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.jpg): Failed to open stream: No such file or directory in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 117 J+Clin+Rheumatol
2016 ; 22
(6
): 299-306
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Long-term Outcome of Lupus Nephritis Class II in Argentine Patients: An Open
Retrospective Analysis
#MMPMID27152693
Collado MV
; Dorado E
; Rausch S
; Gomez G
; Khoury M
; Zazzetti F
; Gargiulo M
; Suarez L
; Chaparro R
; Paira S
; Galvan L
; Juarez V
; Pisoni C
; Garcia M
; Martinez L
; Alvarez A
; Alvarez C
; Barreira J
; Sarano J
J Clin Rheumatol
2016[Sep]; 22
(6
): 299-306
PMID27152693
show ga
BACKGROUND: There is controversy in medical literature over the outcome of
patients with lupus nephritis (LN) class II. The aim of this study was to explore
the risk of histological transformation (HT) and possible factors related to
negative response to treatment in patients with mesangial LN class II. METHODS: A
retrospective and multicenter study was carried out that includes patients who
had received a diagnosis of LN class II on their first renal biopsy. Creatinine,
urine sediment, and proteinuria were recorded at the time of the first biopsy, 6
months, and 1, 2, and 5 years after the first biopsy. Response to treatment, HT,
and long-term outcome were evaluated. RESULTS: Forty-one patients were included.
The manifestation at first biopsy was proteinuria greater than 0.5 g/d in 28
patients (68.29%; 8 [28.57%] of 28 patients had nephrotic syndrome), hematuria in
18 patients (43.90%), and deterioration of renal function in 3 patients (7.31%).
During the follow-up (median, 8 years; range, 1-35 years), a new biopsy was
performed in 18 patients (43.90%), and in 17 patients (17/18 [94.44%]), there was
HT. Median time at rebiopsy was 32 months (range, 11-305 months). Of the 18
patients who had a second biopsy, 10 (55.55%) were on hydroxychloroquine versus
100% (19/19) of patients who did not undergo the procedure (P = 0.001). A year
after the first renal biopsy, there are data available from 34 patients; of them,
24 patients (70.58%) had achieved response, and 10 patients (29.41%) had no
response (NR) (missing data in 7). A higher 24-hour urinary protein at 6 months
was predictor of worse outcome at 1 year, with statistical significance
difference for the nonresponder group (median proteinuria, 2.3 g/d [range, 0-4.7
g/d]) compared with responders (median proteinuria, 0.28 g/d [range, 0-1.7 g/d])
(P = 0.0133).In the long-term follow-up (5 years), HT was the main cause of
unfavorable outcome and was measured in 78.57% of patients (11/14 patients).
CONCLUSIONS: This series shows a high rate of HT in long-term follow-up.
Proteinuria at 6 months made it possible to set aside patients who will have an
unfavorable outcome in the long term and who will thus benefit from a more
aggressive treatment. The results suggest that hydroxychloroquine had a
nephroprotective effect.