Background
Methods
Patients
Data collection
Prognostic factors for CR at 3 years
Renal pathology
Statistical analysis
Results
Baseline clinicopathological characteristics and treatment regimens
Baseline characteristics | Complete renal response |
p Value | |
---|---|---|---|
Achieved (n = 44) | Not achieved (n = 36) | ||
Female sex, n (%) | 40 (90.9) | 27 (75.0) | 0.32 |
Age, years | 39.7 ± 13.1 | 38.3 ± 11.5 | 0.43 |
BMI, kg/m2
| 22.1 ± 2.9 | 21.7 ± 3.1 | 0.31 |
Systolic blood pressure, mmHg | 128.3 ± 16.7 | 130.0 ± 18.3 | 0.34 |
Diastolic blood pressure, mmHg | 80.1 ± 13.2 | 79.9 ± 13.6 | 0.57 |
Disease duration, years | 5.9 ± 8.0 | 7.7 ± 7.2 | 0.23 |
SLEDAI | 16.3 ± 4.7 | 13.4 ± 4.9 | <0.01 |
SDI | 0.4 ± 0.6 | 0.5 ± 0.6 | 0.26 |
Proteinuria, g/g creatinine | 2.6 ± 2.2 | 3.1 ± 1.8 | 0.14 |
eGFR, ml/minute | 72.9 ± 27.4 | 77.6 ± 32.3 | 0.27 |
Anti-dsDNA antibody, IU/ml | 212 ± 300 | 155 ± 259 | 0.26 |
Anticardiolipin antibody, IU/ml | 23.5 ± 30.6 | 15.4 ± 25.6 | 0.12 |
Lupus anticoagulant-positive, n (%) | 9 (20.5) | 3 (8.3) | 0.13 |
CH50, U/ml | 16.1 ± 8.6 | 21.4 ± 12.4 | 0.02 |
Prednisolone, mg/day | 45.9 ± 14.9 | 41.1 ± 14.1 | 0.07 |
Induction therapy, n (%) | |||
IVCY | 25 (56.8) | 15 (44.4) | 0.34 |
MMF | 8 (18.2) | 3 (11.1) | 0.23 |
Tacrolimus | 7 (15.9) | 6 (19.4) | 0.96 |
PSL monotherapy | 2 (4.5) | 6 (16.7) | 0.07 |
Others | 2 (4.5) | 6 (16.7) | 0.07 |
Renal pathological findings | |||
ISN/RPS classification | |||
III (A) or III (A/C), n (%) | 18 (40.9) | 9 (25.0) | 0.13 |
III (A) or III (A/C) + V, n (%) | 4 (9.1) | 6 (16.7) | 0.34 |
IV (A) or IV (A/C), n (%) | 14 (31.8) | 15 (41.7) | 0.41 |
IV (A) or IV (A/C) + V, n (%) | 8 (18.2) | 6 (16.7) | 0.92 |
Endocapillary hypercellularity, % | 41.2 ± 29.5 | 43.0 ± 33.1 | 0.27 |
Leukocyte infiltration, % | 1.9 ± 5.5 | 1.4 ± 4.0 | 0.34 |
Subendothelial hyaline deposits, % | 31.2 ± 32.7 | 30.7 ± 29.3 | 0.43 |
Fibrinoid necrosis/karyorrhexis, % | 6.9 ± 12.4 | 15.3 ± 28.0 | 0.17 |
Cellular crescents, % | 8.3 ± 7.3 | 10.6 ± 21.8 | 0.18 |
Interstitial inflammation, % | 1.2 ± 4.8 | 2.1 ± 7.1 | 0.44 |
Glomerular sclerosis, % | 3.7 ± 8.2 | 6.9 ± 9.1 | 0.25 |
Fibrous crescents, % | 1.6 ± 3.1 | 1.1 ± 4.2 | 0.43 |
Tubular atrophy, % | 3.8 ± 6.3 | 6.3 ± 6.1 | 0.14 |
