPR）、完全肾脏缓解（CRR）和主要疗效肾脏缓解（PERR）。长期结局包括基线估计肾小球滤过率持续降低≥40%、终末期肾病（ESKD）、心血管（CV）事件、系统性红斑狼疮国际协作临床（SLICC）/美国风湿病学会（ACR）损伤指数增加≥2以及死亡。采用单变量和多变量Cox比例风险模型来检验基线特征对长期结局的影响。
在215例患者中，51例为单纯MLN，164例为PLN。我们发现两组在1年和2年时实现CPR、CRR和PERR方面无显著差异。MLN组达到结局的中位时间稍长，但无统计学意义。对于长期结局，PLN与更差的肾脏和非肾脏结局相关，但这无统计学意义。在多变量Cox比例风险模型中，ESKD与以下基线变量相关：年龄较小[风险比（HR）0.92，95%置信区间（CI）0.87 - 0.97]、肌酐水平较高（HR 1.01，95% CI 1.01 - 1.02）、补体水平低（HR 4.0，95% CI 1.04 - 11.10）以及慢性指数较高（HR 1.28，95% CI 1.08 - 1.51）。
狼疮性肾炎中蛋白尿的缓解缓慢。MLN并非良性疾病，可能与肾功能恶化、ESKD、损伤、CV事件和死亡相关。
