Renal Flare And Prognosis In Proliferative Lupus Nephritis Patients

Part 1----Predictors of renal relapse in proliferative lupus nephritis patientsABSTRACT.Objective:We investigated the relapse rate in the patients with proliferative lupus nephritis(LN)after complete remission(CR)or partial remission(PR)from induction therapy,as well as the risk factors of renal relapse.Methodology:A total of 487(65 males and 422 females)proliferative LN patients from January 2003 and December 2008 were enrolled in this study.Renal relapse was defined as persistent proteinuria ?1.0 g/24h after complete remission or an increase of?2.0 g/24 h after partial remission with or without hematuria(defined as doubling of red blood cell count in urinary sediment,?10 cells per high power field,or the appearance of red cellular casts and white cellular casts)or increase in SCr?25%from baseline.All the subjects had CR or PR after 6-12 months induction therapy.Univariate and multivariate COX regression were employed to analysis various clinical and pathological variates to determine the risk factors for renal relapse.Results:Followed for a median of 32.5(IQR:21.0,51.8)months,there were 180(37.0%)renal recurrence.There was no difference in clinical and pathological variates between the relapsed and relapsed free group except for gender and age of LN onset.Compared to the relapsed free group,the relapsed group have a lower rate of female patients and have a higher rate of the younger patients.COX regression analysis showed onset age of LN(HR 0.982,95%CI[0.967-0.997],P=0.020),serum complement 4(C4)concentrations(HR 1.031,95%CI[1.009-1.054],P=0.006),and the gender(HR 0.673,95%CI[0.453-0.998],P=0.049)were important influence factors.Conclusion:Our study demonstrated that proferative LN was an easily relapsed disease.Earlier onset age of LN,lower C4 and male patients might increase the risk of renal recurrence.Part 2-------Recurrence frequency predict long-term renal outcomes in the patients with proliferative lupus nephritisABSTRACT Objective:To investigate whether the recurrence frequency could predict of long-term renal outcome in the patients with proliferative lupus nephritis.Methodology:A total of 487(65 males and 422 females)proliferative LN patients from January 2003 and December 2008 were enrolled.The renal endpoint was defined as sustained doubling of the SCr from the baseline value or entered end-stage renal disease.All the subjects had CR or PR after 6-12 months induction therapy.Univariate and multivariate COX regression were employed to analysis various clinical and pathological variates to determine the risk factors for renal outcome.Results:Followed for a median of 75.25(IQR:60.99,91.07)months,there were 24(4.92%)patients entered to the renal endpoint.There was no difference in clinical and pathological variates between the progress and the non-progress group.Compared to non-progress group,the rate of CR were lower in progress group.COX regression result showed that systolic blood pressure(HR 1.026,95%CI[1.002-1.052],P=0.035),serum complement 3(C3)concentration(HR 1.429,95%CI[1.081-1.887],P=0.012),the rate of CR(HR 4.309,95%CI[1.355-13.696],P=0.013),reach CR during the follow-up(HR 0.180,95%CI[0.063-0.514],P=0.001)and recurrence frequency(P=0.009)were influence factors for ESRD.Conclusion:Repeated recurrence and remission status were the independent risk factors for the long-term renal outcomes in the patients with proliferative lupus nephritis.Part 3----The long-term effect of Triptergium Wilfordii in maintenance therapy for lupus nephritis-----a single center,5± years,randomized controlled trialABSTRACT Objective:To investigate the long-term effect of Triptergium Wilfordii on maintenance therapy of proliferative lupus nephritis(LN)patients,comparing with azathioprine.Methodology:A total of 86 proliferative LN patients who received complete remission or partial remission from January 2007 and June 2008 were enrolled.These patients were randomized to either Triptergium Wilfordii group or azathioprine group.Before taking experimental drugs,two patients withdrew consents.The remaining patients were treated for two years,then the follow-up treatment was determined by investigations,including discontinued therapy.The primary end point was the the rate of relapse(renal flare and extrarenal flare).Secondary assessments included time to relapse,rate of reaching renal endpoint patients(renal endpoint was defined as end-stage renal disease,doubling of the serum creatinine level,or a change of-30%or greater in estimated GFR),changes of proteinuria and SCr during treatment,adverse effects.Results:There was a median follow-up of 57.5(IQR:18.8,69.0)months.The rate of relapses was similar in TW group and in AZA group.The media time of the relapse was 17.5 months(IQR:5,56)and 38 months(IQR:3,75),respectively.There was no significantly difference in serum creatinine,proteinuria and the level of anti-dsDNA between two groups during the first two years.Although the adverse events was higher in TW group(75.0%)than that in AZA group(59.1%),but there was no statistical difference.The incidences of amenorrhea in TW group were significantly higher than that in AZA group while leukopenia was higher in AZA group.Both groups had a similar incidence of infection.Conclusion:Triptergium Wilfordii had the similar relapse rate as azathioprine and similar adverse effects except for menstrual disorder.So Triptergium Wilfordii is a better choice for maintenance therapy of lupus patients.