Long-term Outcome of Lupus Nephritis Class II in Argentine Patients: An Open Retrospective Analysis
| Autor: | María Victoria Collado, Marina Khoury, V. Juarez, Graciela Gómez, Analía Alvarez, Cecilia Pisoni, Judith Sarano, Silvia Rausch, Liliana Martinez, J.C. Barreira, Enrique Dorado, Rafael Chaparro, F. Zazzetti, María De Los Ángeles Gargiulo, Sergio Paira, Lorena Suarez, Clarisa Alvarez, Laura Galvan, Mercedes A. García |
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| Rok vydání: | 2016 |
| Předmět: |
Adult
Male long-term outcome medicine.medical_specialty Biopsy Lupus nephritis Argentina 030204 cardiovascular system & hematology Kidney Kidney Function Tests Time 03 medical and health sciences 0302 clinical medicine Rheumatology lupus nephritis class II Internal medicine Retrospective analysis Medicine Humans In patient Renal Insufficiency Chronic Hematuria Retrospective Studies histological transformation 030203 arthritis & rheumatology business.industry mesangial proliferative lupus nephritis Original Articles medicine.disease Lupus Nephritis Surgery Proteinuria Negative response Creatinine Female business Medical literature Follow-Up Studies |
| Zdroj: | Journal of Clinical Rheumatology |
| ISSN: | 1536-7355 |
| Popis: | Background There is controversy in medical literature over the outcome of patients with lupus nephritis (LN) class II. The aim of this study was to explore the risk of histological transformation (HT) and possible factors related to negative response to treatment in patients with mesangial LN class II. Methods A retrospective and multicenter study was carried out that includes patients who had received a diagnosis of LN class II on their first renal biopsy. Creatinine, urine sediment, and proteinuria were recorded at the time of the first biopsy, 6 months, and 1, 2, and 5 years after the first biopsy. Response to treatment, HT, and long-term outcome were evaluated. Results Forty-one patients were included. The manifestation at first biopsy was proteinuria greater than 0.5 g/d in 28 patients (68.29%; 8 [28.57%] of 28 patients had nephrotic syndrome), hematuria in 18 patients (43.90%), and deterioration of renal function in 3 patients (7.31%). During the follow-up (median, 8 years; range, 1–35 years), a new biopsy was performed in 18 patients (43.90%), and in 17 patients (17/18 [94.44%]), there was HT. Median time at rebiopsy was 32 months (range, 11–305 months). Of the 18 patients who had a second biopsy, 10 (55.55%) were on hydroxychloroquine versus 100% (19/19) of patients who did not undergo the procedure (P = 0.001). A year after the first renal biopsy, there are data available from 34 patients; of them, 24 patients (70.58%) had achieved response, and 10 patients (29.41%) had no response (NR) (missing data in 7). A higher 24-hour urinary protein at 6 months was predictor of worse outcome at 1 year, with statistical significance difference for the nonresponder group (median proteinuria, 2.3 g/d [range, 0–4.7 g/d]) compared with responders (median proteinuria, 0.28 g/d [range, 0–1.7 g/d]) (P = 0.0133). In the long-term follow-up (5 years), HT was the main cause of unfavorable outcome and was measured in 78.57% of patients (11/14 patients). Conclusions This series shows a high rate of HT in long-term follow-up. Proteinuria at 6 months made it possible to set aside patients who will have an unfavorable outcome in the long term and who will thus benefit from a more aggressive treatment. The results suggest that hydroxychloroquine had a nephroprotective effect. |
| Databáze: | OpenAIRE |
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