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Initial renal histology and early response predict outcomes of Brazilian lupus nephritis patients.
Vajgel, G; Oliveira, C B L; Costa, D M N; Cavalcante, M A G M; Valente, L M; Sesso, R; Crovella, S; Kirsztajn, G M; Sandrin-Garcia, P.
Afiliação
  • Vajgel G; Division of Nephrology, Hospital das Clinicas, Federal University of Pernambuco, Recife, Brazil.
  • Oliveira CBL; Molecular Biology Laboratory, Keizo Asami Immunopathology Laboratory, Federal University of Pernambuco, Recife, Brazil.
  • Costa DMN; Division of Nephrology, Hospital das Clinicas, Federal University of Pernambuco, Recife, Brazil.
  • Cavalcante MAGM; Division of Nephrology, Instituto de Medicina Integral Professor Fernando Figueira, Recife, Brazil.
  • Valente LM; Division of Nephrology, Hospital das Clinicas, Federal University of Pernambuco, Recife, Brazil.
  • Sesso R; Division of Nephrology, Instituto de Medicina Integral Professor Fernando Figueira, Recife, Brazil.
  • Crovella S; Division of Nephrology, Hospital das Clinicas, Federal University of Pernambuco, Recife, Brazil.
  • Kirsztajn GM; Division of Nephrology, Hospital das Clinicas, Federal University of Pernambuco, Recife, Brazil.
  • Sandrin-Garcia P; Division of Nephrology, Department of Medicine, Federal University of São Paulo, São Paulo, Brazil.
Lupus ; 29(1): 83-91, 2020 Jan.
Article em En | MEDLINE | ID: mdl-31801041
OBJECTIVE: We analyzed baseline and follow-up characteristics related to poorer renal outcomes in a Brazilian cohort of admixture race patients with lupus nephritis. METHODS: Overall, 280 outpatients with a diagnosis of systemic lupus erythematosus and previous kidney biopsy of lupus nephritis were recruited from August 2015 to December 2018 and had baseline laboratory and histologic data retrospectively analyzed; patients were then followed-up and data were recorded. The main outcome measure was the estimated glomerular filtration rate at last follow-up. Secondary analyses assessed the impact of initial kidney histology and treatment in long-term kidney survival. RESULTS: Median duration of lupus nephritis was 60 months (interquartile range: 27-120); 40 (14.3%) patients presented progressive chronic kidney disease (estimated glomerular filtration rate <30 and ≥10 ml/min/1.73 m2) or end-stage kidney disease at last visit. Adjusted logistic regression analysis showed that class IV lupus nephritis (odds ratio 14.91; 95% confidence interval 1.77-125.99; p = 0.01) and interstitial fibrosis ≥25% at initial biopsy (odds ratio 5.87; 95% confidence interval 1.32-26.16; p = 0.02), lack of complete or partial response at 12 months (odds ratio 16.3; 95% confidence interval 3.74-71.43; p < 0.001), and a second renal flare (odds ratio 4.49; 95% confidence interval 1.10-18.44; p = 0.04) were predictors of progressive chronic kidney disease. In a Kaplan-Meier survival curve we found that class IV lupus nephritis and interstitial fibrosis ≥25% were significantly associated with end-stage kidney disease throughout follow-up (hazard ratio 2.96; 95% confidence interval 1.3-7.0; p = 0.036 and hazard ratio 4.96; 95% confidence interval 1.9-12.9; p < 0.0001, respectively). CONCLUSION: In this large cohort of admixture race patients, class IV lupus nephritis and chronic interstitial damage at initial renal biopsy together with non-response after 1 year of therapy and relapse were associated with worse long-term renal outcomes.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Nefrite Lúpica / Progressão da Doença / Falência Renal Crônica Tipo de estudo: Clinical_trials / Etiology_studies / Incidence_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Adult / Female / Humans / Male / Middle aged País/Região como assunto: America do sul / Brasil Idioma: En Revista: Lupus Assunto da revista: REUMATOLOGIA Ano de publicação: 2020 Tipo de documento: Article País de afiliação: Brasil País de publicação: Reino Unido

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Nefrite Lúpica / Progressão da Doença / Falência Renal Crônica Tipo de estudo: Clinical_trials / Etiology_studies / Incidence_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Adult / Female / Humans / Male / Middle aged País/Região como assunto: America do sul / Brasil Idioma: En Revista: Lupus Assunto da revista: REUMATOLOGIA Ano de publicação: 2020 Tipo de documento: Article País de afiliação: Brasil País de publicação: Reino Unido