Article Figures & Data
Figures
- Figure 1.
Comparisons of doubling SCr or ESRD long term in patients with different ranges and types of crescents. SCr: serum creatinine; ESRD: endstage renal disease.
Tables
- Table 1.
Comparison of general information, and baseline clinical and laboratory variables. Values are mean ± SD unless otherwise specified.
Variables Groups NC SC C1 C2 No. patients 59 59 64 49 Sex, m/f 7/52 7/52 6/58 9/40 Age, yrs 36.34 ± 10.60 34.61 ± 12.13 33.97 ± 11.14 36.90 ± 12.69 Hemoglobin, g/l 100.26 ± 20.20 97.59 ± 21.72 97.89 ± 19.39 90.40 ± 16.73a,c WBC count,109/l 4.54 ± 2.32 4.29 ± 1.97 4.76 ± 2.69 5.73 ± 3.05b Platelet count, 109/l 141.79 ± 68.67 152.26 ± 76.00 142.57 ± 67.57 169.25 ± 74.69c Serum albumin, g/l 26.89 ± 6.28 28.90 ± 6.98 26.35 ± 6.65b 24.52 ± 6.15b uPCR, g/g 4.08 ± 3.00 4.24 ± 2.82 5.54 ± 4.55 6.20 ± 3.42a,b SCr, mg/dl, median (IQR) 0.88 (0.70–1.32) 0.88 (0.67–1.40) 0.89 (0.72–1.37) 1.32 (0.85–2.27)a,b,c C3, mg/dl, median (IQR) 32.90 (24.30–48.50) 37.15 (24.80–50.35) 37.80 (26.1–48.45) 43.25 (35.08–57.10)a,c C4, mg/dl, median (IQR) 5.60 (4.00–7.20) 6.00 (4.58–8.02) 6.30 (5.00–10.25) 8.30 (5.80–12.00)a,b Anti-dsDNA positive, % 54.4 71.2a 62.9 63.0 Hypertension, % 55.3 47.7 50.0 67.7 Acute kidney injury, % 39.0 32.8 53.2b 68.8a,b Nephrotic syndrome, % 55.2 46.6 58.1 77.1a,b,c - Table 2.
Comparisons of renal pathological data. Values are % or median (IQR) or both unless otherwise specified.
Variables Groups NC SC C1 C2 No. patients 59 59 64 49 ISN/RPS class Class III 20.3 15.3 12.5 6.2a Class IV 47.5 50.8 56.3 67.3a Class V + III/V + IV 32.2 33.9 31.2 26.5 Crescents, median (IQR), % 0 6.06 (3.57–12.5) 11.44 (7.55–15.19)b 37.04 (30.04–62.31)b,c Segmental crescents 0 6.06 (3.57–12.5) 5.13 (2.45–9.30)b 21.74; (13.2–27.53)b,c Circumferential crescents 0 0 5.26 (3.23–7.48) 15.63 (6.93–39.17)c Sclerotic glomeruli, median (IQR), % 1.96 (0–10.53) 0 (0–7.43) 1.85 (0–8.99) 4.65 (0–10) Mesangial proliferation 1 (1–1) 1 (1–1) 1 (1–2) 1 (1–2)a,b Endothelial cells proliferation 78.0 84.5 84.1 81.6 Karyorrhexis/fibrinoid necrosis 1.7 10.2 12.5a 14.3a Subendothelial deposit 56.3 72.9 67.9 64.3 Tubulitis 18.6 33.9 39.1a 44.9a Interstitial infiltration 1 (1–1) 1 (1–1) 1 (1–1) 1 (1–2)a,b,c Interstitial fibrosis 0 (0–1) 0 (0–1) 0 (0–1) 0 (0–1) Arteriole thrombosis 3.4 3.4 1.6 2.0 Immunofluorescence of glomerulus IgM 2 (1–2) 2 (1–3) 2 (1–2) 2 (1–2) IgG 1 (0–2) 1 (0–2) 1 (0–2) 1 (0–1) IgA 2 (1–3) 2 (1–3) 2 (1–3) 2 (0.5–2.5)b C3 3 (2–3) 3 (3–4) 3 (3–3) 3 (3–3) C4 1 (0–2) 1 (0–2) 1 (0–2) 1 (0–2) C1q 2 (1–3) 3 (2–3)a 2 (1.75–3)b 2 (1–3)b ↵a p < 0.05 compared with NC group.
