Analysis Of Risk Factors Of Progression For Patients With Proliferative Diffuse Lupus Nephropathy

Objective To investigate the risk factors predicting the outcome of diffuse proliferative lupus nephropathy(DPLN).Methods In this retrospective study,all the episodes of biopsy-proven DPLN(ISN /RPS2003 classification criteria)during Mar 2008 to Dec 2016 in our center were enrolled in this study.Patients who reached the primary composite outcome of doubling serum creatinine,end-stage renal disease or death were divided into the development of kidney disease group,others were divided into the non-development kidney disease group.Social demography,clinical,laboratory and treatment-related data were recorded at the time of kidney biopsy.Results(1)One hundred and twenty-two patients were enrolled in this study,including 113 females(92.6%),9 males(7.4%).Their average age was(26.63±8.83)years old,and average follow-up time was(51.45±38.57)months(median time for 36 months).During the follow-up process,8 patients reached the primary composite,including 6 episodes of doubling serum creatinine,1 episode of end-stage renal disease,1 episode of death.The doubling serum time was(37.13±34.24)months with median time was 24.5 months.(2)Compared to the non-development of kidney disease group,thrombocytopenia was more prevalent in the development kidney disease group(P<0.05).(3)There was no significant difference of autoantibodies(ANA,Sm,RNP,SSA,SSB,ACL)and complements(C3,C4)in two groups(P>0.05),however,anti-ds-DNA antibody was more prevalent in the development kidney disease group(P<0.05).(4)There was no significant difference of activity index(AI)≥10,chronic index(CI)≥3,platinum ear,loop thrombosis,loop necrosis,and pathological type in two groups(P>0.05).Compared to the non-development of kidney disease group,the renal vascular lesion was more prevalent in the development kidney disease group(P<0.05).(5)Compared to the non-development of kidney disease group,there was higher proportion of no remission after induction treat ment in the development kidney disease group(P<0.05).(6)logistic analyses model revealed that thrombocytopenia(OR 32.90,95%CI:1.21~50.99),and renal vascular lesion(0R 7.86,95%CI: 4.42~245.14)were independent risk factors for developing renal disease.Conclusions Thrombocytopenia and renal vascular lesion were independent risk factors for the patients with DPLN.They should be monitored carefully and managed aggressively to avoid deterioration of kidney function.