An observational study of outcome in SLE patients with biopsy-verified glomerulonephritis between 1986 and 2004 in a defined area of Southern Sweden: the clinical utility of the ACR renal response criteria and predictors for renal outcome
An observational study of outcome in SLE patients with biopsy-verified glomerulonephritis between 1986 and 2004 in a defined area of Southern Sweden: the clinical utility of the ACR renal response criteria and predictors for renal outcome
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DOI：
10.3109/03009742.2013.799224
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发表时间：
2013-01-01
影响因子：
2.1
通讯作者：
Bengtsson, A. A.
中科院分区：
文献类型：
--
作者：
Nived, O.;Hallengren, C. S.;Bengtsson, A. A.
目的：在一个观察性队列中检验世界卫生组织（WHO）和国际肾脏病学会/肾脏病理学会（ISN/RPS）狼疮性肾炎（LN）诊断标准和美国流变学会肾脏反应标准（ACR-RRC）在肾脏随访中的效用。方法：对19年间52例经活检证实的LN患者的肾小球滤过率（GFR）、血肌酐、蛋白尿、血尿、系统性红斑狼疮疾病活动指数（SLE 2000在诊断肾炎时、6个月和12个月后以及最近一次访视时检索SLEDAI-2K和补体。45例肾活检可用于ISN/RPS标准的重新评价。结果：平均随访时间为9年，11例患者达到完全肾反应（CRR），4例终末期肾病（ESRD），1例肾病综合征（NS）。最终GFR随着活检时年龄的增加而降低（p < 0.01），并随着ISN/RPS分类中增加的间质性表现而降低（p < 0.05）。治疗6个月后，最终GFR与蛋白尿或管型和实际血清肌酐的减少相关（所有p < 0.05）。ACR-RRC定义的结果与治疗6个月后SLEDAI-2K的肾脏学成分相关（p < 0.01），与活检时C1 q抗体的存在相关（p < 0.05）。结论：肾脏结果与6个月后对治疗的反应相关，并与ISN/RPS分类中增加的间质性变化相关，这可能为预测提供有用的信息。ACR-RRC提供了一种定义的替代方法来分类肾脏反应。
Objectives: To test the utility of the World Health Organization (WHO) and International Society of Nephrology/Renal Pathology Society (ISN/RPS) criteria for lupus nephritis (LN) in systemic lupus erythematosus (SLE) and the American College of Rheumatology renal response criteria (ACR-RRC) for renal follow-up in an observational cohort.Method: All 52 biopsy-verified cases of LN during 19 years were identified, and glomerular filtration rate (GFR), serum creatinine, proteinuria, haematuria, Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K), and complement were retrieved at diagnosis of nephritis, after 6 and 12 months, and at the latest visit. Forty-five renal biopsies were available for re-evaluation with the ISN/RPS criteria. Outcome was defined by the ACR-RRC and the final GFR.Results: The mean follow-up time was 9 years; complete renal response (CRR) was achieved in 11 cases, end-stage renal disease (ESRD) in four, and nephrotic syndrome (NS) in one. The final GFR decreased with increasing age at biopsy (p < 0.01) and with interstitial manifestations added to the ISN/RPS classification (p < 0.05). The final GFR correlated with the decrease of proteinuria or casts and actual serum creatinine after 6 months of treatment (all p < 0.05). The outcome defined by ACR-RRC correlated with the nephrological components of SLEDAI-2K after 6 months of therapy (p < 0.01) and with the presence of antibodies to C1q at biopsy (p < 0.05).Conclusions: Renal outcome is correlated with the response to treatment after 6 months and with the addition of interstitial changes to the ISN/RPS classification, which might add useful information for prediction. The ACR-RRC offers a defined alternative to categorize renal response.