Predictors of treatment outcomes in lupus nephritis with severe acute kidney injury and requirement of dialytic support,Clinical Rheumatology

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Predictors of treatment outcomes in lupus nephritis with severe acute kidney injury and requirement of dialytic support
Clinical Rheumatology ( IF 2.9 ) Pub Date : 2023-05-16 , DOI: 10.1007/s10067-023-06629-1
Sofia E Márquez-Macedo ₁ , Abril A Perez-Arias ₁ , Óscar R Pena-Vizcarra ₁ , María Fernanda Zavala-Miranda ₁ , Bernardo Juárez-Cuevas ₁ , Megan A Navarro-Gerrard ₁ , Luis E Morales-Buenrostro ₁ , Juan M Mejía-Vilet ₁

Affiliation

Introduction/objectives

Acute kidney injury (AKI) with the requirement of kidney replacement therapy (KRT) portends a poor prognosis for kidney function in lupus nephritis (LN). This study evaluated the kidney function recovery rates, the rates of reinitiation of KRT, and factors associated with these outcomes in LN.

Method

All consecutive patients hospitalized for LN with KRT requirement between 2000 and 2020 were included. Their clinical and histopathologic characteristics were retrospectively registered. The outcomes and associated factors were evaluated by multivariable Cox regression analysis.

Results

Among 140 patients, 75 (54%) recovered kidney function, with recovery rates of 50.9% and 54.2% by 6 and 12 months of therapy. The factors associated with a lower probability of recovery included a previous history of LN flares, worse eGFR and higher proteinuria at presentation, immunosuppression with azathioprine, and hospitalizations within 6 months of therapy initiation. There was no difference in the kidney function recovery rates between mycophenolate and cyclophosphamide treatment schemes. Out of 75 patients who recovered kidney function, 37 (49%) reinitiated KRT, with KRT reinitiation rates of 27.2% and 46.5% by 3 and 5 years. Seventy-three (52%) patients had at least one hospitalization within 6 months of initial therapy, 52 (72%) of them secondary to infectious events.

Conclusions

Approximately 50% of patients with LN and KRT requirement recover kidney function within 6 months. The risk-to-benefit ratio decisions may be aided by clinical and histological factors. These patients require close follow-up as ≈50% of those who recover kidney function will reinitiate dialysis in the long term.

Key Points

• Approximately 50% of patients with severe acute lupus nephritis with the need for kidney replacement therapy requirement recover their kidney function.

• The factors associated with a lower probability of recovery of kidney function include a previous history of LN flares, worse eGFR and higher proteinuria at presentation, immunosuppression with azathioprine, and hospitalizations within 6 months of therapy initiation.

• Patients who recover kidney function will require close follow-up as around 50% of them will eventually reinitiate kidney replacement therapy.

中文翻译：

狼疮性肾炎合并严重急性肾损伤和透析支持需求治疗结果的预测因素

简介/目标

需要肾脏替代治疗 (KRT) 的急性肾损伤 (AKI) 预示着狼疮性肾炎 (LN) 肾功能的预后不良。本研究评估了 LN 的肾功能恢复率、KRT 重新启动率以及与这些结果相关的因素。

方法

2000 年至 2020 年期间因 LN 住院且需要 KRT 的所有连续患者均纳入其中。回顾性记录他们的临床和组织病理学特征。通过多变量 Cox 回归分析评估结果和相关因素。

结果

在 140 名患者中，75 名患者（54%）恢复了肾功能，治疗 6 个月和 12 个月时恢复率分别为 50.9% 和 54.2%。与恢复可能性较低相关的因素包括既往 LN 发作病史、就诊时 eGFR 较差和蛋白尿较高、硫唑嘌呤免疫抑制以及治疗开始后 6 个月内住院治疗。麦考酚酯和环磷酰胺治疗方案的肾功能恢复率没有差异。在 75 名肾功能恢复的患者中，37 名（49%）重新开始 KRT，3 年和 5 年 KRT 重新开始率分别为 27.2% 和 46.5%。73 名 (52%) 患者在初始治疗后 6 个月内至少住院过一次，其中 52 名 (72%) 继发于感染事件。