Clinical and Prognostic Factors in Patients with IgG4-Related Kidney Disease.

Autor:	Chaba A; Departement of Nephrology-Dialysis-Transplantation, Assistance Publique des Hôpitaux de Paris (AP-HP), Bicêtre University Hospital, Paris-Saclay University, Le Kremlin Bicêtre, France., Devresse A; Department of Nephrology, Cliniques universitaires Saint-Luc, Bruxelles, Belgium., Audard V; Nephrology and Renal Transplantation Department, Assistance Publique des Hôpitaux de Paris (AP-HP), Henri Mondor Hospital University, Rare Disease Center « Idiopathic Nephrotic syndrome », Fédération Hospitalo-Universitaire « Innovative therapy for immune disorders, Créteil, France.; Univ Paris Est Créteil, Institut National de la Santé et de la Recherche Médicale (INSERM) U955, Institut Mondor de Recherche Biomédicale (IMRB), Créteil, France., Boffa JJ; Department of Nephrology, CHU Tenon, Paris, France., Karras A; Department of Nephrology, CHU HEGP, Paris, France., Cartery C; Department of Nephrology, CH Valenciennes, Valenciennes, France., Deltombe C; Institute for Transplantation, Urology and Nephrology (ITUN) Nantes University Hospital, Nantes, France., Chemouny J; Department of Nephrology, CHU Rennes, Rennes, France., Contamin C; Department of Internal Medicine, GHM Grenoble, France., Courivaud C; Department of Nephrology, CHRU Jean Minjoz, Bensançon, France., Duquennoy S; Department of Nephrology, Fondation AUB Santé Avranches, France., Garcia H; Department of Nephrology, Hôpitaux Sorbonne Université, Paris, France., Joly D; Department of Nephrology, CHU Necker, Paris, France., Goumri N; Department of Nephrology, CH Chartres, Chartres, France., Hanouna G; Department of Nephrology, CHU Bichat, Paris, France., Halimi JM; Department of Nephrology, CHU Tours, Tours, France., Plaisier E; Department of Nephrology, AURA Plaisance, Paris, France., Hamidou M; Department of Internal Medicine, CHU Nantes, Nantes, France., Landron C; Department of Internal Medicine, CHU Poitier, Poitier, France., Launay D; Univ. Lille, Inserm, CHU Lille, Service de Médecine Interne et Immunologie Clinique, Centre de référence des maladies autoimmunes systémiques rares du Nord et Nord-Ouest de France (CeRAINO), U1286-INFINITE-Institute for Translational Research in Inflammation, Lille, France., Lebas C; Department of Nephrology, CHU Valenciennes, Valenciennes, France., Legendre M; Department of Nephrology, CHU Dijon, Dijon, France., Masseau A; Department of Internal Medicine, CHU Nantes, Nantes, France., Mathian A; Department of Internal Medicine, Hôpital Cochin, APHP, Paris, France., Mercadal L; Department of Nephrology, Hôpitaux Sorbonne Université, Paris, France., Morel N; Department of Internal Medicine, Hôpital Cochin, APHP, Paris, France., Mutinelli-Szymanski P; Department of Nephrology, CHU Tours, Tours, France., Palat S; Department of Internal Medicine, CHU Limoges, Limoges, France., Pennaforte JL; Department of Internal Medicine, CH Epernay, Reims, France., Peraldi MN; Department of Nephrology, CHU Saint Louis, Paris, France., Pozdzik A; Department of Nephrology, CHU Brugmann, Bruxelles, Belgium., Schleinitz N; Department of Internal Medicine, CHU Timone, Marseille, France., Thaunat O; Department of Nephrology, CH Edouart Heriot, Lyon, France., Titeca-Beauport D; Department of Nephrology, CHU Amiens, Amiens, France., Mussini C; Departement of Pathology, Assistance Publique des Hôpitaux de Paris (AP-HP), Bicêtre University Hospital, Paris-Saclay University, Le Kremlin Bicêtre, France., Touati S; Department of Nephrology, CH Pontoise, Pontoise, France., Prinz E; Department of Nephrology, NHC Strasbourg, France., Faller AL; Department of Nephrology, Clinique Sainte Anne, Strasbourg, France., Richter S; Department of Nephrology, Clinique Sainte Anne, Strasbourg, France., Vilaine E; Department of Nephrology, CHU