Remission of proteinuria indicates good prognosis in patients with diffuse proliferative lupus nephritis
Remission of proteinuria indicates good prognosis in patients with diffuse proliferative lupus nephritis
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DOI：
10.1177/0961203315595130
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发表时间：
2016-01-01
期刊：
影响因子：
2.6
通讯作者：
Chin, H. J.
中科院分区：
文献类型：
--
作者：
Koo, H. S.;Kim, S.;Chin, H. J.
蛋白尿是慢性肾脏疾病肾功能不全进展的一个众所周知的危险因素，然而，其对估计狼疮性肾炎预后的重要性需要验证。入选韩国成人肾活检诊断为弥漫性增生性狼疮性肾炎的患者，这些患者在肾活检后6个月内接受了连续3次或3次以上的尿蛋白/肌酐比值或尿试纸检测。对蛋白尿缓解和发作的累积风险、预测因素和结局进行了评价。该研究包括26名男性和167名女性，肾活检时的平均年龄为31.2 ± 9.8岁。82例（42.5%）患者在随访期间出现蛋白尿缓解。在平均157.9 +/- 69.5个月的随访期间，在达到蛋白尿缓解的患者中，1例死亡，1例发展为终末期肾病（ESRD），2例有复合结局;在未缓解的患者中，9例死亡，24例发展为ESRD，30例有复合结局。与未缓解的患者相比，达到蛋白尿缓解的患者的死亡风险为0.089倍（95% CI：0.011-0.736），ESRD事件风险为0.110倍（95% CI：0.013-0.904），复合结局风险为0.210倍（95% CI：0.048-0.920）。在82例达到蛋白尿缓解的患者中，59例（72.0%）至少发生了一次蛋白尿发作;然而，复发与结局的发生率无关。总之，无论从活检到缓解的时间间隔、缓解后蛋白尿的复发、缓解时的肾功能状态或血尿缓解，蛋白尿缓解都是肾存活率和死亡率良好的独立预测性预后标志。
Proteinuria is a well-known risk factor for the progression of renal dysfunction in chronic kidney disease; however, its importance for estimating the prognosis of lupus nephritis requires verification. Korean adult patients with renal biopsy-diagnosed diffuse proliferative lupus nephritis who had undergone three or more consecutive urine protein to creatinine ratio or urine dipstick tests within six months after renal biopsy were enrolled. The cumulative risks, predictors, and outcomes of proteinuric remission and flare were evaluated. This study included 26 men and 167 women with a mean age at renal biopsy of 31.2 +/- 9.8 years. Eighty-two (42.5%) patients experienced proteinuric remission during the follow-up period. During a mean follow-up of 157.9 +/- 69.5 months, among patients who achieved proteinuric remission, one died, one developed end-stage renal disease (ESRD), and two had composite outcomes; among patients without remission, nine died, 24 developed ESRD, and 30 had composite outcomes. Patients who achieved proteinuric remission had a 0.089-fold risk (95% CI: 0.011-0.736) of mortality, 0.110-fold risk (95% CI: 0.013-0.904) of incident ESRD, and 0.210-fold risk (95% CI: 0.048-0.920) of a composite outcome compared to patients without remission. Among the 82 patients who achieved proteinuric remission, 59 (72.0%) experienced at least one proteinuria flare; however, relapse did not correlate with the incidence of outcomes. In conclusion, proteinuric remission is an independent predictive prognostic marker of good renal survival and mortality, regardless of the interval from biopsy to remission, recurrence of proteinuria after remission, renal function status at remission, or hematuria remission.