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Early Vs Late Lupus Nephritis Onset And ESKD Risk Explored – Renal And Urology News –

The risk for end-stage kidney disease (ESKD) appeared similar regardless of the timing of lupus nephritis (LN) onset in 2 Asian studies, but results might differ depending on population characteristics and the definition of early vs late onset.

In a retrospective study of 3779 Korean patients with systemic lupus erythematosus (SLE) identified from a nationwide claims database, biopsy-proven LN of any class developed in 60% within 12 months of SLE diagnosis (early-onset LN) and 40% at 12 or more months of diagnosis (delayed-onset LN). The median durations until LN diagnosis were 0.2 and 34.0 months, respectively. Progression to ESKD occurred in 69 patients with early-onset LN (3.0%) and 29 patients with delayed-onset LN (1.9%).

In adjusted analyses, ESKD risk did not differ significantly between groups, Yoon-Kyoung Sung, MD, PhD, MPH, of Hanyang University Hospital for Rheumatic Diseases in Seoul, Korea, and colleagues reported in Seminars in Arthritis & Rheumatology. However, in subgroup analyses of patients treated with cyclophosphamide or mycophenolate mofetil (purportedly for class 3 or 4 proliferative LN), ESKD risk was a significant 2.6-fold higher for the delayed-onset LN group.

Further, in a sensitivity analysis, using 5 years from SLE diagnosis as the threshold for early vs late LN onset, ESKD risk was 3.4-fold higher for the delayed-onset LN group.

Dr Sung’s team suggested that patients who develop LN late despite receiving appropriate treatment and monitoring may have refractory or intractable SLE and possibly a greater comorbidity burden.

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In a multivariable analysis, hypertension, hyperlipidemia, and chronic kidney disease emerged as independent risk factors for ESKD. The investigators could not adjust analyses for body mass index, serum antibody positivity, and complement status, which is a study limitation. As expected, use of immunosuppressive agents overall was significantly associated with a 22% decreased risk of ESKD. Corticosteroid use was associated with a nearly 10-fold increased risk of ESKD.

According to Dr Sung’s team, “controllable comorbidities, such as hypertension and hyperlipidaemia, should be actively monitored and strictly treated to prevent ESRD associated with LN, especially in young patients.”

In a previous retrospective study, Wei Chen, MD, PhD, of The First Affiliated Hospital of Sun Yat-sen University in Guangzhou, China, and colleagues used age to define early vs late LN. Among 1264 Chinese patients at their center, LN developed in 1162 patients before age 50 years and in 102 patients at age 50 years or older. Over 55 months, ESKD developed in 9.1%; 12.2% had doubling of creatinine, and 13.1% died.

Kidney survival did not differ significantly between the early and late onset groups, the investigators reported in Frontiers in Medicine. Kidney histopathology indicated that chronic lesions (glomerular sclerosis, interstitial fibrosis, tubular atrophy, and cortex wall thickening) were more severe in patients with late-onset LN, likely due to older age and comorbidities. However, active lesions such as crescents, karyorrhexis, capillary tuft necrosis, glomerular capsule adhesion, tubular necrosis, were not significantly different.

“Age-related impairments are the most significant determinant of both clinical and pathological manifestations in patients with late-onset LN,” Dr Chen’s team wrote. “Patients with late-onset LN have milder active lesions related to SLE but severer chronic lesions in kidney pathology, and they have an unfavorable patient outcome but rather acceptable kidney prognosis.”