Risk factors to predict the development of chronic kidney disease in patients with lupus nephritis

Park, D J; Kang, Ji-Hyoun; Lee, J W; Lee, K E; Kim, T J; Park, Y W; Lee, J S; Choi, Yoo‐Duk; Lee, S S

doi:10.1177/0961203317694257

Cited by 21 publications

(17 citation statements)

References 32 publications

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“…Previous studies have mainly focused on the achievement of CR, which is defined as a UPCR of <0.5 at six months after induction treatment. 10,[12][13][14][15][16] A recent study by Hanaoka et al 7 suggested a novel concept of deep remission, which might be a more beneficial therapeutic target than the present recommendations regarding prevention of renal flare. We adopted this concept and expanded this previous work to identify the risk factors of the development of CKD in proliferative LN, focusing on the impact of stringent CR.…”

Section: Discussionmentioning

confidence: 79%

Impact of stringent response in proteinuria on long-term renal outcomes in proliferative lupus nephritis

Won

et al. 2019

Lupus

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Objectives Favourable long-term prognosis in proliferative lupus nephritis (LN) is associated with the achievement of complete renal response (CR), which is defined as a urine protein/creatinine ratio (UPCR) of < 0.5. However, it is unclear whether a more stringent cut-off for proteinuria (normal value of proteinuria; UPCR < 0.15) is better than CR. We aimed to evaluate the effect of stringent CR, defined as a UPCR of <0.15, on long-term renal outcomes in proliferative LN. Methods We included 87 patients with class III or IV LN who achieved CR at one year after induction therapy. Clinical and laboratory data were compared between the stringent and non-stringent CR groups. Logistic regression analysis was performed to identify factors associated with achievement of stringent CR. Cox analysis was performed to analyse the risk factors for renal flare and development of chronic kidney disease (CKD). Results The stringent and non-stringent CR groups included 58 and 29 patients, respectively. The two groups showed no significant baseline differences in terms of the clinical, laboratory and pathological classification. The sustained CR rates during five years were 91.3% and 50.0% ( p = 0.014) in the stringent and non-stringent CR groups, respectively. In Cox analyses, the achievement of stringent CR was associated with a lower risk of five-year renal flare rate (hazard ratio (HR) = 0.161, 95% confidence interval (CI) 0.063–0.411, p < 0.01) and development of CKD (HR = 0.189, 95% CI 0.047–0.752, p = 0.018). Mycophenolate mofetil induction therapy was associated with achievement of stringent CR at a borderline level of significance (HR = 7.268, 95% CI 0.894–59.089, p = 0.064). Conclusion Achievement of stringent CR predicted lower risk of renal flare and development of CKD in proliferative LN. These findings suggest that stringent CR is a valuable treatment target in proliferative LN.

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Section: Discussionmentioning

confidence: 79%

Impact of stringent response in proteinuria on long-term renal outcomes in proliferative lupus nephritis

Won

et al. 2019

Lupus

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“…The SLR identified that, at the time of LN diagnosis, (i) compromised kidney function, 21 – 28 (ii) hypertension 27 29 and (iii) increased patient age 30 – 32 have been associated with adverse long-term kidney outcomes. With regard to histologic features, proliferative forms of LN (histologic classes III and IV according to the 2003 International Society of Nephrology/Renal Pathology Society (ISN/RPS) classification), increasing percentage of crescents and higher National Institutes of Health histologic activity and chronicity scores have all been associated with adverse long-term kidney outcomes.…”

Section: Resultsmentioning

confidence: 99%

“…In individual studies, use of HCQ has been associated with a lower risk for tubulointerstitial inflammation on kidney biopsy 56 and with a higher likelihood for complete response at 1 year. 57 Regarding long-term outcomes, HCQ use has been associated with reduced risk for ESKD/chronic kidney disease (CKD) or doubling of serum creatinine (adjusted HR 0.18–0.40); 27 58 59 a posthoc analysis of the Aspreva Lupus Management Study (ALMS) RCT showed that lack of treatment with antimalarials had more than double risk for treatment failure (defined as death or ESKD or sustained doubling of serum creatinine or renal flare or requirement for rescue therapy) during the maintenance phase (OR 2.4, p = 0.02). 60 Data regarding protection from kidney flares are equivocal 61 62 ; a single study showed lower blood concentrations of HCQ in patients with LN who experienced a flare (0.59 vs 0.81 mg/L; p = 0.005).…”

