Characteristics and outcomes of biopsy-proven lupus nephritis in the Eastern Cape province of South Africa.

IF 1.9 4区 医学 Q3 RHEUMATOLOGY Lupus Pub Date : 2024-10-01 Epub Date: 2024-09-06 DOI:10.1177/09612033241281042
Hanri Gerber, Robert Freercks
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Abstract

Objective: In Africa, the treatment outcomes of lupus nephritis (LN) are not well known. This is especially true in the current era where contemporary treatment options are more widely available. This retrospective study aimed to measure the outcomes of biopsy-proven LN treated at the Livingstone Tertiary Hospital (LTH) Renal Unit in Gqeberha (formerly Port Elizabeth), South Africa and to identify predictors of a poor outcome.

Methods: A retrospective cohort study of 131 patients with biopsy-proven LN who had a kidney biopsy between 01 January 2012 to 31 December 2021 as identified from the biopsy register. A sub-analysis of 107 patients with proliferative and/or membranous LN was performed.

Results: Mean age was 31.4 ± 12.7 years with a female predominance of 86.3%. At 6-month follow-up, 69.6% of patients had complete or partial response to treatment. This increased to 70.3% and 72.6% at 18 and 30 months, respectively. Twenty-seven patients were lost to follow-up, while 7 (5.3%) patients progressed to kidney failure (KF). There were 3 (2.3%) deaths. Predictors of poor response were an elevated baseline serum creatinine (OR = 2.53, 95% CI 0.99 - 6.52, p = .054), a decreased eGFR (OR = 2.92, 95% CI 0.94 - 9.09, p = .065) and an elevated blood pressure (OR = 6.06, 95% CI 1.11 - 33.33, p = .038) at the time of biopsy. Infections were the most common adverse event with 50 infections seen in 39 (29.8%) patients. Herpes viral infections were frequently noted (n = 12) accounting for 24.0% of all documented infections.

Conclusion: Response rates were similar in this cohort when compared to other contemporary studies. Predictors of poor response were an elevated baseline serum creatinine, a decreased eGFR and an elevated blood pressure at time of the biopsy. Infections were the most common occurring adverse event, although the mortality rate remained low at 2.3%.

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南非东开普省经活检证实的狼疮性肾炎的特征和结果。
目的:在非洲,狼疮性肾炎(LN)的治疗效果并不为人所知。尤其是在现代治疗方案更加普及的今天,情况更是如此。这项回顾性研究旨在衡量在南非盖贝哈(原伊丽莎白港)利文斯通三甲医院(LTH)肾病科接受活检证实的狼疮肾炎的治疗效果,并确定不良治疗效果的预测因素:一项回顾性队列研究,研究对象是活组织检查证实的 LN 患者,131 名患者在 2012 年 1 月 1 日至 2021 年 12 月 31 日期间进行了肾脏活组织检查。对107名增生性和/或膜性LN患者进行了子分析:平均年龄为(31.4 ± 12.7)岁,女性占86.3%。在 6 个月的随访中,69.6% 的患者对治疗有完全或部分反应。18个月和30个月时,这一比例分别增至70.3%和72.6%。27名患者失去了随访机会,7名(5.3%)患者发展为肾衰竭(KF)。死亡人数为 3 人(2.3%)。不良反应的预测因素包括活检时血清肌酐基线升高(OR = 2.53,95% CI 0.99 - 6.52,p = .054)、eGFR 下降(OR = 2.92,95% CI 0.94 - 9.09,p = .065)和血压升高(OR = 6.06,95% CI 1.11 - 33.33,p = .038)。感染是最常见的不良事件,39 名患者(29.8%)共发生 50 例感染。疱疹病毒感染经常发生(12 例),占所有记录感染的 24.0%:结论:与其他当代研究相比,本组患者的反应率相似。活检时血清肌酐基线升高、肾小球滤过率下降和血压升高是不良反应的预测因素。感染是最常见的不良反应,但死亡率仍然很低,仅为 2.3%。
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来源期刊
Lupus
Lupus 医学-风湿病学
CiteScore
4.20
自引率
11.50%
发文量
225
审稿时长
1 months
期刊介绍: The only fully peer reviewed international journal devoted exclusively to lupus (and related disease) research. Lupus includes the most promising new clinical and laboratory-based studies from leading specialists in all lupus-related disciplines. Invaluable reading, with extended coverage, lupus-related disciplines include: Rheumatology, Dermatology, Immunology, Obstetrics, Psychiatry and Cardiovascular Research…
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