FP171SEGMENTAL VERSUS GLOBAL SUBCLASSES OF PROLIFERATIVE LUPUS NEPHRITIS: RENAL OUTCOMES

2015 ◽  
Vol 30 (suppl_3) ◽  
pp. iii123-iii123
Author(s):  
Eduardo Jorge Duque de Sá Carneiro Filho ◽  
Alcino Gama Pires ◽  
Mariana Pin de Andrade ◽  
Beatriz Seves de Holanda ◽  
Jonatas Gonzaga Dantas ◽  
...  
Keyword(s):  
Lupus Nephritis ◽  
Renal Outcomes ◽  
Proliferative Lupus Nephritis

The Crescentic Implication of Renal Outcomes in Proliferative Lupus Nephritis

2018 ◽  
Vol 45 (4) ◽  
pp. 513-520 ◽  
Author(s):  
Fanghao Cai ◽  
Fei Han ◽  
Hongya Wang ◽  
Haidongqin Han ◽  
Jingyun Le ◽  
...  
Keyword(s):  
Risk Factors ◽  
Lupus Nephritis ◽  
Renal Survival ◽  
Endstage Renal Disease ◽  
Tubular Atrophy ◽  
Renal Outcomes ◽  
Proliferative Lupus Nephritis ◽  
Independent Risk Factors ◽  
Cox Proportional Hazard Regression ◽  
Renal Tubular

Objective.To determine the association between crescents and renal outcomes, and the implications on therapeutic choices.Methods.There were 231 patients with biopsy-proven proliferative lupus nephritis (PLN) who were divided into 4 groups: 59 patients were in the noncrescent group (NC); 59 patients exclusively with segmental crescents were in the segmental crescent group (SC); patients with circumferential crescents were categorized into 2 groups according to the crescentic ratio (C1 had 64 patients with ≤ 25%, and C2 had 49 patients with > 25%). Their baseline laboratory tests, histopathological manifestations, and outcomes were compared.Results.Remission rates in NC, SC, C1, and C2 groups were 92.1%, 85.4%, 95.0%, and 76.1%, respectively. Fewer patients in the C2 group achieved complete remission than the other 3 groups. For longterm outcomes evaluated by serum creatinine (SCr) doubling or endstage renal disease (ESRD), the renal survival rate was lowest in the C2 group (p = 0.003). Including clinical and pathological variables in the Cox proportional hazard regression model separately, the multivariate analysis revealed that these were independent risk factors for SCr doubling or ESRD: baseline SCr (with every 1 mg/dl increase: HR = 1.834, 95% CI 1.465–2.296; p < 0.001), hemoglobin (with every 1 g/l increase: HR = 0.970, 95% CI 0.947–0.992; p = 0.009), the proportions of cellular crescents (with every 1% increase: HR = 1.040, 95% CI 1.015–1.066; p = 0.002) and fibrocellular crescents (with every 1% increase: HR = 1.085, 95% CI 1.013–1.163; p = 0.020), and severe renal tubular atrophy (HR = 5.348, 95% CI 1.278–22.373; p = 0.022).Conclusion.PLN with crescents > 25% had worse renal outcomes both in short and long terms. Proportions of cellular and fibrocellular crescents were independent risk factors for poor renal survival.

Impact of stringent response in proteinuria on long-term renal outcomes in proliferative lupus nephritis

Lupus ◽  
2019 ◽  
Vol 28 (11) ◽  
pp. 1294-1301 ◽  
Author(s):  
J Won ◽  
J S Lee ◽  
J S Oh ◽  
Y-G Kim ◽  
C-K Lee ◽  
...  
Keyword(s):  
Lupus Nephritis ◽  
Induction Therapy ◽  
Lower Risk ◽  
Clinical Laboratory ◽  
Laboratory Data ◽  
Class Iii ◽  
Renal Outcomes ◽  
Renal Flare ◽  
Proliferative Lupus Nephritis

