Proteinuria After 12 Months of Treatment For Lupus Nephritis As Predictor of Long-Term Renal Outcome: A Retrospective Cohort Study

2021 ◽  
Author(s):  
Fernanda Braga ◽  
Marta Maria Medeiros ◽  
Antonio Viana Junior ◽  
Levi Barros ◽  
Marcelo Pontes ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Lupus Nephritis ◽  
Negative Predictive Value ◽  
Lupus Erythematosus ◽  
Predictive Value ◽  
Renal Outcome ◽  
Treat To Target ◽  
Operating Characteristics

Abstract Background: Lupus Nephritis (LN) progression to Chronic Kidney Disease (CKD) and End-Stage-Renal-Disease (ESRD) represents one of the most dreaded complications of Systemic Lupus Erythematosus (SLE), directly impacting quality of life and overall survival in affected patients. Identifying LN patients at high risk for poor renal outcome could lead to individualized management and treatment strategies regarding this population. We hypothesized that 24-hour urine proteinuria (PTU) after 12 months of treatment could act as a predictor of poor renal outcome in LN patients Methods: two hundred and fourteen patients who were diagnosed with LN and were followed up for more than 10 years in our center were enrolled retrospectively. Receiver operating characteristics curves (ROC) were used to test the best cut-off value of PTU who predict bad long-term renal outcome. Results: the statistical difference was observed from 12 months when the outcome was ESRD, with a tendency from 6 months (p=0.06). Proteinuria > 0.9g/day at 12 months was the best predictor of ESRD, with the highest AUC (0.72). The sensitivity, specificity, positive predictive value and negative predictive value were 0.83, 0.65, 0.40, and 0.93, respectively. In the first year of LN treatment the serum creatinine was statistically different in any time for CKD (chronic kidney disease), but only at baseline for ESRD. Conclusions: In a population with more severe LN followed for a long time (>10 years), the cut-off point of PTU > 0.9/day is the best that predict progression to ESRD. The high negative predictive value emphasizes the need for a 1-year PTU-based LN treat to target treatment as a predictor of long-term renal outcome.

scholarly journals MP352PREDICTORS OF LONG TERM RENAL OUTCOME IN PREGNANT WOMEN WITH CHRONIC KIDNEY DISEASE ATTENDING A COMBINED REGIONAL RENAL OBSTETRIC SERVICE

2017 ◽  
Vol 32 (suppl_3) ◽  
pp. iii556-iii556
Author(s):  
Monisha Chakravorty ◽  
Nadia Sarween ◽  
Jemma Proudfoot-Jones ◽  
Rachel Clements ◽  
Ellen Knox ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Pregnant Women ◽  
Renal Outcome

P35 Prevalence of chronic kidney disease in patients with juvenile systemic lupus erythematosus: a single centre study

Rheumatology ◽  
2019 ◽  
Vol 58 (Supplement_4) ◽  
Author(s):  
Yasmin Mahfouz ◽  
Anastasia-Vasiliki Madenidou ◽  
Coziana Ciurtin
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Lupus Nephritis ◽  
Lupus Erythematosus ◽  
Conflicts Of Interest ◽  
Moderate Correlation ◽  
Systemic Lupus ◽  
Single Centre ◽  
Baseline Characteristics

Abstract Background Systemic lupus erythematosus (SLE) is a systemic autoimmune/inflammatory disorder that can affect any organ system. An estimated 10- 20% of all patients with SLE develop clinical disease before the age of 16 years and are therefore classified as juvenile-onset SLE (JSLE). JSLE is characterised by more severe clinical manifestations, such as lupus nephritis, more complications and less favourable outcomes compared to adult-onset SLE. Chronic kidney disease (CKD) refers to a state of irreversible kidney damage and/or reduction of kidney function that is associated with progressive loss of function over time. Lupus nephritis does not always lead to CKD. However, when it does it is associated with increased morbidity and mortality. It is important to identify clinical and laboratory predictors of CKD development in JSLE patients, as a more aggressive treatment approach could be advocated for these patients. In this study we compared the baseline characteristics of JSLE patients with and without chronic kidney disease to ascertain if there are any significant differences between the two groups. Methods This is a single-centre retrospective study, who included patients reviewed in our young adult and adolescent clinics. All data were analysed descriptively. Mann-Whitney U or Chi-Square tests were performed to compare the characteristics between the patients with and without CKD. We used the Pearson’s (r) or Kendall’s τ (tau) correlation to examine if there is any association between the CKD and the baseline characteristics. Results We identified 44 JSLE patients, out of which 17 (39%) fulfilled the diagnostic criteria for CKD at their last clinical review. The stages of CKD varied from 2 to 5. All patients with CKD also had lupus nephritis, while 5/44 patients (11%) had lupus nephritis without CKD. There were statistical significant differences in the treatments used for patients with and without CKD. As expected, the highest dsDNAlevels were higher in patients with CKD (p = 0.03). There was also a positive moderate correlation (ρ = 0.32) between raised levels of dsDNAand the development of CKD (p = 0.008). We also found a negative moderate correlation (τ= -0.439) between the presence of RF and CKD (p = 0.04). Conclusion We found a negative moderate correlation between the presence of RF and CKD, which has also been reported in the literature before. Further research using a large JSLE cohort is suggested to explore further if RF exerts a protective effect against renal disease in SLE. dsDNA is a serological marker of lupus nephritis and it is reasonable that the highest dsDNA correlates with CKD. Conflicts of Interest The authors declare no conflicts of interest.

