Austin H A, Boumpas D T, Vaughan E M, Balow J E
Kidney Disease Section, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD 20892-1268, USA.
Nephrol Dial Transplant. 1995;10(9):1620-8.
The pleomorphic nature of lupus nephritis has confounded efforts to refine estimates of prognosis. Consideration of interactions among prognostic factors may help to identify high-risk patients.
By univariate and multivariate survival analysis, race and attributes of severe active lupus nephritis were evaluated as potentially important prognostic factors in 166 patients upon entry into prospective therapeutic trials of lupus kidney disease.
Black patients were significantly more likely than others to develop renal insufficiency. Cellular crescents emerged as the most predictive active pathological feature and interstitial fibrosis was the strongest chronic histological prognostic factor. Combinations of these morphological attributes identified particularly high-risk individuals. Patients with 50% or more cellular crescents and those with less extensive cellular crescents plus moderate to severe interstitial fibrosis were at markedly increased risk for doubling serum creatinine compared to those who lacked these histologic features (P < 0.0001). Azotaemia, anaemia, hypocomplementaemia, hypertension, tubular atrophy and glomerular sclerosis were also associated with an increased probability of renal function deterioration. Serum creatinine, haematocrit, race, and kidney pathology data emerged as independent predictors of renal insufficiency. Black patients in this study were more likely than the others to have high-risk histological features, including extensive cellular crescents (> or = 50%) and moderate to severe interstitial fibrosis, prior to randomization.
Combinations of high-risk demographic, clinical and histological attributes identify patients at increased risk for progressive renal function deterioration. Several factors, including the severity of kidney biopsy findings, probably contribute to the poor prognosis of Black patients in this study population.
狼疮性肾炎的多形性使得精确评估预后变得困难。考虑预后因素之间的相互作用可能有助于识别高危患者。
通过单因素和多因素生存分析，在166例进入狼疮性肾病前瞻性治疗试验的患者中，评估种族和重度活动性狼疮性肾炎的特征作为潜在的重要预后因素。
黑人患者比其他患者更易发生肾功能不全。细胞性新月体是最具预测性的活动性病理特征，间质纤维化是最强的慢性组织学预后因素。这些形态学特征的组合可识别出特别高危的个体。与缺乏这些组织学特征的患者相比，有50%或更多细胞性新月体的患者以及细胞性新月体较少但伴有中度至重度间质纤维化的患者血清肌酐翻倍的风险显著增加（P < 0.0001）。氮质血症、贫血、低补体血症、高血压、肾小管萎缩和肾小球硬化也与肾功能恶化的可能性增加有关。血清肌酐、血细胞比容、种族和肾脏病理数据是肾功能不全的独立预测因素。在本研究中，黑人患者在随机分组前比其他患者更易具有高危组织学特征，包括广泛的细胞性新月体（≥50%）和中度至重度间质纤维化。
高危的人口统计学、临床和组织学特征组合可识别出肾功能进行性恶化风险增加的患者。包括肾活检结果的严重程度在内的几个因素可能导致本研究人群中黑人患者预后不良。
