1. Outcome of biopsy-proven lupus nephritis with low glomerular filtration rate at presentation.
- Author
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Haridasan S, Rathi M, Sharma A, Nada R, Kumar S, Ramachandran R, and Kohli HS
- Subjects
- Adult, Biopsy, Cause of Death, Female, Humans, Kidney Failure, Chronic etiology, Kidney Failure, Chronic mortality, Kidney Failure, Chronic physiopathology, Lupus Nephritis complications, Lupus Nephritis mortality, Lupus Nephritis therapy, Male, Prognosis, Prospective Studies, Renal Insufficiency etiology, Renal Insufficiency mortality, Renal Insufficiency therapy, Risk Assessment, Risk Factors, Severity of Illness Index, Time Factors, Young Adult, Glomerular Filtration Rate, Kidney pathology, Kidney physiopathology, Lupus Nephritis pathology, Renal Insufficiency physiopathology
- Abstract
Objectives: Currently, there is limited data regarding the outcomes of lupus nephritis (LN) with moderate to severe renal failure at presentation (defined by low glomerular filtration rate; GFR <30 mL/min)., Methods: Sixty-four patients with biopsy-proven LN and estimated GFR (eGFR) <30 mL/min were prospectively analyzed. Outcome measure of persistently low eGFR, end-stage renal disease (ESRD) or death at 365 days were grouped as Major Adverse Kidney Events (MAKE365)., Results: Diagnosis of lupus was simultaneous with onset of renal disease in 60% of cases. Histologically, 82.3% (n = 51) were class IV, the median serum creatinine was 4 mg/dL (interquartile range [IQR] 3.1-5.9 mg/dL), median eGFR was 13.75 mL/min (IQR 9.25-19 mL/min) and 42.2% (n = 27) required dialysis at presentation. Induction regimens included National Institute of Health (68.2%), Eurolupus protocol (10.9%) and mycophenolate mofetil (8%). Over 365 days, 23 (37.5%) subjects died, while 41 (62.5%) survived. The majority of deaths were due to infection and sepsis (14/23). Among the survivors, 70.7% had good renal outcome, 12.1% had persistently low GFR (<30 mL/min), while 17% developed ESRD. In this group, treatment response rate was 84.6% (complete response 25.6%, partial response 59%). Those with a better renal function at presentation had a good treatment response (100% vs. 40%). Altogether, n = 35 (54.6%) were included in the MAKE365 category. Between the renal survival group (n = 29) versus the MAKE365 group (n = 35) there was no difference in clinical or histological parameters., Conclusion: The current treatment protocols had a good response rate in patients with LN even with severe kidney injury at presentation. However, the risk of serious infections and subsequent mortality was high., (© 2020 Asia Pacific League of Associations for Rheumatology and John Wiley & Sons Australia, Ltd.)
- Published
- 2020
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