Comparison of Lupus Nephritis Onset Before and After Age 50: Impact on Presentation and Outcomes in an Inception Cohort.

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

OBJECTIVE Renal involvement in systemic lupus erythematosus (SLE) most commonly occurs in women of the reproductive age group. However, it may theoretically start at any age. In this study, We aimed to explore the impact of lupus nephritis (LN) stratified by age of onset, with a cutoff at 50 years, on clinical presentation and disease outcomes. METHODS We included 246 inception cohort patients who developed LN during follow-up. We classified patients based on the age of LN onset into Group 1 (before age 50; 205 patients) and Group 2 (≥50, late-onset LN [LoLN]; 41 patients). Outcomes included complete proteinuria recovery (CPR) at one year, an adverse composite outcome (end-stage renal disease [ESRD], a sustained ≥40% eGFR decline, or death), subsequent LN flares, and any increase in non-renal SLICC damage index (SDI). The association with outcomes was studied using Cox proportional hazards model. RESULTS At baseline, the median [IQR] age was 31.4 [25.2, 38.5] years for Group 1 and 58.4 [53.9, 64.5] years for Group 2 (p<0.01). Group 2 (LoLN) patients had a higher median creatinine level (p=0.03), lower median eGFR (p<0.01) and proteinuria levels (p=0.01), and lower median SLEDAI-2K score (p=0.04). In the Cox models, there were no significant differences between the two groups in terms of achieving CPR or developing the adverse composite outcome. However, LoLN was associated with higher odds of any increase in non-renal SDI and showed a trend for fewer subsequent flares. CONCLUSION LoLN is not associated with significant differences in short- or long-term renal outcomes.
50岁前后狼疮性肾炎发病的比较:对初始队列的表现和结果的影响。
目的:系统性红斑狼疮(SLE)最常见于育龄妇女。然而,从理论上讲,它可以在任何年龄开始。在这项研究中,我们旨在探讨按发病年龄分层的狼疮性肾炎(LN)对临床表现和疾病结局的影响,以50岁为截止年龄。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LN发病年龄将患者分为1组(50岁前;205例)和2组(≥50例,迟发性LN [LoLN];41名患者)。结果包括一年内尿蛋白完全恢复(CPR),不良综合结果(终末期肾病[ESRD],持续≥40%的eGFR下降或死亡),随后的LN发作以及非肾脏SLICC损伤指数(SDI)的任何增加。采用Cox比例风险模型研究其与预后的关系。结果基线时,组1的中位年龄为31.4[25.2,38.5]岁,组2的中位年龄为58.4[53.9,64.5]岁(p<0.01)。2组(LoLN)患者肌酐中位数水平较高(p=0.03), eGFR中位数水平较低(p<0.01),蛋白尿中位数水平较低(p=0.01), SLEDAI-2K评分中位数较低(p=0.04)。在Cox模型中,两组在实现心肺复苏术或发生不良综合结局方面没有显著差异。然而,LoLN与非肾性SDI增加的几率较高相关,并显示出后续发作较少的趋势。结论:ln与短期或长期肾脏预后无显著差异。
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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