BACKGROUND: Lupus nephritis (LN) is a major source of morbidity and mortality in patients with systemic lupus erythematosus (SLE), with 10-25% of patients progressing to end-stage renal disease (ESRD). OBJECTIVE: This study aims to elucidate the predictive capabilities of 24-h proteinuria (24PTU) and serum creatinine (sCr) after 12 months of treatment with respect to long-term renal outcomes in LN in a single-center cohort of LN patients. METHODS: A retrospective analysis was performed on 214 patients diagnosed with LN followed in our center. Values of 24PTU and sCr were assessed at baseline and after 3, 6 and 12 months, and after 5 years and/or the last evaluation. Chronic kidney disease (CKD) was defined as an estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m2 for 3 months or longer. End-stage renal disease (ESRD) was defined as the need for permanent dialysis. Receiver operating characteristics curves (ROC) were used to test the best cut-off value of 24PTU and sCr at 12 months who predict bad long-term renal outcomes. RESULTS: The mean follow-up period was 11.2 ± 7.2 years. The best cut-off values for 24PTU and sCr as predictor of CKD were, respectively, 0.9 g/24 h and 0.9 mg/dL. ROC curve for 24PTU had a slightly lower performance than ROC curve for sCr as predictor for CKD (PTU AUC = 0.68; sCr AUC = 0.70), but sensitivity and specificity were better for 24PTU (24PTU: sensitivity = 63.5%, specificity = 71.2%; sCr: sensitivity = 54.8%, specificity = 75.3%). When the outcome was ESRD the best cut-off points were 0.9 g/24hs and 1.3 mg/dL for 24PTU and sCr, respectively, and the curve performance was better for 24PTU (PTU AUC = 0.72; sCr AUC = 0.61). CONCLUSIONS: In this ethnically diverse population with LN followed for a long time (> 10 years), levels of 24PTU > 0.9/day at 12 months was a good predictor of bad long-term renal outcome. The serum creatinine > 0.9 mg/dL and > 1.3 mg/dL at 12 months were also good predictors of CKD and ESRD, respectively. Patients with 24PTU < 0.9 g/day and sCr < 1.3 mg/dL at 12 months are not likely to develop ESRD because of the high negative predictive values (NPV) (93.2% and 82%). 24PTU and sCr are relevant as components for a treat-to-target strategy for LN treatment, since their high NPV corroborates their importance as good predictors of long-term renal outcome.
BACKGROUND: Lupus nephritis (LN) is a major source of morbidity and mortality in patients with systemic lupus erythematosus (SLE), with 10-25% of patients progressing to end-stage renal disease (ESRD). OBJECTIVE: This study aims to elucidate the predictive capabilities of 24-h proteinuria (24PTU) and serum creatinine (sCr) after 12 months of treatment with respect to long-term renal outcomes in LN in a single-center cohort of LN patients. METHODS: A retrospective analysis was performed on 214 patients diagnosed with LN followed in our center. Values of 24PTU and sCr were assessed at baseline and after 3, 6 and 12 months, and after 5 years and/or the last evaluation. Chronic kidney disease (CKD) was defined as an estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m2 for 3 months or longer. End-stage renal disease (ESRD) was defined as the need for permanent dialysis. Receiver operating characteristics curves (ROC) were used to test the best cut-off value of 24PTU and sCr at 12 months who predict bad long-term renal outcomes. RESULTS: The mean follow-up period was 11.2 ± 7.2 years. The best cut-off values for 24PTU and sCr as predictor of CKD were, respectively, 0.9 g/24 h and 0.9 mg/dL. ROC curve for 24PTU had a slightly lower performance than ROC curve for sCr as predictor for CKD (PTU AUC = 0.68; sCr AUC = 0.70), but sensitivity and specificity were better for 24PTU (24PTU: sensitivity = 63.5%, specificity = 71.2%; sCr: sensitivity = 54.8%, specificity = 75.3%). When the outcome was ESRD the best cut-off points were 0.9 g/24hs and 1.3 mg/dL for 24PTU and sCr, respectively, and the curve performance was better for 24PTU (PTU AUC = 0.72; sCr AUC = 0.61). CONCLUSIONS: In this ethnically diverse population with LN followed for a long time (> 10 years), levels of 24PTU > 0.9/day at 12 months was a good predictor of bad long-term renal outcome. The serum creatinine > 0.9 mg/dL and > 1.3 mg/dL at 12 months were also good predictors of CKD and ESRD, respectively. Patients with 24PTU < 0.9 g/day and sCr < 1.3 mg/dL at 12 months are not likely to develop ESRD because of the high negative predictive values (NPV) (93.2% and 82%). 24PTU and sCr are relevant as components for a treat-to-target strategy for LN treatment, since their high NPV corroborates their importance as good predictors of long-term renal outcome.
Authors: Ilana B Richman; Kimberly E Taylor; Sharon A Chung; Laura Trupin; Michelle Petri; Edward Yelin; Robert R Graham; Annette Lee; Timothy W Behrens; Peter K Gregersen; Michael F Seldin; Lindsey A Criswell Journal: Arthritis Rheum Date: 2012-10
Authors: Bernardo A Pons-Estel; Luis J Catoggio; Mario H Cardiel; Enrique R Soriano; Silvana Gentiletti; Antonio R Villa; Isaac Abadi; Francisco Caeiro; Alejandro Alvarellos; Donato Alarcón-Segovia Journal: Medicine (Baltimore) Date: 2004-01 Impact factor: 1.889
Authors: Farah Tamirou; Bernard R Lauwerys; Maria Dall'Era; Meggan Mackay; Brad Rovin; Ricard Cervera; Frédéric A Houssiau Journal: Lupus Sci Med Date: 2015-11-12
Authors: Michelle R Ugolini-Lopes; Luciana Parente C Seguro; Maitê Xavier F Castro; Danielle Daffre; Alex C Lopes; Eduardo F Borba; Eloisa Bonfá Journal: Lupus Sci Med Date: 2017-06-12
Authors: John G Hanly; Aidan G O'Keeffe; Li Su; Murray B Urowitz; Juanita Romero-Diaz; Caroline Gordon; Sang-Cheol Bae; Sasha Bernatsky; Ann E Clarke; Daniel J Wallace; Joan T Merrill; David A Isenberg; Anisur Rahman; Ellen M Ginzler; Paul Fortin; Dafna D Gladman; Jorge Sanchez-Guerrero; Michelle Petri; Ian N Bruce; Mary Anne Dooley; Rosalind Ramsey-Goldman; Cynthia Aranow; Graciela S Alarcón; Barri J Fessler; Kristjan Steinsson; Ola Nived; Gunnar K Sturfelt; Susan Manzi; Munther A Khamashta; Ronald F van Vollenhoven; Asad A Zoma; Manuel Ramos-Casals; Guillermo Ruiz-Irastorza; S Sam Lim; Thomas Stoll; Murat Inanc; Kenneth C Kalunian; Diane L Kamen; Peter Maddison; Christine A Peschken; Soren Jacobsen; Anca Askanase; Chris Theriault; Kara Thompson; Vernon Farewell Journal: Rheumatology (Oxford) Date: 2015-09-05 Impact factor: 7.580