Renal flares in 91 SLE patients with diffuse proliferative glomerulonephritis

Mosca, Marta; Bencivelli, W.; Neri, R; Pasquariello, Antonio; Batini, Valentina; Puccini, R; Tavoni, Antonio; Bombardieri, Stefano

doi:10.1046/j.1523-1755.2002.00280.x

Cited by 80 publications

(64 citation statements)

References 25 publications

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“…In the present study, 36% of the patients were African American, suggesting that, as expected, renal flare is an important risk factor for all patients with LN. Although the study by Moroni et al (1) found only nephritic flares to be significantly associated with poor renal outcomes, a more recent study of 91 Caucasian Systemic Lupus Erythematosus patients with proliferative LN found both nephritic and proteinuric flares to be associated with poor kidney outcomes (14), similar to our data. The recent EULAR guidelines emphasized nephritic flares.…”

Section: Discussionsupporting

confidence: 89%

Renal Flare as a Predictor of Incident and Progressive CKD in Patients with Lupus Nephritis

Parikh

Nagaraja

Hebert

et al. 2014

Clinical Journal of the American Society of Nephrology

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SummaryBackground 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. ConclusionIn patients with lupus nephritis, the relative duration of renal flare is an independent predictor of incident and progressive CKD.

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Section: Discussionsupporting

confidence: 89%

Renal Flare as a Predictor of Incident and Progressive CKD in Patients with Lupus Nephritis

Parikh

Nagaraja

Hebert

et al. 2014

Clinical Journal of the American Society of Nephrology

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“…This finding is in agreement with prior lupus nephritis cohorts (27,28). Mosca et al found that nephritic flares and early proteinuric flares among adults were highly associated with doubling of serum creatinine (27,29). Similar findings have been reported in another adult cohort (28).…”

Section: Discussionsupporting

confidence: 87%

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

Gibson¹,

Gipson²,

Massengill³

et al. 2009

Clinical Journal of the American Society of Nephrology

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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.

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“…One aim of the study was to evaluate which of the two regimens offered better protection against renal flares, a factor that was associated strictly with long-term disease outcome (18,20). However, during the 4-yr follow-up, seven flares occurred in the cyclosporine group (10.6 flares/100 patient-years) and eight in the azathioprine group (13.4 flares/100 patientyears).…”

Section: Discussionmentioning

confidence: 99%

A Randomized Pilot Trial Comparing Cyclosporine and Azathioprine for Maintenance Therapy in Diffuse Lupus Nephritis over Four Years

Moroni

Doria

Mosca

et al. 2006

Clinical Journal of the American Society of Nephrology

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There is not agreement about the best maintenance treatment for patients with diffuse lupus nephritis. This multicenter, randomized trial compared the safety and efficacy of cyclosporine and azathioprine. Seventy-five patients with diffuse proliferative lupus were given three intravenous methylprednisolone pulses followed by prednisone and oral cyclophosphamide for a median of 90 d. Subsequently, patients were randomly assigned either to cyclosporine or to azathioprine for 2 yr (core study). Treatment continued for up to 4 yr (follow-up study). The primary outcome measure was the incidence of disease flares. Secondary end points were proteinuria per day, creatinine clearance, and adverse effects. Seven flares occurred in the cyclosporine group, and eight occurred in the azathioprine group. At the end of the core study, mean proteinuria decreased from 2.

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Renal flares in 91 SLE patients with diffuse proliferative glomerulonephritis

Abstract: Our results suggest that (a) a distinct subgroup of SLE patients exists, made up of younger patients with extensive, active lesions on renal biopsy, who are at higher risk for renal flares, (b) renal flares represent important predictors of doubling serum creatinine.

Cited by 80 publications

References 25 publications

Renal Flare as a Predictor of Incident and Progressive CKD in Patients with Lupus Nephritis

Renal Flare as a Predictor of Incident and Progressive CKD in Patients with Lupus Nephritis

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

A Randomized Pilot Trial Comparing Cyclosporine and Azathioprine for Maintenance Therapy in Diffuse Lupus Nephritis over Four Years

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