Objectives Favourable long-term prognosis in proliferative lupus nephritis (LN) is associated with the achievement of complete renal response (CR), which is defined as a urine protein/creatinine ratio (UPCR) of < 0.5. However, it is unclear whether a more stringent cut-off for proteinuria (normal value of proteinuria; UPCR < 0.15) is better than CR. We aimed to evaluate the effect of stringent CR, defined as a UPCR of <0.15, on long-term renal outcomes in proliferative LN. Methods We included 87 patients with class III or IV LN who achieved CR at one year after induction therapy. Clinical and laboratory data were compared between the stringent and non-stringent CR groups. Logistic regression analysis was performed to identify factors associated with achievement of stringent CR. Cox analysis was performed to analyse the risk factors for renal flare and development of chronic kidney disease (CKD). Results The stringent and non-stringent CR groups included 58 and 29 patients, respectively. The two groups showed no significant baseline differences in terms of the clinical, laboratory and pathological classification. The sustained CR rates during five years were 91.3% and 50.0% ( p = 0.014) in the stringent and non-stringent CR groups, respectively. In Cox analyses, the achievement of stringent CR was associated with a lower risk of five-year renal flare rate (hazard ratio (HR) = 0.161, 95% confidence interval (CI) 0.063–0.411, p < 0.01) and development of CKD (HR = 0.189, 95% CI 0.047–0.752, p = 0.018). Mycophenolate mofetil induction therapy was associated with achievement of stringent CR at a borderline level of significance (HR = 7.268, 95% CI 0.894–59.089, p = 0.064). Conclusion Achievement of stringent CR predicted lower risk of renal flare and development of CKD in proliferative LN. These findings suggest that stringent CR is a valuable treatment target in proliferative LN.

Good outcomes with mycophenolate-cyclosporine-based induction protocol in children with severe proliferative lupus nephritis

Lupus ◽  
2010 ◽  
Vol 19 (8) ◽  
pp. 965-973 ◽  
Author(s):  
E. Aragon ◽  
YH Chan ◽  
KH Ng ◽  
YW Lau ◽  
PH Tan ◽  
...  
Keyword(s):  
Lupus Nephritis ◽  
Proliferative Lupus Nephritis

Principles of pediatric lupus nephritis in a prospective contemporary multi-center cohort

Lupus ◽  
2021 ◽  
pp. 096120332110286
Author(s):  
Kathleen M Vazzana ◽  
Ankana Daga ◽  
Beatrice Goilav ◽  
Ekemini A Ogbu ◽  
Daryl M Okamura ◽  
...  
Keyword(s):  
Lupus Nephritis ◽  
Kidney Function ◽  
Lupus Erythematosus ◽  
Extensive Literature ◽  
Short Term ◽  
Renal Outcomes ◽  
Childhood Arthritis ◽  
Black Patients ◽  
End Stage

Lupus nephritis (LN) is a life-threatening manifestation of systemic lupus erythematosus (SLE) and is more common in children than adults. The epidemiology and management of childhood-onset SLE (cSLE) have changed over time, prompting the need to reassess expected outcomes. The purpose of this study is to use the Childhood Arthritis and Rheumatology Research Alliance (CARRA) prospective registry to validate historical principles of LN in a contemporary, real-world cohort. After an extensive literature review, six principles of LN in cSLE were identified. The CARRA registry was queried to evaluate these principles in determining the rate of LN in cSLE, median time from cSLE diagnosis to LN, short-term renal outcomes, and frequency of rituximab as an induction therapy. Of the 677 cSLE patients in the CARRA registry, 32% had documented LN. Decline in kidney function was more common in Black cSLE patients than non-Black patients ( p = 0.04). Black race was associated with worse short-term renal outcomes. In short-term follow up, most children with LN had unchanged or improved kidney function, and end stage kidney disease (ESKD) was rare. Ongoing follow-up of cSLE patients in the CARRA registry will be necessary to evaluate long-term outcomes to inform risk, management, and prognosis of LN in cSLE.

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