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首页> 外文期刊>Clinical immunology: The official journal of the Clinical Immunology Society >Prognostic significance of repeat biopsy in lupus nephritis: Histopathologic worsening and a short time between biopsies is associated with significantly increased risk for end stage renal disease and death
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Prognostic significance of repeat biopsy in lupus nephritis: Histopathologic worsening and a short time between biopsies is associated with significantly increased risk for end stage renal disease and death

机译：狼疮性肾炎重复活检的预后意义：组织病理学恶化和活检之间的短时间与结束阶段肾病和死亡的风险显着增加

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Background/purpose: Approximately half of patients with systemic lupus erythematosus (SLE) develop lupus nephritis (LN), a major cause of morbidity and early mortality in that disease. Prolonged renal inflammation is associated with irreversible kidney damage which confers a 30% risk of end stage renal disease (ESRD), making early, aggressive treatment mandatory. Failure to achieve therapeutic response or recurrence of renal flare often prompts repeat biopsy. However, the role of repeat biopsy in determining long-term renal prognosis remains controversial. For this reason repeat biopsies are usually not utilized unless clinical evidence of refractory or recurrent disease is already present, despite known mismatches between clinical and biopsy findings. The current study quantifies the degree to which histopathologic worsening between first and second biopsies and duration between them predicts ESRD and death. Methods: Medical records of 141 LN patients with more than one biopsy were obtained from a single large urban medical center. Cases were attained using billing codes for diagnosis and procedures from 1/1999-1/2015. Biopsy worsening was defined as unfavorable histopathologic classification transitions and/or increased chronicity; if neither were present, the patient was defined as non-worsening. We used Cox proportional hazard models to study the relationship between ESRD and survival adjusting for covariates which included age at first biopsy, gender, race, initial biopsy class, and initial induction therapy. Results: Of 630 patients screened, 141 had more than one biopsy. Advancing chronicity was detected in 48 (34.0%) and a renal class switch to worse grade of pathology was found in 54 (38.3%). At least one of these adverse second biopsy features was reported in 79 (56.0%) patients. Five years following initial biopsy, 28 (35.4%) of those with worsening histopathology on second biopsy developed ESRD, compared to 6 (9.7%) of non-worsening patients and 10 (12.7%) of patients with worsening histopathology had died compared to 2 (3.2%) of non-worsening patients. Biopsy worsening was associated with a significantly greater 15-year risk of ESRD (Hazard Ratio 4.2, p = 0.0001) and death (Hazard Ratio 4.3, p = 0.022), adjusting for age, gender, race, biopsy class, and treatment. Time between first and second biopsies was b 1 year in 32 patients, 1-5 years in 81, and N 5 years in 28. Over a 15-year period, those with b1 year between first and second biopsies (presumably enriched for patients with early clinical signs of progression) had a significantly greater risk of ESRD (Hazard Ratio 13.7, p b 0.0001) and death (Hazard Ratio 16.9, p = 0.0022) after adjusting for age, gender, race, biopsy class, and treatment.
机译：背景/目的：大约一半的全身狼疮患者红斑（SLE）开发狼疮肾炎（LN），是这种疾病的发病率和早期死亡的主要原因。长期肾炎症与不可逆的肾脏损伤有关，赋予末期肾病（ESRD）的30％风险，提前侵略性治疗强制性。未能达到治疗反应或肾耀斑的复发通常会提示重复活检。然而，重复活检在确定长期肾预后的作用仍存在争议。由于这种原因，除非已经存在难治性或复发疾病的临床证据，否则通常不使用重复活检，尽管临床和活检结果之间已知不匹配。目前的研究量化了第一和第二活组织检查之间的组织病理学的程度和它们之间的持续时间预测ESRD和死亡。方法：从一个大型城市医疗中心获得141磅患者的141毫升患者的病程。使用计费代码从1 / 1999-1 / 2015年的诊断和程序获得案件。活检恶化被定义为不利的组织病理学分类过渡和/或增加慢性;如果没有存在，患者被定义为不恶化。我们使用Cox比例危险模型来研究ESRD和生存调整的关系，所述协变量调整，所述协变量调整，所述协变量调整，所述协变量在第一次活检，性别，种族，初始活组织检查阶级和初始感应治疗中含有年龄。结果：630例筛选的患者，141例有多种活组织检查。在48（34.0％）中检测到促进慢性慢性，并且在54（38.3％）中发现了肾类转换到较差的病理成绩。 79例（56.0％）患者报告了这些不良第二活检特征中的至少一个。在初始活组织检查后五年，28（35.4％）在第二次活组织检查中发育eSRD组织病理学组织病变的初始活组织检查，而患者的6（9.7％）和10名（12.7％）的患者患者的恶化组织病理学的患者相比死于2 （3.2％）非恶化的患者。活组织检查恶化与ESRD（危害比率4.2，P = 0.0001）和死亡（危险比4.3，P = 0.022）的患者显着提高，调整年龄，性别，种族，活组织检查等级和治疗。第一和第二次活检之间的时间为32例患者1年，1-5岁，在81岁，28岁5岁。在15年期间，第一和第二次和第二次活组织检查（可能为患者富集在调整年龄，性别，种族，活检阶级和治疗后，进展的早期临床症状的临床症状的患者（危险比13.7，PB 0.0001）和死亡（危险比16.9，p = 0.0022）的风险显着更大。

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