Lupus & antiphospholipid syndrome
Extra-renal disease patterns in lupus nephritis: clinical and serological activity confers increased risk of renal flares and damage accrual
Authors' conclusion
Extra-renal activity in LN following renal response is common. Anti-dsDNA positivity is the main factor associated with adverse outcomes, while concomitant clinical extra-renal activity may further increase risk among serologically active patients.
Study context
- Population
- Patients with biopsy-proven lupus nephritis (LN) who achieved renal responsepatients included
- Participants
- 168 patients
- Exposure
- Patterns of extra-renal disease activity following renal response and their association with renal flares and organ damage accrual
- Outcome
- Extra-renal activity at least once
- Follow-up
- Median 4.0 years
Methodological detailslatent class analysis, Cox proportional hazards models
- Latent class analysis
- Cox proportional hazards models
Main finding
As reported in the abstract
Patients exhibiting extra-renal activity at least once
92.3%
Observational data: associations, not effects.
Further findings
| Outcome | aHR (95% CI) | |
|---|---|---|
| Subsequent renal flares, per higher non-renal SLEDAI-2K scoreIndependently associated with increased risk | 1.18 (1.07–1.30) | |
| Damage accrual, per higher non-renal SLEDAI-2K score | 1.23 (1.13–1.35) | |
| 0.512Adjusted hazard ratio (log scale) |
Damage accrual, BILAG-A extra-renal flares
| aHR (95% CI) | ||
|---|---|---|
| BILAG-A extra-renal flares | 10.56 (4.63–24.06) | |
| 0.050.21520Adjusted hazard ratio (log scale) |
Renal flares, latent class analysis (LCA) combined phenotype
| aHR (95% CI) | ||
|---|---|---|
| Combined serological-clinical activityOnly the combined phenotype was independently associated | 2.66 (1.34–5.30) | |
| 0.20.5125Adjusted hazard ratio (log scale) |
Damage accrual, LCA combined phenotype
| aHR (95% CI) | ||
|---|---|---|
| Combined serological-clinical activity | 2.37 (1.07–5.25) | |
| 0.20.5125Adjusted hazard ratio (log scale) |
Clinically significant extra-renal flares
- Patients with clinically significant extra-renal flares
- 37.5%
Adverse outcomes, stratified by anti-dsDNA status (exploratory)
- Clinical extra-renal activity was associated with adverse outcomes among anti-dsDNA positive visits
- Exploratory analyses
Original publication
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