Long-term renal outcomes in a cohort of 1814 Chinese patients with biopsy-proven lupus nephritis

Lupus ◽  
2015 ◽  
Vol 24 (14) ◽  
pp. 1468-1478 ◽  
Author(s):  
J Yang ◽  
D Liang ◽  
H Zhang ◽  
Z Liu ◽  
W Le ◽  
...  
Keyword(s):  
Lupus Nephritis ◽  
Chinese Patients ◽  
Renal Outcomes

scholarly journals Predictors of Good Long-Term Renal Outcomes in Lupus Nephritis: Results from a Single Lupus Cohort

2017 ◽  
Vol 2017 ◽  
pp. 1-8 ◽  
Author(s):  
William A. Fung ◽  
Jiandong Su ◽  
Zahi Touma
Keyword(s):  
Clinical Trials ◽  
Lupus Nephritis ◽  
Positive Predictive Value ◽  
Descriptive Statistics ◽  
First Year ◽  
Receiver Operator Characteristic ◽  
Long Term Outcomes ◽  
Trade Off ◽  
Renal Outcomes

This study aims to elucidate the predictive capabilities of proteinuria, serum creatinine (Cr), and urine RBCs (uRBCs) with respect to long-term renal outcomes in lupus nephritis (LN) in patients followed in clinic. Methods. A retrospective analysis was performed on patients with LN. We evaluated the ability of proteinuria, serum Cr, and uRBCs at 12 months to predict good long-term renal outcomes defined as serum Cr ≤ 100 mmol/L and kidney transplant/dialysis-free at the 7th year. Receiver operator characteristic curves were generated for proteinuria, serum Cr, and uRBCs to study their ability to predict good long-term outcomes and to identify their best cut-off. Descriptive statistics studied the pattern of change of proteinuria and serum Cr. Results. Proteinuria of 0.6 g/d and Cr of 83 mmol/L performed independently moderately well in predicting good long-term renal outcomes while uRBC was less accurate. Combining serum Cr to proteinuria gave a small increase in positive predictive value with a trade-off in sensitivity. Proteinuria changed within the first year whereas serum Cr changed until the 7th year. Conclusions. Both proteinuria and Cr predict good long-term renal outcomes in LN. Proteinuria’s ability to change faster at 12 months makes it a favorable endpoint for clinical trials and research studies.

scholarly journals Proteinuria and serum creatinine after 12 months of treatment for lupus nephritis as predictors of long-term renal outcome: a case–control study

2022 ◽  
Vol 62 (1) ◽  
Author(s):  
Fernanda Nogueira Holanda Ferreira Braga ◽  
Marta Maria das Chagas Medeiros ◽  
Antonio Brazil Viana Junior ◽  
Matheus Eugênio de Sousa Lima ◽  
Levi Coelho Maia Barros ◽  
...  
Keyword(s):  
Lupus Nephritis ◽  
Renal Disease ◽  
Serum Creatinine ◽  
Roc Curve ◽  
End Stage Renal Disease ◽  
Renal Outcome ◽  
Renal Outcomes ◽  
Stage Renal Disease ◽  
End Stage

Abstract Background Lupus nephritis (LN) is a major source of morbidity and mortality in patients with systemic lupus erythematosus (SLE), with 10–25% of patients progressing to end-stage renal disease (ESRD). Objective This study aims to elucidate the predictive capabilities of 24-h proteinuria (24PTU) and serum creatinine (sCr) after 12 months of treatment with respect to long-term renal outcomes in LN in a single-center cohort of LN patients. Methods A retrospective analysis was performed on 214 patients diagnosed with LN followed in our center. Values of 24PTU and sCr were assessed at baseline and after 3, 6 and 12 months, and after 5 years and/or the last evaluation. Chronic kidney disease (CKD) was defined as an estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m2 for 3 months or longer. End-stage renal disease (ESRD) was defined as the need for permanent dialysis. Receiver operating characteristics curves (ROC) were used to test the best cut-off value of 24PTU and sCr at 12 months who predict bad long-term renal outcomes.  Results The mean follow-up period was 11.2 ± 7.2 years. The best cut-off values for 24PTU and sCr as predictor of CKD were, respectively, 0.9 g/24 h and 0.9 mg/dL. ROC curve for 24PTU had a slightly lower performance than ROC curve for sCr as predictor for CKD (PTU AUC = 0.68; sCr AUC = 0.70), but sensitivity and specificity were better for 24PTU (24PTU: sensitivity = 63.5%, specificity = 71.2%; sCr: sensitivity = 54.8%, specificity = 75.3%). When the outcome was ESRD the best cut-off points were 0.9 g/24hs and 1.3 mg/dL for 24PTU and sCr, respectively, and the curve performance was better for 24PTU (PTU AUC = 0.72; sCr AUC = 0.61). Conclusions In this ethnically diverse population with LN followed for a long time (> 10 years), levels of 24PTU > 0.9/day at 12 months was a good predictor of bad long-term renal outcome. The serum creatinine > 0.9 mg/dL and > 1.3 mg/dL at 12 months were also good predictors of CKD and ESRD, respectively. Patients with 24PTU < 0.9 g/day and sCr < 1.3 mg/dL at 12 months are not likely to develop ESRD because of the high negative predictive values (NPV) (93.2% and 82%). 24PTU and sCr are relevant as components for a treat-to-target strategy for LN treatment, since their high NPV corroborates their importance as good predictors of long-term renal outcome.

