Objectives Short-term predictive endpoints of chronic kidney disease (CKD) are needed in lupus nephritis (LN). We tested response to therapy at 1 year. Methods We considered patients with LN who underwent renal biopsy followed by induction therapy between January 1970 and December 2016. LN was assessed using the International Society of Nephrology/Renal Pathology Society (2003) criteria and the National Institute of Health (NIH) activity and chronicity index. The renal outcome was CKD. Response was defined according to EULAR/European League Against Rheumatism/European Renal Association-European Dialysis and Transplant Association (EULAR/ERA-EDTA) recommendations: complete: proteinuria <0.5 g/24 hours, (near) normal estimated glomerular filtration rate (eGFR); partial: ≥50% proteinuria reduction to subnephrotic levels, (near) normal eGFR; and no response: all the other cases. Logistic regression analysis was employed for 12-month response and Cox regression for CKD prediction. Results We studied 381 patients (90.5% Caucasians). After 12-month therapy, 58%, 26% and 16% of patients achieved complete, partial and no response, respectively, according to EULAR/ERA-EDTA. During a median follow-up of 10.7 (IQR: 4.97-18.80) years, 53 patients developed CKD. At 15 years, CKD-free survival rate was 95.2%, 87.6% and 55.4% in patients with complete, partial and no response at 12 months, respectively (p<0.0001). CKD-free survival rates did not differ between complete and partial responders (p=0.067). Serum creatinine (HR: 1.485, 95% CI 1.276 to 1.625), eGFR (HR 0.967, 95% CI 0.957 to 0.977) and proteinuria at 12 months (HR 1.234, 95% CI 1.111 to 1.379) were associated with CKD, yet no reliable cut-offs were identified on the receiver operating characteristic curve. In multivariable analysis, no EULAR/ERA-EDTA response at 12 months (HR 5.165, 95% CI 2.770 to 7.628), low C4 (HR 1.053, 95% CI 1.019 to 1.089) and persistent arterial hypertension (HR 3.154, 95% CI 1.500 to 4.547) independently predicted CKD. Conclusions Lack of EULAR/ERA-EDTA response at 12 months predicts CKD.
Moroni, G., Gatto, M., Tamborini, F., Quaglini, S., Radice, F., Saccon, F., et al. (2020). Lack of EULAR/ERA-EDTA response at 1 year predicts poor long-term renal outcome in patients with lupus nephritis. ANNALS OF THE RHEUMATIC DISEASES, 79(8), 1077-1083.
|Citazione:||Moroni, G., Gatto, M., Tamborini, F., Quaglini, S., Radice, F., Saccon, F., et al. (2020). Lack of EULAR/ERA-EDTA response at 1 year predicts poor long-term renal outcome in patients with lupus nephritis. ANNALS OF THE RHEUMATIC DISEASES, 79(8), 1077-1083.|
|Tipo:||Articolo in rivista - Articolo scientifico|
|Carattere della pubblicazione:||Scientifica|
|Presenza di un coautore afferente ad Istituzioni straniere:||No|
|Titolo:||Lack of EULAR/ERA-EDTA response at 1 year predicts poor long-term renal outcome in patients with lupus nephritis|
|Autori:||Moroni, G; Gatto, M; Tamborini, F; Quaglini, S; Radice, F; Saccon, F; Frontini, G; Alberici, F; Sacchi, L; Binda, V; Trezzi, B; Vaglio, A; Messa, P; Sinico, R; Doria, A|
MORONI, GABRIELLA (Primo) [Membro del Collaboration Group] (Corresponding)
RADICE, FRANCESCA [Membro del Collaboration Group]
TREZZI, BARBARA [Membro del Collaboration Group]
SINICO, RENATO ALBERTO (Co-ultimo) [Membro del Collaboration Group]
|Data di pubblicazione:||2020|
|Rivista:||ANNALS OF THE RHEUMATIC DISEASES|
|Digital Object Identifier (DOI):||http://dx.doi.org/10.1136/annrheumdis-2020-216965|
|Appare nelle tipologie:||01 - Articolo su rivista|