scholarly journals Comparing Diagnostic Value of Renal Parenchymal Resistive Index And Cortical Echogenicity in Chronic Kidney Disease Patients

2020 ◽  
Vol 4 (3) ◽  
pp. 194
Author(s):  
Dria Anggraeny Sutikno ◽  
Nurdopo Baskoro
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Positive Predictive Value ◽  
Negative Predictive Value ◽  
Predictive Value ◽  
Renal Cortex ◽  
Resistive Index ◽  
Renal Ultrasound ◽  
Cross Sectional ◽  
Sensitivity Specificity

Background: Chronic kidney disease (CKD) is a clinically impaired kidney degradation syndrome, which commonly is diagnosed based on glomerulus filtration rate (GFR). Renal parenchymal resistive index and the renal cortex echogenicity are ultrasound parameters that have been reported correlate with GFR values. This study aims to determine the sensitivity, specificity, positive predictive value, and negative predictive value between renal intra-parenchymal resistive index and renal cortical echogenicitybased on GFR in CKD patients.Materials and Methods: This study is a cross sectional design. A renal ultrasound examination was performed to forty one CKD patients to assess the resistive index of the renal intra-parenchymal artery and the echogenicityof the renal cortex. The creatinine serum levels were obtained from the patients, as the gold standard of CKD diagnosis. Statistical data processing uses diagnostic test and Inter class Correlation Coefficients (ICC).Results: The sensitivity, specificity, positive predictive value, and negative predictive value of renal intraparenchymal resistive indexes were 23%, 79%, 33%, and 69% respectively. Sensitivity, specificity, positive predictive value, and negative predictive value between renal cortex echogenicity were 23%, 96%, 75%, and 73% respectively. The ICC analysisreported a Single Rater value of 0.1538 and Average of Raters 0.3528.Conclusion: Renal intra-parenchymal resistive artery was more specific than renal cortex echogenicity for diagnosing patients with chronic kidney disease.International Journal of Human and Health Sciences Vol. 04 No. 03 July’20 Page : 194-199

scholarly journals Management of Lupus Nephritis

2021 ◽  
Vol 10 (4) ◽  
pp. 670
Author(s):  
Farah Tamirou ◽  
Frédéric A. Houssiau
Keyword(s):  
Kidney Disease ◽  
Lupus Nephritis ◽  
Lupus Erythematosus ◽  
Randomized Trials ◽  
Treatment Strategies ◽  
Sequential Therapy ◽  
Current Treatment ◽  
Treat To Target ◽  
Severe Manifestation ◽  
End Stage

Lupus nephritis (LN) is a frequent and severe manifestation of systemic lupus erythematosus. The main goal of the management of LN is to avoid chronic kidney disease (CKD). Current treatment strategies remain unsatisfactory in terms of complete renal response, prevention of relapses, CKD, and progression to end-stage kidney disease. To improve the prognosis of LN, recent data suggest that we should (i) modify our treat-to-target approach by including, in addition to a clinical target, a pathological target and (ii) switch from conventional sequential therapy to combination therapy. Here, we also review the results of recent controlled randomized trials.

scholarly journals Preterm delivery is associated with long-term risk of maternal renal disease

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
P Barrett ◽  
F P McCarthy ◽  
M Evans ◽  
M Kublickas ◽  
I J Perry ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Renal Disease ◽  
Preterm Delivery ◽  
Gestational Age ◽  
Lupus Erythematosus ◽  
Cox Regression ◽  
Gestational Age At Delivery

