Artículo de revista
Predictors of renal damage in systemic lupus erythematous patients: data from a multiethnic, multinational Latin American lupus cohort (GLADEL)
Fecha
2020Registro en:
RMD Open 2020;6:e001299.
10.1136/rmdopen-2020-001299
Autor
Reátegui-Sokolova, Cristina
Ugarte Gil, Manuel
Harvey, Guillermina B.
Wojdyla, Daniel
Pons Estel, Guillermo J.
Quintana, Rosana
Serrano Morales, Rosa M.
Sacnun, Mónica P.
Catoggio, Luis J.
Soriano, Enrique R.
García, Mercedes A.
Saurit, Verónica
Alvarellos, Alejandro
Caeiro, Francisco
Berbotto, Guillermo A.
Sato, Emilia I.
Borba Neto, Eduardo Ferreira
Bonfa, Eloisa
de Oliveira e Silva Montandon, Ana Carolina
Da Silva, Nilzio A
Cavalcanti, Fernando
Chacón Vásquez, Gloria
Guibert Toledano, Marlene
Reyes Llerena, Gil A.
Massardo, Loreto
Neira Quiroga, Óscar
Cardiel, Mario H.
Barile Fabris, Leonor A.
Amigo, Mary Carmen
Silveira, Luis H.
Portela-Hernández, Margarita
García de la Torre, Ignacio
Segami, María Inés
Chacón-Diaz, Rosa
Esteva Spinetti, María H.
Alarcón, Graciela S.
Pons-Estel, Bernardo A.
Institución
Resumen
Aim A decrease in proteinuria has been considered protective
from renal damage in lupus nephritis (LN), but a cut-off point
has yet to be established. The aim of this study was to identify
the predictors of renal damage in patients with LN and to
determine the best cut-off point for a decrease in proteinuria.
Methods We included patients with LN defined clinically or
histologically. Possible predictors of renal damage at the time
of LN diagnosis were examined: proteinuria, low complement,
anti-double-stranded DNA antibodies, red cell casts, creatinine
level, hypertension, renal activity (assessed by the Systemic
Lupus Erythematosus Disease Activity Index (SLEDAI)),
prednisone dose, immunosuppressive drugs and antimalarial
use. Sociodemographic variables were included at baseline.
Proteinuria was assessed at baseline and at 12 months, to
determine if early response (proteinuria <0.8 g/day within
12 months since LN diagnosis) is protective of renal damage
occurrence. Renal damage was defined as an increase of one
or more points in the renal domain of The Systemic Lupus
International Collaborating Clinics (SLICC)/American College of
Rheumatology (ACR) Damage Index (SDI). Cox regression
models using a backward selection method were performed.
Results Five hundred and two patients with systemic lupus
erythematosus patients were included; 120 patients
(23.9%) accrued renal damage during their follow-up. Early
response to treatment (HR=0.58), antimalarial use
(HR=0.54) and a high SES (HR=0.25) were protective of
renal damage occurrence, whereas male gender (HR=1.83),
hypertension (HR=1.86) and the renal component of the
SLEDAI (HR=2.02) were risk factors for its occurrence.
Conclusions Early response, antimalarial use and high
SES were protective of renal damage, while male gender,
hypertension and higher renal activity were risk factors for
its occurrence in patients with LN.