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.

scholarly journals Renal outcomes in mixed proliferative and membranous lupus nephritis (Class III/IV + V): A long-term observational study

2016 ◽  
Vol 26 (6) ◽  
pp. 908-913 ◽  
Author(s):  
Hidekazu Ikeuchi ◽  
Keiju Hiromura ◽  
Ken Kayakabe ◽  
Kadiombo Anastasie Tshilela ◽  
Kazuhiko Uchiyama ◽  
...  
Keyword(s):  
Lupus Nephritis ◽  
Observational Study ◽  
Class Iii ◽  
Renal Outcomes ◽  
Membranous Lupus Nephritis

Long-term renal outcomes and related risk factors of familial systemic lupus erythematosus patients with lupus nephritis

2018 ◽  
Vol 90 (4) ◽  
pp. 262-269
Author(s):  
Xiao Huang ◽  
Zheng Tang ◽  
Xiaomei Wu ◽  
Lihua Zhang ◽  
Wenjing Fan ◽  
...  
Keyword(s):  
Risk Factors ◽  
Systemic Lupus Erythematosus ◽  
Lupus Nephritis ◽  
Lupus Erythematosus ◽  
Systemic Lupus ◽  
Renal Outcomes ◽  
Related Risk

Lupus Nephritis: Induction Therapy

Lupus ◽  
2005 ◽  
Vol 14 (3_suppl) ◽  
pp. 27-32 ◽  
Author(s):  
TM Chan
Keyword(s):  
Mycophenolate Mofetil ◽  
Lupus Nephritis ◽  
Adverse Effects ◽  
Induction Therapy ◽  
Chinese Patients ◽  
Renal Outcome ◽  
Induction Treatment ◽  
Renal Survival ◽  
Proliferative Lupus Nephritis

Effective induction therapy is of pivotal importance in minimizing renal parenchymal damage by the active immune-mediated inflammatory processes in severe proliferative lupus nephritis. Preservation of nephron mass is prerequisite to long-term renal survival. Data from US-based studies have shown improved efficacy with induction treatment comprising corticosteroid and cyclophosphamide, compared with corticosteroid treatment alone. Data from European studies have shown similar efficacy with a modified treatment regimen, in which smaller doses of cyclophosphamide were given at weekly or fortnightly intervals over a shortened treatment duration, and the treatment related adverse effects appeared less frequent with the reduced-dose regimen. We have also reported that sequential immunosuppression with prednisolone and oral cyclophosphamide as induction followed by azathioprine maintenance was associated with a high incidence of remission and relatively favourable long-term renal outcome in Chinese patients. However, cyclophosphamide treatment is associated with considerable adverse effects, which could be potentially fatal. Mycophenolate mofetil selectively inhibits lymphocyte proliferation, and thus targets an instrumental step in the pathogenesis of systemic lupus erythematosus. There is accumulating evidence that the combined use of mycophenolate mofetil and corticosteroid presents an effective treatment for severe proliferative lupus nephritis in different ethnic groups, and is associated with much fewer adverse effects compared with cyclophosphamide-based regimens. Recent data from our group also demonstrate the long-term efficacy of mycophenolate mofetil in preserving renal survival, when used continuously as both induction and maintenance therapy.

Sign in / Sign up

Export Citation Format

Share Document