title: Predictive factors for low rate of remission in a population of Colombian patients with severe proliferative lupus nephritis.
abstract: The objective of this study is to determine the predictive risk factors of failure to achieve remission within 12 months in a group of patients with proliferative lupus nephritis from Northwestern Colombia. Pragmatic clinical study with retrospective analysis was conducted. We included subjects with systemic lupus erythematosus as defined by the American College of Rheumatology with biopsy-proven nephritis. We assessed 149 patients, with 84 % female. Age at diagnosis of systemic lupus erythematosus is 24.7 years (16-31). The time between diagnosis of lupus erythematosus and proliferative nephritis is 2 months (0-35.5). ISN/RPS 2003 histologic classification types are the following: IV (63.8 %), III (13.4 %), V + III (3.3 %), and V + IV (3.3 %). Activity index is 6.18 ± 4.55 and chronicity index is 1 (0-3). The result of 24-h proteinuria is 2000 mg (667-4770) and baseline creatinine is 0.9 mg/dL (0.7-1.3). Induction therapy includes corticosteroids (100 %), cyclophosphamide (74.1 %), and mycophenolate mofetil (25.9 %). At 12 months, 40.7 % of individuals failed to attain partial or complete remission. Elevated creatinine (p = 0.0001) and 24-h proteinuria greater than 1500 mg (p = 0.0011) were basal predictors of failure to attain partial or complete remission by bivariate analysis. Similar results were obtained in multivariate analysis: Baseline creatinine elevation (OR 3.62, 95 % CI, 1.59-8.23; p = 0.002) and 24-h proteinuria greater than 1500 mg (OR 3.62, 95 % CI, 1.29-10.13; p = 0.014) were independent predictors of failure to achieve partial or complete remission. At 12 months, 40.7 % of patients did not attain partial or complete remission. Baseline elevated creatinine and 24-h proteinuria over 1500 mg were predictors for poor response.
authors.affiliation: Rheumatology Section, Hospital Pablo Tobón Uribe, Calle 78B 69-240, Medellin, Colombia.
authors.forename: Luis Fernando
authors.initials: LF
authors.lastname: Pinto-Peñaranda
authors.forename: Vladimir
authors.initials: V
authors.lastname: Duque-Caballero
authors.forename: Javier Darío
authors.initials: JD
authors.lastname: Márquez-Hernández
authors.forename: Carolina
authors.initials: C
authors.lastname: Muñoz-Grajales
authors.forename: Carlos Jaime
authors.initials: CJ
authors.lastname: Velásquez-Franco
mesh_terms: D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000328:Adult; D015331:Cohort Studies; D003105:Colombia; D003404:Creatinine / Q000097:blood; D003520:Cyclophosphamide / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D007199:Indians, South American; D008181:Lupus Nephritis / Q000097:blood / Q000188:drug therapy* / Q000473:pathology; D008297:Male; D009173:Mycophenolic Acid / Q000031:analogs & derivatives / Q000627:therapeutic use; D011379:Prognosis; D011446:Prospective Studies; D011507:Proteinuria; D012074:Remission Induction / Q000379:methods; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000305:Adrenal Cortex Hormones; D007166:Immunosuppressive Agents; D003520:Cyclophosphamide; D003404:Creatinine; D009173:Mycophenolic Acid