EVALUATION OF CLINICAL AND PATHOLOGICAL FINDINGS AND TREATMENT OUTCOMES OF PATIENTS WITH LUPUS NEPHRITIS: A SINGLE CENTRE EXPERIENCE

Year 2025, Volume: 88 Issue: 1, 1 - 8, 31.01.2025

Batunay Duran , Ömer Faruk Akçay , Arzu Sağlam , Ebru Gök Oğuz , Mehmet Deniz Aylı

https://doi.org/10.26650/IUITFD.1542884

Abstract

Objective: Renal involvement in systemic lupus erythematosus (SLE), also known as lupus nephritis (LN), leads to a worse prognosis than SLE without kidney involvement.
Material and Methods: Biopsy-proven LN patients diagnosed between January 2012 and January 2021 were reviewed. Complete remission (CR) was defined as a reduction in the urinary protein-to-creatinine ratio (UPCR) below 0.50 g/g. Partial response is characterised by a 24-h urine protein excretion reduction to below 3 g/day with at least a 50% decrease in proteinuria. Primary effective renal response was defined as PCR of less than 0.7 g/g and the absence of any rescue therapy for treatment failure.
Result: All patients exhibited proteinuria at diagnosis, with class IV LN being the most common (36.4%) form, and 65.9% had prolif erative LN. At 12 months, CR was achieved in 16 patients (37.2%) with significant differences in systolic and diastolic blood pressure and eGFR at diagnosis (p=0.01, p=0.02, and p=0.016, respective ly). CR rates were lower at 12 months in patients with proliferative LN (p=0.024) and interstitial inflammation (p=0.04). Besides, no significant difference was found in CR rates at 6 and 12 months between PLN patients treated initially with steroids and cyclo phosphamide and those treated with steroids and mycopheno late mofetil (p>0.05). However, the median time to achieve CR was shorter in the mycophenolate mofetil group (p=0.048).
Conclusion: LN remains a significant source of morbidity and mortality in patients with SLE; therefore, early diagnosis and prompt initiation of the treatment are crucial for renal and patient survival.

Keywords

Renal survival, lupus nephritis, end-stage renal dis ease, remission, induction therapy

LUPUS NEFRİTLİ HASTALARIN KLİNİK VE PATOLOJİK BULGULARININ DEĞERLENDİRİLMESİ VE TEDAVİ SONUÇLARI: TEK MERKEZ DENEYİMİ

Abstract

Amaç: Sistemik lupus eritematozusun (SLE) böbrek tutulumu olarak bilinen lupus nefriti (LN), böbrek tutulumu olmayan SLE’ye göre daha kötü bir prognoza yol açar.
Gereç ve Yöntem: Ocak 2012 ile Ocak 2021 arasında tanı konulan biyopsiyle kanıtlanmış LN hastaları incelendi. Tam remisyon (TR), idrar protein-kreatinin oranının (PKO) 0,50 g/g’nin altına düşmesi olarak tanımlandı. Kısmi yanıt, 24 saatlik idrar protein atılımının günde 3 g/günün altına düşmesi ve proteinüride en az %50 azalma olarak tanımlandı. Birincil etkili renal yanıt ise 0,7 g/g'dan düşük PKO ve tedavi başarısızlığı için herhangi bir kurtarma tedavisinin olmamasıdır.
Bulgular: Tanı anında tüm hastalarda proteinüri mevcut olup, en yaygın form %36,4 ile sınıf IV LN idi ve hastaların %65.9’unda proliferatif LN vardı. Oniki ayda, 16 hastada (%37,2) TR elde edil di ve tanı anında sistolik ve diyastolik kan basıncı ile eGFR’de anlamlı farklar vardı (sırasıyla, p=0,01, p=0,02 ve p=0,016). Pro liferatif LN (p=0,024) ve interstisyel inflamasyonu olan hastalarda 12 aylık TR oranları daha düşük bulundu (p=0,04). Ayrıca, ste roid ve siklofosfamid ile tedavi edilen PLN hastaları ile steroid ve mikofenolat mofetil (MMF) ile tedavi edilenler arasında 6 ve 12 aylık TR oranlarında anlamlı fark bulunmadı (p>0,05). Bununla birlikte, mikofenolat mofetil grubunda TR elde etme süresi daha kısaydı (p=0,048).
Sonuç: LN, SLE hastalarında morbidite ve mortalitenin önemli bir kaynağı olmaya devam etmekte olup erken tanı ve tedavi böbrek ve hasta sağkalımı için kritik öneme sahiptir.

Keywords

Böbrek sağkalımı, lupus nefriti, son dönem böbrek hastalığı, remisyon, indüksiyon tedavisi

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