Interstitial fibrosis, % | 4.6 ± 7.2 | 7.1 ± 6.0 | 0.26 |
Activity index | 5.1 ± 3.1 | 5.9 ± 4.1 | 0.21 |
Chronicity index | 1.3 ± 0.2 | 1.8 ± 1.6 | 0.12 |
Renal response at each visit and CR status at year 3
Observational period (week) | Patients who achieved PR, n (%) |
p Value | |
---|---|---|---|
CR at year 3 (n = 44) | Non-CR at year 3 (n = 36) | ||
2 | 23 (52.5) | 17 (47.2) | 0.08 |
4 | 26 (59.1) | 18 (50.0) | 0.41 |
8 | 31 (70.4) | 18 (50.0) | 0.06 |
12 | 34 (77.3) | 20 (55.5) | 0.03 |
24 | 38 (86.4) | 20 (55.5) | <0.01 |
48 | 40 (90.1) | 25 (69.4) | 0.01 |
96 | 40 (90.1) | 25 (69.4) | 0.01 |
Identification of prognostic factors for CR at 3 years
Parameters | OR | 95% confidence interval |
p Value |
---|---|---|---|
PR at 12 weeks | 3.57 | 1.16–12.1 | 0.03 |
eGFR, ml/minute/1.73 m2
| 1.00 | 0.98–1.02 | 0.62 |
SLEDAI | 0.94 | 0.82–1.07 | 0.48 |
CH50, U/ml | 1.03 | 0.97–1.09 | 0.21 |
MMF use | 4.43 | 0.78–30.6 | 0.09 |
IVCY use | 1.32 | 0.38–4.58 | 0.62 |
Renal outcomes and damage accrual
Renal response at week 12/year 3 | |||||
---|---|---|---|---|---|
Baseline characteristics | PR/CR (n = 34) | PR/non-CR (n = 20) | Non-PR/CR (n = 10) | Non-PR/non-CR (n = 16) |
p Value |
Female sex, n (%) | 33 (97.1) | 15 (75.0) | 7 (70.0) | 12 (75.0) | 0.05 |
Age, years | 38.9 ± 12.8 | 38.8 ± 11.5 | 42.6 ± 14.5 | 37.8 ± 11.9 | 0.82 |
BMI, kg/m2
| 22.3 ± 3.1 | 21.6 ± 2.9 | 21.9 ± 2.9 | 21.9 ± 3.5 | 0.94 |
Systolic blood pressure, mmHg | 128.8 ± 17.7 | 130.3 ± 15.4 | 126.5 ± 14.0 | 129.9 ± 22.1 | 0.91 |
Diastolic blood pressure, mmHg | 80.8 ± 14.1 | 79.9 ± 13.3 | 77.4 ± 9.4 | 79.9 ± 14.6 | 0.86 |
Disease duration, years | 4.6 ± 7.4 | 6.3 ± 6.5 | 10.8 ± 8.9 | 9.6 ± 7.9 | 0.09 |
SLEDAI | 16.9 ± 4.5 | 14.1 ± 5.7 | 13.8 ± 4.9 | 12.6 ± 3.8 | 0.15 |
SDI | 0.3 ± 0.6 | 0.5 ± 0.5 | 0.6 ± 0.7 | 0.6 ± 0.7 | 0.33 |
Proteinuria, g/g creatinine | 2.4 ± 2.1 | 3.1 ± 1.9 | 2.9 ± 2.5 | 3.1 ± 1.7 | 0.47 |
eGFR, ml/minute/1.73 m2
| 73.5 ± 27.0 | 78.3 ± 32.2 | 70.9 ± 29.9 | 76.8 ± 33.4 | 0.84 |
Anti-dsDNA antibody, IU/ml | 234.5 ± 332.1 | 106.3 ± 104.59 | 139.3 ± 150.1 | 212.9 ± 364.9 | 0.21 |
Anticardiolipin antibody, IU/ml | 27.6 ± 14.1 | 19.1 ± 32.4 | 11.9 ± 7.7 | 10.5 ± 11.5 | 0.13 |
Lupus anticoagulant-positive, n (%) | 8 (23.5) | 2 (10.0) | 1 (10.0) | 1 (6.2) | 0.34 |
