Combination immunosuppressant therapy and lupus nephritis outcome: a hospital-based study

Autor:	Kuo-Tung Tang, Hsin-Hua Chen, Wei-Ting Hung, C W Tseng, Tsu-Yi Hsieh, Chia-Wei Hsieh, K L Lai, Wen-Nan Huang, Yi-Ming Chen, Yi-Hsing Chen, C T Lin, C Y Hsu, Y W Liao
Rok vydání:	2019
Předmět:	Adult Male medicine.medical_specialty Adolescent Referral Treatment outcome Taiwan 030232 urology & nephrology Lupus nephritis Kaplan-Meier Estimate Kidney Hospital based study Young Adult 03 medical and health sciences 0302 clinical medicine Rheumatology Risk Factors Induction therapy Internal medicine Azathioprine medicine Humans Propensity Score Retrospective Studies 030203 arthritis & rheumatology Systemic lupus erythematosus business.industry Remission Induction Middle Aged Mycophenolic Acid medicine.disease Lupus Nephritis Treatment Outcome Multivariate Analysis Cyclosporine Kidney Failure Chronic Drug Therapy Combination Female business Immunosuppressive Agents
Zdroj:	Lupus. 28:658-666
ISSN:	1477-0962 0961-2033
DOI:	10.1177/0961203319842663
Popis:	Lupus nephritis (LN) is the leading cause of mortality in lupus patients. This study aimed to investigate the treatment outcome and renal histological risk factors of LN in a tertiary referral center. Between 2006 and 2017, a retrospective observational study enrolled 148 biopsy-proven LN patients. After propensity score matching, 75 cases were included for further analysis. The classification and scoring of LN were assessed according to the International Society of Nephrology/Renal Pathology Society. Treatment response was evaluated by daily urine protein and urinalysis at two years after commencing induction treatment and the development of end-stage renal disease (ESRD). In total, 50.7% patients achieved complete remission (CR) or partial remission (PR), while 49.3% patients were categorized as nonresponders. Therapeutic responses in terms of CR/PR rates were associated with Systemic Lupus Erythematosus Disease Activity Index scores (odds ratio (OR): 1.34, 95% confidence interval (CI): 1.12–1.60, p = 0.001). Moreover, higher baseline creatinine levels (hazard ratio (HR): 2.10, 95% CI: 1.29–3.40, p = 0.003), higher renal activity index (HR: 1.30, 95% CI: 1.07–1.58, p = 0.008) and chronicity index (HR: 1.40, 95% CI: 1.06–1.85, p = 0.017) predicted ESRD. Among pathological scores, cellular crescents (HR: 4.42, 95% CI: 1.01–19.38, p = 0.049) and fibrous crescents (HR: 5.93, 95% CI: 1.41–24.92, p = 0.015) were independent risk factors for ESRD. In conclusion, higher lupus activity was a good prognostic marker for renal remission. Renal histology was predictive of ESRD. Large-scale prospective studies are required to verify the efficacy of mycophenolate in combination with azathioprine or cyclosporine in LN patients.
Databáze:	OpenAIRE
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