Lupus Nefritinde Histolojik Sınıflar Arasında Klinik ve Serolojik Özellikler ile Renal Sonuçlar: Retrospektif Bir Kohort Çalışması

Abstract

Lupus nefriti (LN), 2003 Uluslararası Nefroloji Derneği/Renal Patoloji Derneği (ISN/RPS) sınıflamasına göre histopatolojik olarak sınıflandırılmaktadır. Bu çalışmada, özellikle Sınıf I/II hastalığa vurgu yaparak LN’nin histolojik sınıfları arasında klinik özellikler ve renal sonuçları karşılaştırmayı amaçladık. Biyopsi ile doğrulanmış LN tanısı olan hastaların dahil edildiği retrospektif bir kohort çalışması yürütüldü. Hastalar üç gruba ayrıldı: Sınıf I/II, Sınıf V veya mikst Sınıf II/V ve proliferatif Sınıf III/IV (±V). Gruplar arasında başlangıç demografik, klinik ve serolojik özellikler ile kısa dönem renal sonuçlar [12. ayda tam renal yanıt (CRR), parsiyel renal yanıt (PRR) ve yetersiz renal yanıt (IRR)] karşılaştırıldı. Uzun dönem sonuçlar [kronik böbrek hastalığı (KBH) veya son dönem böbrek yetmezliği (SDBY)] sağkalım analizleri ile değerlendirildi.Toplam 82 hasta dahil edildi: 13’ü Sınıf I/II, 15’i Sınıf V veya mikst Sınıf II/V ve 54’ü proliferatif Sınıf III/IV (±V) LN idi. Başlangıçta daha yüksek proteinüri ve serum kreatinin düzeyleri ile daha düşük eGFR proliferatif grupta gözlendi (tüm karşılaştırmalar için p<0,05). Demografik, klinik ve serolojik özelliklerin çoğu gruplar arasında benzerdi; ancak anti-sentromer B pozitifliği yalnızca Sınıf I/II grubunda saptandı (%27, p=0,004). On ikinci ayda renal yanıt oranları gruplar arasında benzer bulundu (p=0,766). Medyan 158 aylık takip süresince 18 hastada (%22) KBH veya SDBY gelişti. On yıllık KBH/SDBY’siz sağkalım oranları Sınıf I/II ve Sınıf V veya II/V gruplarında %82, Sınıf III/IV (±V) grubunda ise %77 olarak saptandı ve gruplar arasında anlamlı fark gözlenmedi (log-rank p=0,371). CRR veya PRR elde eden hastalarda, yanıt vermeyenlere kıyasla daha iyi renal sağkalım eğilimi gözlendi (log-rank p=0,065). Bu bulgular, LN’nin histolojik sınıfları arasında belirgin bir klinik heterojenite olduğunu ortaya koymakta ve yalnızca histopatolojik sınıflamaya dayalı yaklaşımın ötesinde bireyselleştirilmiş yönetim stratejilerine ihtiyaç olduğunu vurgulamaktadır. Ayrıca, Sınıf I/II LN’nin uzun dönem renal prognozu, ileriye dönük çalışmalarda daha ayrıntılı olarak değerlendirilmelidir.

Keywords

• Lupus nefriti
• Gerçek yaşam kohortu
• Renal sonuçlar
• Klass I/II lupus nefriti

Supporting Institution

Yok

Ethical Statement

Bu çalışma, 2013 yılında revize edilen Helsinki Bildirgesi ilkelerine uygun olarak yürütülmüştür. Etik onay, Aydın Adnan Menderes Üniversitesi Tıp Fakültesi Klinik Araştırmalar Etik Kurulu’ndan alınmıştır (Karar No: 09; Protokol No: 2025/109). Çalışmanın retrospektif tasarımı ve anonimleştirilmiş klinik verilerin kullanılması nedeniyle yazılı bilgilendirilmiş onam gerekliliği etik kurul tarafından muaf tutulmuştur.

Thanks

Yazarların beyan edecek herhangi bir teşekkür notu bulunmamaktadır.

Clinical and serological characteristics and renal outcomes across histological classes of lupus nephritis: A retrospective cohort study

Abstract

Lupus nephritis (LN) is classified histopathologically according to the 2003 International Society of Nephrology/Renal Pathology Society (ISN/RPS) classification. We aimed to compare characteristics and renal outcomes across histological classes of LN, with particular emphasis on class I/II disease. We conducted a retrospective cohort study of patients with biopsy-proven LN. Patients were categorized into three groups: class I/II, class V or mixed class II/V, and proliferative class III/IV(±V). Baseline demographic, clinical, and serological characteristics and short-term renal outcomes [12-month complete renal response (CRR), partial renal response (PRR), and inadequate renal response (IRR)] were compared between groups. Long-term outcomes [chronic kidney disease (CKD) or end-stage renal disease (ESRD)] were assessed with survival analyses. A total of 82 patients were included: 13 with class I/II, 15 with class V or mixed class II/V, and 54 with proliferative class III/IV(±V) LN. Baseline proteinuria and serum creatinine levels were significantly higher, whereas the estimated glomerular filtration rate (eGFR) was significantly lower, in patients with proliferative disease (all p<0.05). Most demographic, clinical, and serological features were otherwise comparable, except for anti-centromere B positivity, observed only in the class I/II group (27%, p=0.004). Rates of renal responses at 12 months were similar across groups (p=0.766). During a mean follow-up of 158 months, 18 patients (22%) developed CKD or ESRD. Ten-year CKD/ESRD-free survival was 82% in both class I/II and in class V or II/V and was 77% in class III/IV(±V) LN, respectively, without significant differences between groups (log-rank p=0.371). Patients achieving CRR or PRR showed a trend toward better renal survival compared with non-responders (log-rank p=0.065). These findings underscore the clinical heterogeneity across LN classes and the need for individualized management beyond histopathology, while the long-term prognosis of class I/II LN remains to be clarified in prospective studies.

Keywords

• Lupus nephritis
• Real-word cohort
• Renal outcomes
• Class I/II lupus nephritis

Supporting Institution

None

Ethical Statement

This study was conducted in accordance with the principles of the Declaration of Helsinki as revised in 2013. Ethical approval was obtained from the Clinical Research Ethics Committee of Aydın Adnan Menderes University Faculty of Medicine (Decision No: 09; Protocol No: 2025/109). Due to the retrospective design of the study and the use of anonymized clinical data, the requirement for written informed consent was waived by the ethics committee.

Thanks

The authors have no acknowledgements to declare.

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