Predictors of renal relapse in Korean patients with lupus nephritis who achieved remission six months following induction therapy

Sj, Moon; Hs, Park; Sk, Kwok; Ju, Jianhua; Bs, Choi; Ks, Park; Jk, Min; Hy, Kim; Park, Sang Hoon

doi:10.1177/0961203313476357

Cited by 23 publications

(32 citation statements)

References 39 publications

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“…Age at onset may also affect renal recurrence. A study conducted in South Korea demonstrated that patients with LN type IV aged <28 years old were more likely to experience renal recurrence (16). However, the results of the present study did not identify an association between age and renal recurrence in patients with LN type IV.…”

Section: Discussioncontrasting

confidence: 99%

Analysis of clinical risk factors in relapsed patients with class IV lupus nephritis

Wang

Chen

et al. 2018

Exp Ther Med

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The present study aimed to investigate risk factors for renal recurrence in patients with type IV lupus nephritis (LN). Univariate and multivariate analyses were conducted to using the Cox proportional hazard model and the Kaplan-Meier method. A total 244 patients were diagnosed with type IV LN; 100 (28.49%) relapsed and 144 (41.03%) recovered successfully. Kaplan-Meier method analysis indicated that patients with type IV LN affecting the digestive tract had high renal recurrence rates. Patients with hyperglobulinemia, positive anti-ribonucleoprotein and anti-Sjögren's syndrome type B (anti-SSB) antibodies, thrombus in the loop or non-inflammatory necrotizing vasculopathy also had a high recurrence rate. Furthermore, patients achieving partial remission had an increased recurrence rate compared with patients achieving complete remission. Patients undergoing maintenance treatment with glucocorticoids alone had a higher recurrence rate compared with patients who used alternative treatment schemes. Univariate and multivariate regression analyses by the Cox proportional hazard model determined that the effect of systemic lupus erythematosus in the gastrointestinal tract, increased serum globulin levels and positive anti-SSB antibody at onset were risk factors for the recurrence of LN type IV. The present study demonstrated that clinical risk factors of renal recurrence in patients with LN type IV include LN in the gastrointestinal tract, increased serum globulin levels, positive anti-SSB antibodies at onset and the use of glucocorticoid-only maintenance treatment.

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Section: Discussioncontrasting

confidence: 99%

Analysis of clinical risk factors in relapsed patients with class IV lupus nephritis

Wang

Chen

et al. 2018

Exp Ther Med

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“…Anti-Ro antibodies in patients with SLE have been associated with neonatal lupus heart block, photosensitivity, and valvular heart disease 21–23 . In a study by Moon et al, investigators noted that adult patients with lupus nephritis and anti-Ro antibody had a decreased chance of renal relapse 24 . Another report by Chien et al showed that kidney disease in adults with SLE was associated with absence of anti-Ro antibody, suggesting a protective effect 25 .…”

Section: Discussionmentioning

confidence: 99%

Predictors of kidney disease in a cohort of pediatric patients with lupus

Sule

Moodalbail

Burnham

et al. 2015

Lupus

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Introduction Children with systemic lupus erythematosus (SLE) have an increased prevalence of kidney disease compared to their adult counterparts. Our goal was to identify potential clinical and laboratory predictors of renal disease. Methods We performed a cohort study of incident and prevalent patients with SLE aged ≤ 19 years. Retrospective data from initial presentation until study enrollment was also collected. Laboratory and clinic data were recorded from each clinic visit including disease activity indices, autoantibodies, urinalyses, blood counts, and metabolic profile. Kidney disease was defined as the presence of abnormal renal biopsy or by American College of Rheumatology case definition for lupus nephritis. Logistic regression analyses were used to determine the association between clinical and laboratory data with kidney disease in those who had renal involvement within 30 days of SLE diagnosis. We also performed a time to event analysis to identify antecedents of renal disease. Results 47 children and adolescents with SLE were followed in the cohort, 91% female and 68% Black. All of the males in the cohort developed renal disease, and all within one month of the diagnosis of SLE. In logistic regression, low serum albumin (Odds Ratio: 4.8, 95% CI: 1.9–12.5) and positive dsDNA antibodies (OR: 3.2, 95% CI: 1.7–5.9) were associated with kidney disease. In longitudinal analyses, isolated sterile pyuria (Hazard Ratio (HR): 3, 95% CI: 1.1–6.4) and low serum albumin (HR: 3.4, 95% CI: 1.7–6.9) were predictors of future kidney disease. The presence of antibodies against Ro were protective against renal disease (HR: 0.2, 95% CI: 0.05–0.5). Conclusion We identified variables associated with kidney disease, both at initial diagnosis of SLE and in longitudinal follow-up in a cohort of children with SLE. The recognition of these abnormal laboratory values may help clinicians identify patients at risk for kidney disease before its onset thus preventing long-term complications.

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“…No response (NR) was defined as a UPE > 3.5 g/d, or a < 50% reduction in UPE with or without renal deterioration [ 31 ]. Relapse was defined as the reappearance of significant proteinuria, defined as > 1.0 g/d and as a UPE increase of > 50% from the lowest level of proteinuria after remission [ 31 – 32 ].…”

Section: Methodsmentioning

confidence: 99%

Comparison of combined leflunomide and low-dose corticosteroid therapy with full-dose corticosteroid monotherapy for progressive IgA nephropathy

et al. 2017

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IgA nephropathy is the most common primary glomerulonephritis and one of the leading causes of end-stage renal disease. We performed a randomized, controlled, prospective, open-label trial to determine whether leflunomide combined with low-dose corticosteroid is safe and effective for the treatment of progressive IgA nephropathy, as compared to full-dose corticosteroid monotherapy. Biopsy-proved primary IgA nephropathy patients with an estimated glomerular filtration rate ≥ 30 ml/min/1.73m2 and proteinuria ≥1.0 g/24h were randomly assigned to receive leflunomide+low-dose corticosteroid (leflunomide group; n = 40) or full-dose corticosteroid (corticosteroids group; n = 45). The primary outcome was renal survival; secondary outcomes were proteinuria and adverse events. After 12 months of treatment and an average follow-up of 88 months, 11.1% vs. 7.5% of patients reached end-stage renal disease and 20% versus 10% of patients had a ≥ 50% increase in serum creatinine in the corticosteroids and leflunomide groups, respectively. Kaplan-Meier analysis did not reveal a between-group difference in these outcomes. Decreases in 24-hour proteinuria were similar in the two groups during the treatment period, but a more marked reduction was observed during follow-up in the leflunomide group. Although the incidence of adverse events was similar in the two groups, serious adverse events were observed only in the corticosteroid group. Thus, leflunomide combined with low-dose corticosteroid is at least as effective as corticosteroid alone for the treatment of progressive IgA nephropathy, and showed a greater reduction of proteinuria during long-term follow-up and fewer severe adverse events.

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Predictors of renal relapse in Korean patients with lupus nephritis who achieved remission six months following induction therapy

Cited by 23 publications

References 39 publications

Analysis of clinical risk factors in relapsed patients with class IV lupus nephritis

Analysis of clinical risk factors in relapsed patients with class IV lupus nephritis

Predictors of kidney disease in a cohort of pediatric patients with lupus

Comparison of combined leflunomide and low-dose corticosteroid therapy with full-dose corticosteroid monotherapy for progressive IgA nephropathy

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