Abstract Background Preterm delivery is an independent risk factor for maternal cardiovascular disease. Little is known about the association between preterm delivery and maternal renal function, and whether any association is independent of preeclampsia or intra-uterine growth restriction. This study aimed to examine the association between gestational age and long-term maternal chronic kidney disease (CKD) and end-stage kidney disease (ESKD). Methods Using data from the Swedish Medical Birth Register, singleton live births from 1973-2012 were identified and linked to data from the Swedish Renal Register and National Patient Register (up to 2013). Women with pre-pregnancy CKD/ESKD, cardiovascular disease, diabetes, hypertension, systemic lupus erythematosus were excluded. Gestational age at delivery was the main exposure, treated as a time-dependent variable. Primary outcomes were maternal CKD or ESKD. Cox regression was used, adjusting for maternal age, year of delivery, country of origin, education, parity, interpregnancy interval, smoking, BMI, gestational diabetes. Models were stratified by exposure to preeclampsia or small for gestational age (SGA). Results There were 3,847,694 pregnancies among 1,990,273 unique women. Nine percent of women (n = 172,915) had at least one preterm delivery (<37 weeks). Exposure to preterm delivery was associated with higher risk of CKD (aHR 1.48, 95%CI 1.41-1.54) and ESKD (aHR 2.52, 95%CI 2.17-2.92). Earlier gestational age at delivery was associated with increasing risk of CKD and ESKD. Women with spontaneous preterm delivery were at higher risk of CKD (vs. normal term, aHR 1.33, 95% CI 1.26-1.40) and ESKD (aHR 2.02, 95%CI 1.69-2.40) independently of preeclampsia/SGA. Associations persisted after excluding women who developed postpartum cardiovascular disease, hypertension or diabetes. Conclusions Women who gave birth at earlier gestation were at higher risk of later CKD and ESKD. This association persisted independently of preeclampsia and SGA. Key messages Preterm delivery is an independent predictor of long-term maternal renal disease. Obstetric history should be considered as part of overall risk stratification for chronic kidney disease in women.

EFFECTIVENESS OF ANTIAGGREGANT THERAPY ON KIDNEY ACTIVITY IN THE PREDIALYSIS STAGE OF CHRONIC KIDNEY DISEASE

2020 ◽  
Vol 6 (1) ◽  
pp. 55-60
Author(s):  
Khabib Barnoev ◽  
◽  
Sherali Toshpulatov ◽  
Nozima Babajanova ◽  
Keyword(s):  
Chronic Kidney Disease ◽  
Renal Function ◽  
Kidney Disease ◽  
Comparative Study ◽  
Functional Status ◽  
Stage Ii ◽  
Term Administration ◽  
Antiaggregant Therapy

The article presents the results of a study to evaluate the effectiveness of antiaggregant therapy on the functional status of the kidneys in 115 patients with stage II and III chronic kidney disease on the basis of a comparative study of dipyridamole and allthrombosepin. Studies have shown that long-term administration of allthrombosepin to patients has led to improved renal function.

ASSESSMENT OF KIDNEY FUNCTIONAL RESERVE ON THE BACKGROUND OF ANTI-AGGREGATE THERAPY IN CHRONIC KIDNEY DISEASE II-III STAGE

2020 ◽  
Vol 6 (1) ◽  
pp. 49-54
Author(s):  
Khabib Barnoev ◽  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Comparative Study ◽  
Early Stage ◽  
Raw Material ◽  
Functional Reserve ◽  
Functional Reserves ◽  
Term Administration ◽  
Antiaggregant Therapy

The article presents the results of a study to assess the functional reserve of the kidneys against the background of a comparative study of antiaggregant therapy dipyridamole and allthrombosepin in 50 patients with a relatively early stage of chronic kidney disease. Studies have shown that long-term administration of allthrombosepin to patients has resulted in better maintenance of kidney functional reserves. Therefore, our research has once again confirmed that diphtheridamol, which is widely used as an antiaggregant drug in chronic kidney disease, does not lag behind the domestic raw material allthrombosepin

Risk factors to predict the development of chronic kidney disease in patients with lupus nephritis

Lupus ◽  
2017 ◽  
Vol 26 (11) ◽  
pp. 1139-1148 ◽  
Author(s):  
D J Park ◽  
J H Kang ◽  
J W Lee ◽  
K E Lee ◽  
T J Kim ◽  
...  
Keyword(s):  
Risk Factors ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Lupus Nephritis
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