Early-stage predictors for treatment responses in patients with active lupus nephritis

Abstract

Objective We analyzed data of lupus nephritis (LN) patients to find parameters that can predict remission. Methods Sixty-four LN patients who were diagnosed with class III, IV, V or V + III/IV by renal biopsy and were followed up for more than six months in our center were enrolled retrospectively. Receiver operating characteristic curves were used to test the predictive values of urinary protein-to-creatinine ratio (UPCR), serum albumin and complement C3 at the first, second and third months as predictors for remission at the sixth month. Results The patients' renal pathologies were class III (five cases), class IV (33 cases), class V (nine cases) and class V + III/IV (17 cases). All patients received standard immunosuppressive therapy. Forty-six (71.9%) patients (grouped as the remission group) achieved remission at the end of the sixth month, including 23 complete remissions and 23 partial remissions. The other 18 patients were grouped as the no-remission group. There were no significant differences in clinical data, proportion of immunosuppressive therapy or renal pathological characteristics between the remission group and no-remission group at baseline, except the serum urea nitrogen of the remission group was lower than in the no-remission group. The UPCR were significantly lower in the remission group than in the no-remission group at months 1, 2, 3 and 6, respectively, while the serum albumin was significantly higher in the remission group than in the no-remission group at months 3 and 6, respectively. There were no significant differences in serum creatinine between the remission group and no-remission group, except at month 1. The C3 levels were higher in the remission group than in the no-remission group at months 1, 2 and 3, respectively. The areas under the curve (AUC) of the change percentage of UPCR at month 3 and the serum albumin at month 3 were the most significant (AUC 0.778, p = 0.002; AUC 0.773, p = 0.001, respectively). The cutoff value of the change percentage of UPCR at month 3 was 59%. The cutoff value of serum albumin at month 3 was 32.9g/l. Conclusion The change percentage of UPCR ≥59% and the serum albumin ≥32.9 g/l at the third month were valuable for predicting remission at the sixth month in LN. Because of the small-size and retrospective nature, this study needs to be validated.

Predictors of Early Response, Flares, and Long-Term Adverse Renal Outcomes in Proliferative Lupus Nephritis: A 100-Month Median Follow-Up of an Inception Cohort

“…In our study, response to treatment was achieved early after induction treatment; 59% of patients had a renal response at 3 months (26% CR, 33% PR), 67% at 6 months (43% CR, 24% PR), 88% at 12 months (69%CR, 19% PR) and 88% (71% CR, 17% PR) at 2 years. These results are encouraging compared to previous studies reporting 33–50% CR at 6 months, 49–68% CR at 12 months, and 63% CR at 2 years [ 9 , 14 , 18 , 19 , 20 , 21 , 22 , 23 , 24 ], although our population was predominantly Caucasian. Response to treatment has been associated with better long-term renal outcomes [ 25 , 26 , 27 , 28 ], with some studies reporting better renal survival in patients with CR than those with PR only [ 19 , 27 ].…”

The utility of urinary biomarker panel in predicting renal pathology and treatment response in Chinese lupus nephritis patients

“…Previous studies also haven’t validated the correlation ship between urinary NGAL and the histopathological type of LN. Since patients’ baseline character including renal pathological characteristics were not predictors for treatment response [ 40 , 41 ], it’s not surprising that urinary NGAL could predict treatment response but not renal histopathology type while the biomarkers which could differentiate different pathological types of LN could not predict treatment response.…”

Comparison of the Clinical Implications among Five Different Nutritional Indices in Patients with Lupus Nephritis

“…However, the discordant results between disease activity and the development of ESRF could be attributed to the fact that baseline disease activity is not a predictive factor for patient prognosis in SLE [37]. In contrast, it has been reported that persistent proteinuria, which could lead to hypoalbuminemia as a consequence of albumin loss, as well as the serum albumin level itself, were indicative of renal outcomes in LN [38,39,40]. Compared to the CONUT score in which a relatively equal weighting is given between serum albumin, lymphocyte count, and total cholesterol level, the PNI is mainly dependent on the serum albumin level.…”