↵b p < 0.05 compared with SC group.
↵c p < 0.05 compared with C1 group. IQR: interquartile range; ISN/RPS: International Society of Nephrology/Renal Pathology Society; IgM: immunoglobulin M; C3: complement factor 3; NC: noncrescent group; SC: segmental crescent group.
- Table 3.
Comparisons of therapeutic protocols and outcomes. Values are % unless otherwise specified.
Variables Groups NC SC C1 C2 Followup duration, median (IQR), mos 30.5 (10.6–66.5) 29 (10–52) 29.5 (12–66) 21.5 (8.3–32.25) Induction treatment Methylprednisolone pulse 13 20.4 15.7 35a Prednisone 23.7 10.2a 17.2 10.2a Prednisone + IVC 13.6 27.1 29.7a 46.9a,b,c Prednisone + MMF 40.7 32.2 31.3 20.4 Prednisone + CNI 16.9 20.3 15.6 10.2 Prednisone + MMF + CNI 5.1 10.2 6.2 12.2 Maintenance treatment Prednisone 26.2 10.6 19.1 12.9 Prednisone + MMF 45.2 34 34 25.8 Prednisone + CNI 19 21.3 17 12.9 Prednisone + AZA 4.8 6.4 6.4 9.7 Prednisone + MMF + CNI 0 10.6a 6.4 16.1a Others 4.8 17 17 22.6a Treatment response Complete remission 72.5 54.5 56.7 34.8a,b,c Partial remission 19.6 30.9 38.3a 41.3a Treatment failure 7.8 14.5 5.0 23.9c Longterm prognosis Relapse 30.0 24.4 37.5 29.7 Doubling of SCr 8.5 13.6 11.1 28.6a,c ESRD 6.8 6.8 7.8 18.4 ↵a p < 0.05 compared with NC group.
↵b p < 0.05 compared with SC group.
↵c p < 0.05 compared with C1 group. IVC: intravenous cyclophosphamide; MMF: mycophenolate mofetil; CNI: calcineurin inhibitor; AZA: azathioprine; SCr: serum creatinine; ESRD: endstage renal disease; NC: noncrescent group; SC: segmental crescent group.
- Table 4.
Cox hazard analysis of clinical risk factors for doubling of SCr or ESRD in patients with proliferative lupus nephritis.
Variables Univariate Multivariate HR 95% CI p HR 95% CI p Clinical Age 0.983 0.953–1.013 0.265 Female/male 3.176 1.414–7.131 0.005 1.561 0.494–4.935 0.448 WBC count, 109/l 1.146 1.018–1.29 0.024 1.034 0.888–1.205 0.665 Hemoglobin, g/l 0.967 0.949–0.985 < 0.001 0.970 0.947–0.992 0.009 Platelet, × 109/l 0.999 0.994–1.004 0.705 C3, mg/dl 0.993 0.972–1.014 0.500 C4, mg/dl 1.035 0.981–1.093 0.204 Positive anti-dsDNA 0.910 0.459–2.002 0.959 uPCR, g/g 1.105 1.306–1.178 0.002 1.086 0.989–1.192 0.084 SCr, mg/dl 1.920 1.613–2.285 < 0.001 1.834 1.465–2.296 < 0.001 Albumin, g/l 0.935 0.882–0.992 0.027 0.967 0.899–1.040 0.372 Renal pathological characteristics Glomerular sclerosis, % 1.036 1.012–1.061 0.003 1.031 0.998–1.066 0.065 Segmental crescents, % 1.024 1.000–1.048 0.054 Cellular crescents, % 1.043 1.025–1.060 < 0.001 1.040 1.015–1.066 0.002 Fibrous crescents, % 1.285 1.115–1.482 0.001 0.975 0.785–1.210 0.816 Fibrocellular crescents, % 1.116 1.068–1.166 < 0.001 1.085 1.013–1.163 0.020 Fibrinoid necrosis 0.684 0.163–2.871 0.603 Mesangial proliferation 0.616 Mild 0.400 0.052–3.100 0.380 Moderate 0.452 0.054–3.778 0.464 Severe 0.672 0.081–5.547 0.712 Podocyte fusion 0.705 Localized 1667 0–4.4 × 108 0.936 Partial 3455 0–9.2 × 108 0.930 Extensive 3423 0–9.1 × 108 0.930 Thrombosis 1.290 0.175–9.489 0.803 Tubulitis 1.568 0.795–3.092 0.194 Tubular atrophy < 0.001 Mild 1.945 0.765–4.949 0.162 Moderate 7.045 1.339–37.064 0.021 1.200 0.01–15.739 0.890 Severe 10.854 3.482–33.830 < 0.001 5.348 1.278–22.373 0.022 Interstitial infiltration 0.314 Mild 1.254 0.430–3.660 0.678 Moderate 1.779 0.501–6.310 0.373 Severe 5.019 0.899–28.032 0.066 Interstitial fibrosis 0.102 Mild 1.380 0.556–3.427 0.487 Moderate 3.027 0.395–23.218 0.287 Severe 5.734 1.317–24.963 0.020 0.292 0.045–1.887 0.196 C1q 0.468 Mild 0.308 0.069–1.382 0.124 Moderate 0.609 0.198–1.896 0.392 Severe 0.703 0.228–2.170 0.540 SCr: serum creatinine; ESRD: endstage renal disease; WBC: white blood cell; C3: complement factor 3; uPCR: urine protein creatinine ratio.
