Outcomes of membranous and proliferative lupus nephritis - analysis of a single-centre cohort with more than 30 years of follow-up.
Outcomes of membranous and proliferative lupus nephritis - analysis of a single-centre cohort with more than 30 years of follow-up.
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膜和增殖性狼疮性肾炎的结局 - 分析具有超过30年随访的单中心队列。
DOI：
10.1093/rheumatology/keaa103
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发表时间：
2020-11-01
期刊：
影响因子：
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通讯作者：
Rahman A
中科院分区：
文献类型：
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作者：
Farinha F;Pepper RJ;Oliveira DG;McDonnell T;Isenberg DA;Rahman A
比较膜性狼疮肾炎（MLN）和增殖性狼疮肾炎（PLN）的生存率、人口统计学、临床和实验室特征;并研究肾脏和患者生存率的预测因素。单中心回顾性观察性研究。包括活检证实的PLN、MLN和混合型狼疮性肾炎患者。使用适当的统计检验比较各组，并通过Kaplan-Meier方法分析生存期。进行考克斯回归分析以研究肾脏和患者生存的预测因子。共有187例活检证实的狼疮性肾炎患者（135例PLN，38例MLN和14例混合LN）随访长达42年（中位数12年）。非裔加勒比人中MLN的比例高于白人（31% vs 15%，P = 0.010）。MLN患者在诊断时抗dsDNA抗体显著降低（P = 0.001），C3水平升高（P = 0.018）。PLN的5、10、15和20年累积肾存活率分别为91、81、75和66%，MLN分别为100、97、92和84%（P = 0.028）。5年、10年、15年和20年的累积患者生存率分别为94%、86%、80%和76%，PLN和MLN之间无差异。LN诊断后1年，尿蛋白-肌酐比值高于42 mg/mmol和eGFR低于76 ml/min/1.73 m2是进展为终末期肾病的最强预测因子。1年时eGFR低于77 ml/min/1.73 m2、发生终末期肾病和非洲裔加勒比人与较高的死亡率相关。MLN和PLN患者的血清学特征和肾脏生存率显着不同，表明发病机制不同。第1年的肾功能可预测肾脏和患者的生存率。
To compare membranous lupus nephritis (MLN) and proliferative lupus nephritis (PLN) with respect to survival, demographic, clinical and laboratory characteristics; and to investigate predictors of renal and patient survival. Single-centre retrospective observational study. Patients with biopsy-proven PLN, MLN and mixed lupus nephritis were included. Groups were compared using appropriate statistical tests and survival was analysed through the Kaplan-Meier method. Cox regression analysis was performed to investigate predictors of renal and patient survival. A total of 187 patients with biopsy-proven lupus nephritis (135 with PLN, 38 with MLN and 14 with mixed LN) were followed for up to 42 years (median 12 years). There was a higher proportion of MLN amongst Afro-Caribbeans than amongst Caucasians (31% vs 15%, P = 0.010). Patients with MLN had significantly lower anti-dsDNA antibodies (P = 0.001) and higher C3 levels (P = 0.018) at diagnosis. Cumulative renal survival rates at 5, 10, 15 and 20 years were 91, 81, 75 and 66% for PLN and 100, 97, 92 and 84% for MLN, respectively (P = 0.028). Cumulative patient survival at 5, 10, 15 and 20 years was 94, 86, 80 and 76%, with no difference between PLN and MLN. Urinary protein-creatinine ratio above 42 mg/mmol and eGFR below 76 ml/min/1.73 m2, one year after the diagnosis of LN, were the strongest predictors of progression to end-stage renal disease. eGFR below 77 ml/min/1.73 m2, at one year, development of end-stage renal disease and Afro-Caribbean ethnicity were associated with higher mortality. Patients with MLN and PLN differ significantly regarding serological profiles and renal survival, suggesting different pathogenesis. Renal function at year one predicts renal and patient survival.
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影响因子：
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作者：
Petri, Michelle;Orbai, Ana-Maria;Alarcon, Graciela S.;Gordon, Caroline;Merrill, Joan T.;Fortin, Paul R.;Bruce, Ian N.;Isenberg, David;Wallace, Daniel J.;Nived, Ola;Sturfelt, Gunnar;Ramsey-Goldman, Rosalind;Bae, Sang-Cheol;Hanly, John G.;Sanchez-Guerrero, Jorge;Clarke, Ann;Aranow, Cynthia;Manzi, Susan;Urowitz, Murray;Gladman, Dafna;Kalunian, Kenneth;Costner, Melissa;Werth, Victoria P.;Zoma, Asad;Bernatsky, Sasha;Ruiz-Irastorza, Guillermo;Khamashta, Munther A.;Jacobsen, Soren;Buyon, Jill P.;Maddison, Peter;Dooley, Mary Anne;van vollenhoven, Ronald F.;Ginzler, Ellen;Stoll, Thomas;Peschken, Christine;Jorizzo, Joseph L.;Callen, Jeffrey P.;Lim, S. Sam;Fessler, Barri J.;Inanc, Murat;Kamen, Diane L.;Rahman, Anisur;Steinsson, Kristjan;Franks, Andrew G., Jr.;Sigler, Lisa;Hameed, Suhail;Fang, Hong;Ngoc Pham;Brey, Robin;Weisman, Michael H.;McGwin, Gerald, Jr.;Magder, Laurence S.
通讯作者：
Magder, Laurence S.
影响因子：
2.6
作者：
Koo, H. S.;Kim, S.;Chin, H. J.
通讯作者：
Chin, H. J.
影响因子：
3.4
作者：
Arroyo-Avila, Mariangeli;Santiago-Casas, Yesenia;McGwin, Gerald, Jr.;Cantor, Ryan S.;Petri, Michelle;Ramsey-Goldman, Rosalind;Reveille, John D.;Kimberly, Robert P.;Alarcon, Graciela S.;Vila, Luis M.;Brown, Elizabeth E.
通讯作者：
Brown, Elizabeth E.
影响因子：
39.2
作者：
Levey AS;Stevens LA;Schmid CH;Zhang YL;Castro AF 3rd;Feldman HI;Kusek JW;Eggers P;Van Lente F;Greene T;Coresh J;CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration)
通讯作者：
CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration)
影响因子：
--
作者：
Bernatsky, S.;Boivin, J. -F.;Ramsey-Goldman, R.
通讯作者：
Ramsey-Goldman, R.