Absence of renal remission portends poor long-term kidney outcome in lupus nephritis
Background The very long-term consequences of absence of remission in lupus nephritis (LN) remain understudied.Methods In this retrospective analysis, we studied a selected cohort of 128 patients with biopsy-proven class III, IV or V incident LN followed for a median period of 134 months (minimum 25...
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BMJ Publishing Group
2021-05-01
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| Series: | Lupus Science and Medicine |
| Online Access: | https://lupus.bmj.com/content/8/1/e000533.full |
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| author | Farah Tamirou Frédéric A Houssiau Antoine Enfrein Valérie Pirson |
| author_facet | Farah Tamirou Frédéric A Houssiau Antoine Enfrein Valérie Pirson |
| author_sort | Farah Tamirou |
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| description | Background The very long-term consequences of absence of remission in lupus nephritis (LN) remain understudied.Methods In this retrospective analysis, we studied a selected cohort of 128 patients with biopsy-proven class III, IV or V incident LN followed for a median period of 134 months (minimum 25). Remission was defined as a urine protein to creatinine (uP:C) ratio <0.5 g/g and a serum creatinine value <120% of baseline. Renal relapse was defined as the reappearance of a uP:C >1 g/g, leading to a repeat kidney biopsy and treatment change. Poor long-term renal outcome was defined as the presence of chronic kidney disease (CKD).Results Twenty per cent of patients never achieved renal remission. Their baseline characteristics did not differ from those who did. Absence of renal remission was associated with a threefold higher risk of CKD (48% vs 16%) and a 10-fold higher risk of end-stage renal disease (20% vs 2%). Patients achieving early remission had significantly higher estimated glomerular filtration rate (eGFR) at last follow-up compared with late remitters. Accordingly, patients with CKD at last follow-up had statistically longer time to remission. Among patients who achieved remission, 32% relapsed, with a negative impact on renal outcome, that is, lower eGFR values and higher proportion of CKD (33% vs 8%).Conclusion Early remission should be achieved to better preserve long-term renal function. |
| format | Article |
| id | doaj-art-8272fa522ef243abb408f776b814cb54 |
| institution | OA Journals |
| issn | 2053-8790 |
| language | English |
| publishDate | 2021-05-01 |
| publisher | BMJ Publishing Group |
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| series | Lupus Science and Medicine |
| spelling | doaj-art-8272fa522ef243abb408f776b814cb542025-08-20T02:14:50ZengBMJ Publishing GroupLupus Science and Medicine2053-87902021-05-018110.1136/lupus-2021-000533Absence of renal remission portends poor long-term kidney outcome in lupus nephritisFarah Tamirou0Frédéric A Houssiau1Antoine Enfrein2Valérie Pirson33Cliniques Universitaires Saint-Luc, Service de Rhumatologie, Brussels, BelgiumCliniques Universitaires Saint-Luc, Université catholique de Louvain, Brussels, BelgiumInternal Medicine Department, Centre Hospitalier Universitaire de Nantes, Nantes, FrancePôle de Pathologies Rhumatismales Inflammatoires et Systémiques, Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Brussels, BelgiumBackground The very long-term consequences of absence of remission in lupus nephritis (LN) remain understudied.Methods In this retrospective analysis, we studied a selected cohort of 128 patients with biopsy-proven class III, IV or V incident LN followed for a median period of 134 months (minimum 25). Remission was defined as a urine protein to creatinine (uP:C) ratio <0.5 g/g and a serum creatinine value <120% of baseline. Renal relapse was defined as the reappearance of a uP:C >1 g/g, leading to a repeat kidney biopsy and treatment change. Poor long-term renal outcome was defined as the presence of chronic kidney disease (CKD).Results Twenty per cent of patients never achieved renal remission. Their baseline characteristics did not differ from those who did. Absence of renal remission was associated with a threefold higher risk of CKD (48% vs 16%) and a 10-fold higher risk of end-stage renal disease (20% vs 2%). Patients achieving early remission had significantly higher estimated glomerular filtration rate (eGFR) at last follow-up compared with late remitters. Accordingly, patients with CKD at last follow-up had statistically longer time to remission. Among patients who achieved remission, 32% relapsed, with a negative impact on renal outcome, that is, lower eGFR values and higher proportion of CKD (33% vs 8%).Conclusion Early remission should be achieved to better preserve long-term renal function.https://lupus.bmj.com/content/8/1/e000533.full |
| spellingShingle | Farah Tamirou Frédéric A Houssiau Antoine Enfrein Valérie Pirson Absence of renal remission portends poor long-term kidney outcome in lupus nephritis Lupus Science and Medicine |
| title | Absence of renal remission portends poor long-term kidney outcome in lupus nephritis |
| title_full | Absence of renal remission portends poor long-term kidney outcome in lupus nephritis |
| title_fullStr | Absence of renal remission portends poor long-term kidney outcome in lupus nephritis |
| title_full_unstemmed | Absence of renal remission portends poor long-term kidney outcome in lupus nephritis |
| title_short | Absence of renal remission portends poor long-term kidney outcome in lupus nephritis |
| title_sort | absence of renal remission portends poor long term kidney outcome in lupus nephritis |
| url | https://lupus.bmj.com/content/8/1/e000533.full |
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