Background and objectives: Renal flares are common in lupus nephritis. The impact of flares on the development of CKD in lupus nephritis was examined. Design, setting, participants, & measurements: A retrospective analysis of prospectively collected data from the Ohio Systemic Lupus Erythematosus (SLE) Study was conducted to determine if renal flares predispose to new CKD or progression of preexisting CKD. Patients in the Ohio SLE Study were followed from 2001 to 2009, with a median follow-up of 6 years. For this analysis, patients with biopsy-proven lupus nephritis and at least 3 years of follow-up were included (n=56). Frequency and duration of renal flares were compared between patients who never developed CKD (n=29) and patients who developed new CKD (n=12) and between patients with preexisting but stable CKD (n=7) and patients who progressed (n=8). Groups were also combined into good (no CKD and stable CKD) or poor (new CKD and progressive CKD) for analysis. Results: The new CKD group had more renal flares per year compared with the no CKD group (median=0.56 flares/yr [range=0-2] versus median=0 flares/yr [range=0-1.4]; P<0.001). Additionally, the poor outcome group had more renal flares per year compared with the good outcome group (median=0.50 flares/yr [range=0-2] versus median=0 flares/yr [range=0-1.4]; P<0.001). New or progressive CKD was not preferentially associated with nephritic compared with proteinuric renal flares. Logistic regression showed that spending more than 30% of time in renal flare (odds ratio, 20; 95% confidence interval, 4.6 to 91.3; P<0.001) and age>35 years (odds ratio, 69; 95% confidence interval, 6.3 to 753.6; P<0.001) were independent predictors of the combined end point of developing new or progressive CKD. All four subjects over 35 years of age that spent over 30% of time in renal flare had a poor outcome. Conclusion: In patients with lupus nephritis, the relative duration of renal flare is an independent predictor of incident and progressive CKD.
展开▼
机译：背景与目的：狼疮性肾炎中常见肾脏耀斑。检查了耀斑对狼疮性肾炎中CKD发育的影响。设计，设置，参与者和测量：对俄亥俄州系统性红斑狼疮（SLE）研究的前瞻性收集数据进行了回顾性分析，以确定肾脏耀斑是否易患新的CKD或已有的CKD进展。俄亥俄州SLE研究的患者于2001年至2009年接受了随访，平均随访6年。为了进行该分析，纳入经活检证实为狼疮性肾炎且至少随访3年的患者（n = 56）。比较未发生CKD的患者（n = 29）和发生新CKD的患者（n = 12）以及已存在但稳定的CKD的患者（n = 7）和进展的患者（n = 8）。将各组也分为好（无CKD和稳定CKD）或差（新CKD和进行性CKD）进行分析。结果：新CKD组每年的肾脏耀斑比无CKD组多（中位数= 0.56耀斑/年[范围= 0-2]与中位数= 0耀斑/年[范围= 0-1.4]; P <0.001 ）。此外，与良好结局组相比，不良结局组每年的肾脏耀斑更多（中位数= 0.50耀斑/年[范围= 0-2]与中位数= 0耀斑/年[范围= 0-1.4]; P <0.001 ）。与蛋白尿性肾炎相比，新发或进行性CKD与肾病无关。 Logistic回归分析显示，肾脏耀斑花费的时间超过30％（比值比为20; 95％的置信区间为4.6至91.3; P <0.001）和年龄大于35岁（比数比为69; 95％的置信区间为6.3）至753.6; P <0.001）是发展新的或进行性CKD的联合终点的独立预测因子。在35岁以上的所有四名受试者中，有超过30％的时间花在了肾脏耀斑上，但预后较差。结论：狼疮性肾炎患者的肾脏耀斑的相对持续时间是事件和进行性CKD的独立预测因子。
展开▼