Section: Resultsmentioning

confidence: 99%

Management of lupus nephritis: a systematic literature review informing the 2019 update of the joint EULAR and European Renal Association-European Dialysis and Transplant Association (EULAR/ERA-EDTA) recommendations

et al. 2020

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ObjectivesTo analyse the current evidence for the management of lupus nephritis (LN) informing the 2019 update of the EULAR/European Renal Association-European Dialysis and Transplant Association recommendations.MethodsAccording to the EULAR standardised operating procedures, a PubMed systematic literature review was performed, from January 1, 2012 to December 31, 2018. Since this was an update of the 2012 recommendations, the final level of evidence (LoE) and grading of recommendations considered the total body of evidence, including literature prior to 2012.ResultsWe identified 387 relevant articles. High-quality randomised evidence supports the use of immunosuppressive treatment for class III and class IV LN (LoE 1a), and moderate-level evidence supports the use of immunosuppressive treatment for pure class V LN with nephrotic-range proteinuria (LoE 2b). Treatment should aim for at least 25% reduction in proteinuria at 3 months, 50% at 6 months and complete renal response (<500–700 mg/day) at 12 months (LoE 2a-2b). High-quality evidence supports the use of mycophenolate mofetil/mycophenolic acid (MMF/MPA) or low-dose intravenous cyclophosphamide (CY) as initial treatment of active class III/IV LN (LoE 1a). Combination of tacrolimus with MMF/MPA and high-dose CY are alternatives in specific circumstances (LoE 1a). There is low-quality level evidence to guide optimal duration of immunosuppression in LN (LoE 3). In end-stage kidney disease, all methods of kidney replacement treatment can be used, with transplantation having the most favourable outcomes (LoE 2b).ConclusionsThere is high-quality evidence to guide the initial and subsequent phases of class III/IV LN treatment, but low-to-moderate quality evidence to guide treatment of class V LN, monitoring and optimal duration of immunosuppression.

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“…In a discussion on periodontal therapy in patients with CKD, we must also take into consideration the influence of immunosuppressive agents. In short, a variety of CKD, such as lupus nephritis and IgA nephropathy, is commonly treated with immunosuppressive agents [76,77]. Undoubtedly, the immune response is closely associated with infection control in almost organs and tissues including oral and periodontal tissues.…”

Section: Periodontal Disease and Chronic Kidney Diseasementioning

confidence: 99%

Pathological Characteristics of Periodontal Disease in Patients with Chronic Kidney Disease and Kidney Transplantation

Kitamura

Mochizuki

Miyata

et al. 2019

IJMS

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Chronic kidney disease (CKD) is recognized as an irreversible reduction of functional nephrons and leads to an increased risk of various pathological conditions, including cardiovascular disease and neurological disorders, such as coronary artery calcification, hypertension, and stroke. In addition, CKD patients have impaired immunity against bacteria and viruses. Conversely, kidney transplantation (KT) is performed for patients with end-stage renal disease as a renal replacement therapy. Although kidney function is almost normalized by KT, immunosuppressive therapy is essential to maintain kidney allograft function and to prevent rejection. However, these patients are more susceptible to infection due to the immunosuppressive therapy required to maintain kidney allograft function. Thus, both CKD and KT present disadvantages in terms of suppression of immune function. Periodontal disease is defined as a chronic infection and inflammation of oral and periodontal tissues. Periodontal disease is characterized by the destruction of connective tissues of the periodontium and alveolar bone, which may lead to not only local symptoms but also systemic diseases, such as cardiovascular diseases, diabetes, liver disease, chronic obstructive pulmonary disease, and several types of cancer. In addition, the prevalence and severity of periodontal disease are significantly associated with mortality. Many researchers pay special attention to the pathological roles and clinical impact of periodontal disease in patients with CKD or KT. In this review, we provide information regarding important modulators of periodontal disease to better understand the relationship between periodontal disease and CKD and/or KT. Furthermore; we evaluate the impact of periodontal disease on various pathological conditions in patients with CKD and KT. Moreover, pathogens of periodontal disease common to CKD and KT are also discussed. Finally, we examine the importance of periodontal care in these patients. Thus, this review provides a comprehensive overview of the pathological roles and clinical significance of periodontal disease in patients with CKD and KT.

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Risk factors to predict the development of chronic kidney disease in patients with lupus nephritis

Cited by 21 publications

References 32 publications

Impact of stringent response in proteinuria on long-term renal outcomes in proliferative lupus nephritis

Impact of stringent response in proteinuria on long-term renal outcomes in proliferative lupus nephritis

Management of lupus nephritis: a systematic literature review informing the 2019 update of the joint EULAR and European Renal Association-European Dialysis and Transplant Association (EULAR/ERA-EDTA) recommendations

Pathological Characteristics of Periodontal Disease in Patients with Chronic Kidney Disease and Kidney Transplantation

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