Recovery of renal function in patients with lupus nephritis and reduced renal function: the beneficial effect of hydroxychloroquine

Abstract

Background Reduced renal function is associated with worse renal outcome in patients with lupus nephritis (LN). However, there is insufficient knowledge regarding renal function recovery in patients with LN with reduced baseline renal function. Therefore, the present study aimed to investigate renal function recovery and related factors in patients with reduced baseline renal function. Methods The present retrospective longitudinal cohort study included patients with LN and reduced renal function. Reduced renal function was defined as an estimated glomerular filtration rate (eGFR) of <60 mL/min/1.73 m2. Recovery of renal function was determined by an eGFR of >60 mL/min/1.73 m2 at six months after baseline, and factors associated with it were evaluated using logistic regression analysis. Results We included 90 patients with LN, with a mean eGFR value of 37.2 ± 13.9 mL/min/1.73 m2. Forty-six (51.1%) patients recovered their renal function after six months. On multivariate analysis, hydroxychloroquine use (odds ratio (OR) = 3.891, 95% confidence interval (CI) 1.196–12.653, p = 0.024), prolonged LN (OR = 0.926, 95% CI 0.874–0.981, p = 0.009) and high-grade tubular atrophy (OR = 0.451, 95% CI 0.208–0.829, p = 0.013) were associated with renal function recovery. During follow up, 25 patients were on end-stage renal disease (ESRD). Kaplan–Meier analysis revealed that renal function recovery after six months and lower probability of ESRD are associated. Conclusions In patients with LN and reduced renal function, renal function recovery at six months was associated with use of hydroxychloroquine and inversely related to longer duration of LN and higher grade of tubular atrophy.

Hydroxychloroquine is neutral in risk of chronic kidney disease in patients with systemic lupus erythematosus

“…Furthermore, previous studies had been debating on the effect of HCQ in chronic kidney diseases (CKD) 2 3. Pokroy-Shapira et al 4 investigated 256 lupus patients for up to 25 years and found that HCQ use was negatively associated with risk of earlier CKD.…”

Hydroxychloroquine administration exacerbates acute kidney injury complicated by lupus nephritis

“…HCQ, combined with standard immunosuppressants, has been proven to retard renal damage occurrence, accelerate renal remission, reduce lupus relapse, and decrease mortality in patients with LN [ 7 , 24 ]. However, the renoprotective effects of HCQ monotherapy in LN have not been fully elucidated.…”

The predictive value of serum level of cystatin C for COVID-19 severity

“…For example, hydroxychloroquine is a safe and highly tolerable approach with minimum side effects. A retrospective longitudinal cohort study showed that hydroxychloroquine treatment (OR 3.891, 95% CI 1.196–12.653) was associated with renal function recovery in patients with lupus nephritis 34 . A large-sampled multicentered observational study has shown that the exposure of hydroxychloroquine is associated with a decreased risk of hospitalization from COVID-19 (OR 0.53; 95% CI 0.29–0.95) 35 .…”