Ambroise Paré, France., Ferlicot S; Departement of Pathology, Assistance Publique des Hôpitaux de Paris (AP-HP), Bicêtre University Hospital, Paris-Saclay University, Le Kremlin Bicêtre, France., Von-Kotze C; Department of Nephrology, ADPC Marseille Michelet, Marseille, France., Belliere J; Departement of Nephrology, CHU Toulouse, Toulouse, France., Olagne J; Department of Pathology, NHC Strasbourg, France., Mesbah R; Department of Nephrology, Hopital Boulogne-sur-mer, Boulogne-sur-mer, France., Snanoudj R; Departement of Nephrology-Dialysis-Transplantation, Assistance Publique des Hôpitaux de Paris (AP-HP), Bicêtre University Hospital, Paris-Saclay University, Le Kremlin Bicêtre, France., Nouvier M; Department of Nephrology, CHLS, Lyon, France., Ebbo M; Department of Internal Medicine, CHU Timone, Marseille, France., Zaidan M; Departement of Nephrology-Dialysis-Transplantation, Assistance Publique des Hôpitaux de Paris (AP-HP), Bicêtre University Hospital, Paris-Saclay University, Le Kremlin Bicêtre, France.
Jazyk:	angličtina
Zdroj:	Clinical journal of the American Society of Nephrology : CJASN [Clin J Am Soc Nephrol] 2023 Aug 01; Vol. 18 (8), pp. 1031-1040. Date of Electronic Publication: 2023 Jun 07.
DOI:	10.2215/CJN.0000000000000193
Abstrakt:	Background: IgG4-related kidney disease is a major manifestation of IgG4-related disease, a systemic fibroinflammatory disorder. However, the clinical and prognostic kidney-related factors in patients with IgG4-related kidney disease are insufficiently defined. Methods: We conducted an observational cohort study using data from 35 sites in two European countries. Clinical, biologic, imaging, and histopathologic data; treatment modalities; and outcomes were collected from medical records. Logistic regression was performed to identify the possible factors related to an eGFR ≤30 ml/min per 1.73 m 2 at the last follow-up. Cox proportional hazards model was performed to assess the factors associated with the risk of relapse. Results: We studied 101 adult patients with IgG4-related disease with a median follow-up of 24 (11-58) months. Of these, 87 (86%) patients were male, and the median age was 68 (57-76) years. Eighty-three (82%) patients had IgG4-related kidney disease confirmed by kidney biopsy, with all biopsies showing tubulointerstitial involvement and 16 showing glomerular lesions. Ninety (89%) patients were treated with corticosteroids, and 18 (18%) patients received rituximab as first-line therapy. At the last follow-up, the eGFR was below 30 ml/min per 1.73 m 2 in 32% of patients; 34 (34%) patients experienced a relapse, while 12 (13%) patients had died. By Cox survival analysis, the number of organs involved (hazard ratio [HR], 1.26; 95% confidence interval [CI], 1.01 to 1.55) and low C3 and C4 concentrations (HR, 2.31; 95% CI, 1.10 to 4.85) were independently associated with a higher risk of relapse, whereas first-line therapy with rituximab was protective (HR, 0.22; 95% CI, 0.06 to 0.78). At their last follow-up, 19 (19%) patients had an eGFR ≤30 ml/min per 1.73 m 2 . Age (odd ratio [OR], 1.11; 95% CI, 1.03 to 1.20), peak serum creatinine (OR, 2.74; 95% CI, 1.71 to 5.47), and serum IgG4 level ≥5 g/L (OR, 4.46; 95% CI, 1.23 to 19.40) were independently predictive for severe CKD. Conclusions: IgG4-related kidney disease predominantly affected middle-aged men and manifested as tubulointerstitial nephritis with potential glomerular involvement. Complement consumption and the number of organs involved were associated with a higher relapse rate, whereas first-line therapy with rituximab was associated with lower relapse rate. Patients with high serum IgG4 concentrations (≥5 g/L) had more severe kidney disease. (Copyright © 2023 by the American Society of Nephrology.)
Databáze:	MEDLINE
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