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Clinical Predictors of Recovery and Complications in the Management of Recent-Onset Renal Failure in Lupus Nephritis: A Chinese Experience
LIUQIN LIANG, XIUYAN YANG, HANSHI XU, ZHONGPING ZHAN, YUJIN YE, XUEQING YU, and WEIYING CHEN
ABSTRACT. Methods. Factors possibly influencing the recovery of renal function in patients with lupus nephritis were examined in a 6 month retrospective cohort study. Records of a sample of 198 consecutive inpatients of recently diagnosed renal failure with lupus nephritis admitted to the University Hospital between 1991 and 2001 were examined. Complete records to assess followup were available for 162 (81.8%). The main outcome factor was recovery of renal function, which was defined as discontinuation of dialysis and over 50% reduction of serum creatinine 3 months after discontinuation of dialysis. Collection of clinical and laboratory data and outcome variables was conducted by 2 separate, blinded groups of clinical specialists with 2 structured abstracting forms. Results. After 6 months of followup, 96 patients (59.3%) recovered their renal function and 18 (11.1%) had died. After adjustment with Cox proportional hazards models, sex, renal dysfunction duration, renal size, anemia, level of serum phosphate, and intravenous cyclophosphamide (IV CYC) therapy were found to be significantly associated with recovery of renal function. There was significant association between IV CYC therapy and infections. However, in logistic regression analysis, neither CYC therapy nor infections were significantly associated with mortality, and only severe edema and lower serum albumin level were associated with mortality. Conclusion. Male sex, postponing hospital admission after onset of renal failure, atrophic renal size, and high concentrations of serum phosphate were all predictors of poor recovery of renal function. IV CYC therapy at higher dose had a protective effect on the recovery of renal function. (J Rheumatol 2004;31:701-6) Key Indexing Terms:
LUPUS NEPHRITIS
From the Department of Rheumatology and Clinical Immunology; and Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China. X. Yang, MD, MSc (Clin Epid), Associate Professor of Medicine, Chairman, Department of Rheumatology and Clinical Immunology; L. Liang, MD, Lecturer of Medicine; H. Xu, MD, PhD, Associate Professor of Medicine; Z. Zhan, MD, Lecturer of Medicine; Y. Ye, MD, Lecturer of Medicine, Department of Rheumatology and Clinical Immunology; X. Yu, MD, PhD, Professor of Medicine; W. Chen, MD, PhD, Associate Professor of Medicine, Department of Nephrology. Address reprint requests to Dr. X. Yang, Department of Rheumatology and Clinical Immunology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China. E-mail: xiuyan@public.guangzhou.gd.cn Submitted February 18, 2003; revision accepted October 27, 2003. |