Can we predict kidney involvement in patients with systemic lupus erythematosus? A retrospective cohort study with independent validation.
Rheumatology (Oxford)
; 2024 May 15.
Article
em En
| MEDLINE
| ID: mdl-38745434
ABSTRACT
OBJECTIVES:
To discern predictive factors for incident kidney involvement in patients with systemic lupus erythematosus (SLE).METHODS:
Patients with SLE from the 'Attikon' Lupus cohort were monitored for lupus nephritis (LN), defined by kidney histology and/or classification criteria. Demographic and clinical characteristics at baseline were compared against patients who did not develop LN. LN-free survival curves were generated by Kaplan-Meier. A multivariate Cox proportional hazards model was used to identify independent predictors of LN. Independent validation was performed in the University of Crete Lupus registry.RESULTS:
Among the 570 patients in the derivation cohort, 59 exhibited LN as their initial presentation, while an additional 66 developed LN during the follow-up period (collectively, 21.9% incidence). In the latter group, baseline factors predictive of subsequent kidney involvement were male sex (multivariable-adjusted [a]HR 4.31, 95% CI 1.82-10.2), age of SLE diagnosis below 26 years (aHR 3.71, 95% CI 1.84-7.48), high anti-dsDNA titre (aHR 2.48, 95% CI 1.03-5.97) and low C3 and/or C4 (although not statistically significant, aHR 2.24, 95% CI 0.83-6.05, p= 0.11). A combination of these factors at time of diagnosis conferred an almost 90-fold risk compared with serologically inactive, older, female patients (aHR 88.77, 95% CI 18.75-420.41), signifying a very high-risk group. Independent validation in the Crete Lupus registry showed concordant results with the original cohort.CONCLUSION:
Male sex, younger age and serologic activity at SLE diagnosis are strongly associated with subsequent kidney involvement. Vigilant surveillance and consideration of early use of disease-modifying drugs is warranted in these subsets of patients.
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Idioma:
En
Ano de publicação:
2024
Tipo de documento:
Article