Predictors of Relapse and End Stage Kidney Disease in Proliferative Lupus Nephritis

Abstract

Background and objectives: The prevalence and significance of remission and relapse in children, adolescents, and young adults with lupus nephritis in the United States are poorly understood. Patterns and predictors of disease progression in a southeastern U.S. pediatric cohort with severe lupus nephritis are presented.Design, settings, participants, & measurements: Individuals age 21 or less with kidney biopsy-proven lupus nephritis followed in the Glomerular Disease Collaborative Network were included. Cox regression models were used to evaluate predictors of relapse and end stage kidney disease (ESKD).Results: Seventy-three subjects with a mean age of 15.6 ؎ 3.4 yr were included. Five-year kidney survival was 77%. Complete and partial remission rates within 1 yr of induction therapy were 25 and 64%, respectively. Relapse and ESKD rates were similar between complete and partial responders. Relapse occurred in 35% of responders (complete or partial) in 45 ؎ 32 mo. Disease relapse was a predictor of ESKD (HR ‫؍‬ 10.12, P < 0.0001). Treatment resistance was documented in African Americans more often than non-African Americans (eight versus 0; P ‫؍‬ 0.03). ESKD HR associated with treatment resistance was 6.25, P < 0.002.Conclusions: Remission whether complete or partial is associated with improved kidney survival in children with lupus nephritis. Nephritis relapse is a strong predictor of progression to ESKD. Treatment resistance portends a high risk of ESKD and disproportionately affects African American children with lupus nephritis.

Long-term renal outcomes of childhood-onset global and segmental diffuse proliferative lupus nephritis

“…Fourth, response to CYC and MMF in children with IV-G and IV-S must be interpreted with caution as the treatment was non-randomized and based on physician discretion. The retrospective nature of the study impeded the evaluation of important confounding factors on outcome, including immunosuppressive regimen [29,30], relapse [31], nonadherence, and adjunct therapy such as RAAS blockers, anti-hypertensive agents, and statins. Thus, a prospective study with a larger number of subjects is needed to further determine the significance of DPLN subclassification in children.…”

Discrepancy between Medical Evidence Form 2728 and Renal Biopsy for Glomerular Diseases

“…Private practices, hospitals, and academic centers throughout the southeastern United States send renal biopsies to the UNC Nephropathology Laboratory for evaluation. Patients whose renal biopsies result in a diagnosis in one of the GDCNЈs disease registries are contacted through their referring physicians, and longterm consent is obtained from them for inclusion in the registry and related research studies (13)(14)(15)(16)(17)(18)(19).…”

Predictive factors for low rate of remission in a population of Colombian patients with severe proliferative lupus nephritis

“…LN proliferative classes (types: III, IV, and V associated with class III or IV (V+III and IV+V)) are the most common and serious, which can lead to end-stage renal disease (ESRD) [11]. Several factors have been described as associated with proliferative LN poor prognosis: baseline proteinuria and serum creatinine, presence of arterial hypertension anti-DNA antibodies, low serum levels of C3 and C4 complement components, high activity and chronicity indices, as well as mestizo Latin American patients and African-American ethnicity [12][13][14][15][16][17][18][19][20][21][22].…”