Predictors of poor renal outcome in patients with biopsy-proven lupus nephritis
Predictors of poor renal outcome in patients with biopsy-proven lupus nephritis
复制标题
DOI：
10.1111/j.1440-1797.2010.01290.x
复制
发表时间：
2010-06-01
期刊：
影响因子：
2.5
通讯作者：
Swanepoel, Charles R.
中科院分区：
文献类型：
--
作者：
Ayodele, Olugbenga Edward;Okpechi, Ikechi G.;Swanepoel, Charles R.
目的：狼疮性肾炎（LN）的发展与发病率和死亡率的增加有关。鉴于南非关于LN肾脏预后影响因素的数据很少，我们回顾了作者的经验，以确定肾脏预后不良的预测因素。方法：这是一项回顾性研究，纳入了1995年1月至2007年12月在我们的护理下经活检证实的105例LN患者。四十三（41.0%）患者达到血清肌酐持续加倍超过基线值的复合终点，在平均51.1个月（范围1-137个月）的随访期内发生终末期肾病（ESRD）或死亡。与复合终点相关的基线因素包括存在全身性高血压（P = 0.016），平均收缩压（SBP）（P = 0.004），平均舒张压（DBP）（P = 0.001），平均血清肌酐（P = 0.001）、估计肾小球滤过率（eGFR）（P = 0.003）和弥漫性增生性肾小球肾炎（世界卫生组织IV级）（P = 0.024）。间质性炎症（P = 0.049）、治疗后第一年缓解失败（P < 0.001）、随访时平均SBP（P < 0.001）和平均DBP（P < 0.001）也与复合终点相关。多因素分析显示，基线血肌酐、治疗后未缓解（P = 0.038）和随访时平均收缩压（P = 0.016）是肾功能不佳的预测因子。结论：基线血肌酐、第一年未缓解和平均收缩压是肾功能不佳的预测因子。
Aim: The development of lupus nephritis (LN) is associated with increased morbidity and mortality. In view of scarce data from South Africa on factors affecting renal outcome in LN, the authors' experience was reviewed to identify predictors of poor renal outcome.Methods: This is a retrospective review of 105 patients with biopsy-proven LN under our care from January 1995 to December 2007.Results: Forty-three (41.0%) patients reached the composite end-point of persistent doubling of the serum creatinine over the baseline value, development of end-stage renal disease (ESRD) or death during a mean follow-up period of 51.1 months (range 1-137 months). Baseline factors associated with the composite end-point included presence of systemic hypertension (P = 0.016), mean systolic blood pressure (SBP) (P = 0.004), mean diastolic blood pressure (DBP) (P = 0.001), mean serum creatinine (P = 0.001), estimated glomerular filtration rate (eGFR) (P = 0.003) and diffuse proliferative glomerulonephritis (World Health Organization class IV) (P = 0.024). Interstitial inflammation (P = 0.049), failure of remission in the first year following therapy (P < 0.001), the mean SBP on follow up (P < 0.001) and mean DBP on follow up (P < 0.001) were also associated with composite end-point. On multivariate analysis, baseline serum creatinine, non-remission following therapy (P = 0.038) and mean SBP on follow up (P = 0.016) were predictors of poor renal outcome.Conclusion: Baseline serum creatinine, failure of remission in the first year and mean SBP were predictors of poor renal outcome.