Tubulointerstitial damage predicts end stage renal disease in lupus nephritis with preserved to moderately impaired renal function: A retrospective cohort study.
Tubulointerstitial damage predicts end stage renal disease in lupus nephritis with preserved to moderately impaired renal function: A retrospective cohort study.
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DOI：
10.1016/j.semarthrit.2017.07.007
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发表时间：
2018-03
影响因子：
5
通讯作者：
Putterman C
中科院分区：
文献类型：
--
作者：
Broder A;Mowrey WB;Khan HN;Jovanovic B;Londono-Jimenez A;Izmirly P;Putterman C
肾活检发现肾小管间质损害（TID）被认为是狼疮性肾炎（LN）的晚期后遗症。本研究的目的是确定TID是否可预测无晚期肾病的LN患者进展为终末期肾病（ESRD）。纳入了2005年1月至2015年7月期间索引活检符合LN且eGFR≥30 mL/min/1.73m2的所有SLE患者。中度至重度TID定义为存在中度至重度肾小管萎缩和/或间质性纤维化。至ESRD时间定义为从索引活检日期至ESRD事件日期的时间;非ESRD患者在死亡或2015年12月前的末次访视时删失。进行时间依赖性分析以评估中度至重度TID是否预测ESRD进展。在eGFR≥30 mL/min/1.73m2的131例LN患者中，17例（13%）患者进展为ESRD。eGFR≥60 mL/min/1.73 m2的活检组织中有13%存在中度至重度TID，eGFR在30 - 60 mL/min/1.73 m2之间的活检组织中有33%存在中度至重度TID。中重度TID与ESRD进展风险较高相关：eGFR≥30 mL/min/1.73 m2的校正风险比（HR）= 4.1，95% CI（1.4，12.1），p=0.01; eGFR≥60 mL/min/1.73 m2的校正风险比（HR）= 6.2，95% CI（1.7，23.2），p=0.008。肾小管间质炎症（TII）与ESRD进展之间无相关性。中重度TID（而非TII）是ESRD进展的强预测因子，与eGFR或肾小球结果无关，因此，为潜在的早期干预提供了一个重要窗口。
The presence of tubulointerstitial damage (TID) on renal biopsy is considered to be a late sequela of lupus nephritis (LN). The objective of this study was to determine if TID predicts progression to end stage renal disease (ESRD) in LN patients without advanced kidney disease. All SLE patients with an index biopsy consistent with LN between January 2005 and July 2015, and eGFR≥30 mL/min/1.73m2 were included. Moderate-to-severe TID was defined as the presence of moderate to severe tubular atrophy and/or interstitial fibrosis. Time to ESRD was defined as time from the index biopsy date to incident ESRD date; non-ESRD patients were censored at time of death or the last visit before December 2015. Time-dependent analyses were conducted to evaluate whether moderate to severe TID was predictive of ESRD progression. Of the 131 LN patients with eGFR≥30 mL/min/1.73m2, 17 (13%) patients progressed to ESRD. Moderate-to-severe TID was present in 13% of biopsies with eGFR≥60 mL/min/1.73m2 and in 33% of biopsies with eGFR between 30 and 60 mL/min/1.73m2. Moderate-to-severe TID was associated with a higher risk of ESRD progression: adjusted hazard ratio (HR) = 4.1, 95% CI (1.4, 12.1), p=0.01 for eGFR≥30 mL/min/1.73m2; HR 6.2, 95% CI (1.7, 23.2), p=0.008 for eGFR≥60 mL/min/1.73m2. There was no association between tubulointerstitial inflammation (TII) and ESRD progression. Moderate-to-severe TID, but not TII, was a strong predictor of ESRD progression independent of eGFR or glomerular findings, therefore, providing an important window for potential early interventions.
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影响因子：
3.3
作者：
Clark MR;Trotter K;Chang A
通讯作者：
Chang A
DOI：
10.1038/nrneph.2014.31
发表时间：
2014-05
期刊：
Nature reviews. Nephrology
影响因子：
--
作者：
Declèves AE;Sharma K
通讯作者：
Sharma K
影响因子：
13.3
作者：
Kinloch, Andrew J.;Chang, Anthony;Clark, Marcus R.
通讯作者：
Clark, Marcus R.
影响因子：
5.5
作者：
Izmirly, Peter M.;Barisoni, Laura;Clancy, Robert M.
通讯作者：
Clancy, Robert M.
影响因子：
19.6
作者：
Levey, AS;Eckardt, KU;Eknoyan, G
通讯作者：
Eknoyan, G