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Worse Renal Presentation and Prognosis in Initial-Onset Lupus Nephritis than Early-Onset Lupus Nephritis

Authors
 Oh Chan Kwon  ;  Jung Hwan Park  ;  Sang Won Lee  ;  Jason Jungsik Song  ;  Yong Beom Park  ;  Min Chan Park 
Citation
 YONSEI MEDICAL JOURNAL, Vol.61(11) : 951-957, 2020-11 
Journal Title
 YONSEI MEDICAL JOURNAL 
ISSN
 0513-5796 
Issue Date
2020-11
MeSH
Adult ; Biopsy ; Disease Progression ; Female ; Humans ; Kidney / physiopathology* ; Kidney Failure, Chronic / etiology* ; Lupus Erythematosus, Systemic / pathology* ; Lupus Erythematosus, Systemic / therapy ; Lupus Nephritis / complications ; Lupus Nephritis / pathology* ; Lupus Nephritis / therapy ; Male ; Middle Aged ; Prognosis ; Retrospective Studies ; Severity of Illness Index ; Time Factors ; Young Adult
Keywords
Systemic lupus erythematosus ; lupus nephritis ; prognosis
Abstract
Purpose: To compare the clinical characteristics and renal outcomes between patients who initially had lupus nephritis (LN) at the onset of systemic lupus erythematosus (SLE) (initial-onset LN) and those who developed LN within 5 years after SLE onset (early-onset LN). Materials and methods: SLE patients with biopsy-proven LN were retrospectively reviewed. The clinical parameters and renal outcomes were compared between initial-onset and early-onset LN groups. We used Cox regression analysis to estimate risk of worse renal outcomes according to the onset time of LN. Results: Of all 136 LN patients, 92 (67.6%) and 44 (32.4%) patients were classified into the initial-onset and early-onset LN groups, respectively. The initial-onset LN group had higher prevalences of class IV LN (54.3% vs. 34.1%, p=0.027), impaired renal function (34.8% vs. 11.4%, p=0.004), microscopic hematuria (73.9% vs. 54.5%, p=0.024), and higher urine protein/creatinine ratio [4626.1 (2180.0-6788.3) mg/g vs. 2410.0 (1265.0-5168.5) mg/g, p=0.006] at LN diagnosis. Renal relapse (46.3% vs. 25.7%, p=0.039) and progression to chronic kidney disease (CKD) or end-stage renal disease (ESRD) were more common (24.4% vs. 8.3%, p=0.042) in the initial-onset LN group. In Cox regression analysis, the initial-onset LN group had higher risks of renal relapse [adjusted hazard ratio (HR) 3.56, 95% confidence interval (CI) 1.51-8.35, p=0.004] and progression to CKD or ESRD (adjusted HR 4.57, 95% CI 1.03-20.17, p=0.045), compared with the early-onset LN group. Conclusion: Patients with LN at SLE onset may have more severe renal presentations and experience worse renal outcomes than those who develop LN within 5 years.
Files in This Item:
T202004811.pdf Download
DOI
10.3349/ymj.2020.61.11.951
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Kwon, Oh Chan(권오찬)
Park, Min Chan(박민찬) ORCID logo https://orcid.org/0000-0003-1189-7637
Park, Yong Beom(박용범)
Park, Jung Hwan(박정환)
Song, Jason Jungsik(송정식) ORCID logo https://orcid.org/0000-0003-0662-7704
Lee, Sang-Won(이상원) ORCID logo https://orcid.org/0000-0002-8038-3341
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/180483
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