Does the time to the onset of lupus nephritis impact renal disease presentation and outcomes?

IF 4.6 2区医学 Q1 RHEUMATOLOGY

Seminars in arthritis and rheumatism Pub Date : 2025-04-13 DOI:10.1016/j.semarthrit.2025.152724

Fadi Kharouf, Pankti Mehta, Qixuan Li, Dafna D Gladman, Zahi Touma, Laura P Whittall Garcia

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Abstract

Objectives

Lupus nephritis (LN) most commonly develops in the initial years after Systemic Lupus Erythematosus (SLE) onset. We aimed to investigate the impact of the time to LN onset on the clinical presentation and outcomes of LN.

Methods

We included 246 inception cohort patients who developed LN during follow-up. We categorized patients into three groups based on the time to LN onset: group 1 (early, ≤1 year, 160 patients), group 2 (intermediate, >1 to ≤5 years, 42 patients), and group 3 (delayed, >5 years, 44 patients). The outcomes assessed were complete proteinuria recovery (CPR) at one year, the occurrence of an adverse composite outcome (end-stage kidney disease [ESKD], a sustained ≥40 % decline in eGFR, or death), and the development of subsequent LN flares. Cox proportional hazard models were used to study associations with the outcomes.

Results

At baseline, the median [IQR] age was 34.3 [26.2, 44.7] years, with a median disease duration of 0.6 [0.2, 2.6] years. Delayed LN patients were older at baseline, had higher SDI, used glucocorticoids and immunosuppressives less frequently, and were less likely to achieve CPR at 1 year. Early LN patients had the lowest risk of developing the adverse composite outcome. In the Cox models, compared to early LN, intermediate LN was associated with an increased risk of developing the adverse composite outcome and showed a trend towards a higher association with subsequent LN flares.

Conclusions

Intermediate LN, occurring between the first and fifth year after SLE onset, is associated with the worst renal outcomes.

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红斑狼疮肾炎发病的时间会影响肾脏疾病的表现和结果吗？

目的狼疮肾炎（LN）最常见于系统性红斑狼疮（SLE）发病后的最初几年。我们的目的是研究LN发病时间对LN临床表现和预后的影响。方法我们纳入246例在随访期间发生LN的初始队列患者。我们根据发生LN的时间将患者分为三组：1组（早期，≤1年，160例），2组（中期，≤1年，42例），3组（延迟，≤5年，44例）。评估的结局是一年内尿蛋白完全恢复（CPR），不良复合结局（终末期肾病[ESKD]， eGFR持续下降≥40%，或死亡）的发生，以及随后LN发作的发展。使用Cox比例风险模型来研究与结果的关联。结果基线时，中位[IQR]年龄为34.3[26.2,44.7]岁，中位病程为0.6[0.2,2.6]年。延迟性LN患者在基线时年龄较大，SDI较高，使用糖皮质激素和免疫抑制剂的频率较低，并且在1年时实现CPR的可能性较低。早期LN患者发生不良综合结局的风险最低。在Cox模型中，与早期LN相比，中期LN与发生不良综合结果的风险增加相关，并且与随后的LN耀斑有更高的相关性。中期LN，发生在SLE发病后1 - 5年之间，与最差的肾脏预后相关。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Seminars in arthritis and rheumatism 医学-风湿病学

CiteScore

9.20

自引率

4.00%

发文量

176

审稿时长

46 days

期刊介绍： Seminars in Arthritis and Rheumatism provides access to the highest-quality clinical, therapeutic and translational research about arthritis, rheumatology and musculoskeletal disorders that affect the joints and connective tissue. Each bimonthly issue includes articles giving you the latest diagnostic criteria, consensus statements, systematic reviews and meta-analyses as well as clinical and translational research studies. Read this journal for the latest groundbreaking research and to gain insights from scientists and clinicians on the management and treatment of musculoskeletal and autoimmune rheumatologic diseases. The journal is of interest to rheumatologists, orthopedic surgeons, internal medicine physicians, immunologists and specialists in bone and mineral metabolism.