- Table 5.
Cox hazard analysis of clinical risk factors for ESRD in patients with proliferative lupus nephritis.
Variables Univariate Multivariate HR 95% CI p HR 95% CI p Age 0.979 0.942–1.017 0.276 Sex, f/m 3.668 1.410–9.545 0.008 1.867 0.541–6.445 0.323 WBC count, × 109/l 1.252 1.104–1.421 < 0.001 1.104 0.929–1.312 0.261 Hemoglobin, g/l 0.966 0.945–0.988 0.003 0.972 0.943–1.001 0.056 Platelet, × 109/l 1.003 0.997–1.009 0.705 C3, mg/dl 0.993 0.968–1.019 0.607 C4, mg/dl 1.044 0.981–1.112 0.174 Positive anti-dsDNA 1.364 0.553–3.362 0.5 uPCR, g/g 1.135 1.060–1.216 < 0.001 1.141 1.038–1.253 0.006 SCr, mg/dl 2.093 1.705–2.569 < 0.001 1.876 1.447–2.433 < 0.001 Albumin, g/l 0.937 0.871–1.008 0.079 Renal pathological characteristics Glomerular sclerosis, % 1.037 1.008–1.067 0.012 1.040 1.001–1.081 0.045 Segmental crescents, % 1.001 0.965–1.039 0.942 Cellular crescents, % 1.044 1.023–1.064 < 0.001 1.041 1.014–1.070 0.003 Fibrous crescents, % 1.243 1.024–1.509 0.028 0.846 0.617–1.159 0.298 Fibrocellular crescents, % 1.123 1.069–1.180 < 0.001 1.104 1.027–1.187 0.007 Fibrinoid necrosis 0.517 0.069–3.867 0.521 Mesangial proliferation 0.453 Mild 0.214 0.026–1.737 0.149 Moderate 0.346 0.040–3.004 0.336 Severe 0.262 0.027–2.584 0.251 Podocyte fusion 0.780 Localized 1929 0.000–1.1 × 1010 0.948 Partial 4321 0.000–2.5 × 1010 0.942 Extensive 3024 0.000–1.7 × 1010 0.945 Thrombosis 1.874 0.251–14.022 0.541 Tubulitis 1.816 0.782–4.214 0.165 Tubular atrophy 0.001 Mild 1.159 0.393–3.417 0.789 Moderate 6.746 1.215–37.457 0.029 0.088 7.138–15.739 0.837 Severe 6.326 2.214–31.311 0.002 2.212 0.441–11.106 0.335 Interstitial infiltration 0.643 Mild 0.993 0.284–3.473 0.991 Moderate 1.925 0.459–8.065 0.370 Severe 0.000 0.00–0.00 0.979 Interstitial fibrosis 0.772 0.248–2.402 0.655 C1q 0.778 Mild 0.388 0.054–2.756 0.344 Moderate 0.765 0.162–3.609 0.735 Severe 0.813 0.174–3.803 0.792 ESRD: endstage renal disease; WBC: white blood cell; C3: complement factor 3; uPCR: urine protein creatinine ratio; SCr: serum creatinine.
In this issue