CH50, U/ml | 27.6 ± 14.1 | 19.1 ± 32.4 | 11.9 ± 7.7 | 10.5 ± 11.5 | 0.12 |
Prednisolone, mg/day | 46.5 ± 14.0 | 41.5 ± 14.6 | 44.3 ± 18.6 | 40.7 ± 14.3 | 0.58 |
Induction therapy, n (%) | |||||
IVCY | 20 (58.8) | 10 (50.0) | 5 (50.0) | 5 (33.3) | 0.36 |
MMF | 5 (14.7) | 0 (0.0) | 3 (30.0) | 3 (18.8) | 0.18 |
Tacrolimus | 5 (14.7) | 4 (20.0) | 2 (20.0) | 2 (12.5) | 0.94 |
PSL monotherapy | 2 (5.8) | 4 (20.0) | 0 (0.0) | 2 (12.5) | 0.15 |
Others | 2 (5.8) | 2 (10.0) | 0 (0.0) | 4 (25.0) | 0.16 |
Maintenance therapy, n (%) | |||||
Azathioprine | 14 (41.2) | 4 (20.0) | 3 (30.0) | 3 (18.8) | 0.33 |
MMF | 8 (23.5) | 3 (15.0) | 3 (30.0) | 4 (25.0) | 0.84 |
Tacrolimus | 6 (17.6) | 6 (30.0) | 2 (20.0) | 3 (18.8) | 0.71 |
PSL monotherapy | 4 (11.8) | 4 (20.0) | 1 (10.0) | 1 (6.3) | 0.66 |
Others | 2 (5.9) | 3 (15.0) | 1 (10.0) | 5 (31.3) | 0.17 |
Renal pathological findings, n (%) | |||||
ISN/RPS classification | |||||
III (A) or III (A/C) | 13 (38.2) | 5 (27.9) | 4 (40.0) | 4 (25.0) | 0.65 |
III (A) or III (A/C) + V | 4 (11.8) | 2 (10.0) | 1 (10.0) | 3 (18.8) | 0.94 |
IV (A) or IV (A/C) | 12 (35.3) | 9 (45.0) | 3 (30.0) | 6 (37.5) | 0.93 |
IV (A) or IV (A/C) + V | 6 (17.6) | 3 (15.0) | 2 (20.0) | 3 (18.8) | 1.00 |
Endocapillary hypercellularity, % | 31.2 ± 21.2 | 40.3 ± 13.1 | 41.3 ± 10.1 | 48.1 ± 8.2 | 0.64 |
Leukocyte infiltration, % | 2.0 ± 3.5 | 1.1 ± 2.4 | 2.9 ± 1.3 | 2.2 ± 1.3 | 0.35 |
Subendothelial hyaline deposits, % | 40.1 ± 10.1 | 29.1 ± 12.4 | 27.9 ± 12.7 | 38.1 ± 11.3 | 0.42 |
Fibrinoid necrosis/karyorrhexis, % | 7.0 ± 10.1 | 6.0 ± 11.2 | 6.1 ± 10.4 | 5.9 ± 11.4 | 0.53 |
Cellular crescents, % | 7.1 ± 7.2 | 8.1 ± 6.1 | 7.2 ± 7.4 | 8.8 ± 7.1 | 0.52 |
Interstitial inflammation, % | 1.0 ± 4.8 | 1.2 ± 4.8 | 1.2 ± 4.8 | 1.2 ± 4.8 | 0.84 |
Glomerular sclerosis, % | 3.9 ± 7.2 | 3.7 ± 8.1 | 3.2 ± 7.1 | 3.3 ± 6.2 | 0.71 |
Fibrous crescents, % | 1.6 ± 3.0 | 1.5 ± 2.8 | 2.0 ± 1.1 | 1.7 ± 2.9 | 0.46 |
Tubular atrophy, % | 5.2 ± 5.1 | 3.2 ± 5.1 | 3.1 ± 5.1 | 3.0 ± 6.1 | 0.27 |
Interstitial fibrosis, % | 5.2 ± 6.2 | 4.1 ± 6.1 | 4.3 ± 6.3 | 4.0 ± 5.2 | 0.95 |
Activity index | 5.3 ± 2.8 | 5.1 ± 2.9 | 5.4 ± 3.1 | 6.0 ± 2.1 | 0.27 |
Chronicity index | 1.4 ± 0.1 | 1.3 ± 0.2 | 1.4 ± 0.1 | 1.8 ± 1.6 | 0.88 |