Predictors of Relapse and End Stage Kidney Disease in Proliferative Lupus Nephritis: Focus on Children, Adolescents, and Young Adults
Predictors of Relapse and End Stage Kidney Disease in Proliferative Lupus Nephritis: Focus on Children, Adolescents, and Young Adults
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DOI：
10.2215/cjn.00490109
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发表时间：
2009-12-01
影响因子：
9.8
通讯作者：
Hogan, Susan L.
中科院分区：
文献类型：
--
作者：
Gibson, Keisha L.;Gipson, Debbie S.;Hogan, Susan L.
背景和目标：美国儿童、青少年和年轻人狼疮性肾炎缓解和复发的患病率和意义尚不清楚。在美国东南部的一个儿童队列中，严重的狼疮性肾炎的疾病进展的模式和预测因素presented.Design，设置，参与者和测量：包括21岁或以下的肾活检证实的狼疮性肾炎患者，随后在肾小球疾病协作网络。考克斯回归模型被用来评估复发和终末期肾病（ESKD）的预测因子。5年肾脏存活率为77%。诱导治疗后1年内的完全缓解率和部分缓解率分别为25%和649%。完全缓解者和部分缓解者的复发率和ESKD发生率相似。在45 +/-32个月内，35%的应答者（完全或部分）复发。疾病复发是ESKD的预测因子（HR = 10.12，P <0.0001）。非洲裔美国人中记录的治疗耐药率高于非非洲裔美国人（8对0，P = 0.03）。ESKD HR为6.25，P <0.002。结论：狼疮性肾炎患儿的肾功能完全缓解或部分缓解与肾存活率的提高有关。肾炎复发是ESKD进展的强预测因子。治疗抵抗预示着ESKD的高风险，并且不成比例地影响患有狼疮肾炎的非洲裔美国儿童。Clin J Ani Soc Nephrol 4：1962 - 1967，2009 doi 10.2215/CJN.00490109
Background and objectives: The prevalence and significance of remission and relapse in children, adolescents, and young adults with lupus nephritis in the United States are poorly understood. Patterns and predictors of disease progression in a southeastern U.S. pediatric cohort with severe lupus nephritis are presented.Design, settings, participants, & measurements: Individuals age 21 or less with kidney biopsy-proven lupus nephritis followed in the Glomerular Disease Collaborative Network were included. Cox regression models were used to evaluate predictors of relapse and end stage kidney disease (ESKD).Results: Seventy-three subjects with a mean age of 15.6 +/- 3.4 yr were included. Five-year kidney survival was 77%. Complete and partial remission rates within 1 yr of induction therapy were 25 and 649%, respectively. Relapse and ESKD rates were similar between complete and partial responders. Relapse occurred in 35% of responders (complete or partial) in 45 +/- 32 mo. Disease relapse was a predictor of ESKD (HR = 10.12, P < 0.0001). Treatment resistance was documented in African Americans more often than non-African Americans (eight versus 0, P = 0.03). ESKD HR associated with treatment resistance was 6.25, P < 0.002.Conclusions: Remission whether complete or partial is associated with improved kidney survival in children with lupus nephritis. Nephritis relapse is a strong predictor of progression to ESKD. Treatment resistance portends a high risk of ESKD and disproportionately affects African American children with lupus nephritis. Clin J Ani Soc Nephrol 4: 1962-1967, 2009 doi 10.2215/CJN.00490109