Current medical research and opinion · 2025
A descriptive observational research for the urine protein status, treatment status, and long-term risk of active lupus nephritis in real-world clinical practice using a Japanese EMR/claim database.
СтатьяНаблюдательное исследованиеНазвание и аннотация: Перевод в очереди
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Atsumi Tatsuya, Nishiwaki Shinichi, Shibasaki Yoshiyuki, Toda Rikiya
Аннотация
OBJECTIVE: To describe long-term changes in proteinuria, treatment status, and clinical events among patients with lupus nephritis (LN) in Japan using a database containing electronic medical records and health insurance claims.
METHODS: Patients aged 18-50 years with active LN (i.e. urine protein/creatinine ratio [UPCR] ≥ 0.5 g/gCr or a qualitative urine protein test result of ≥2+) were identified. Assessment variables included temporal changes in UPCR and glucocorticoid (GC) use/dose. The time to renal remission or flare was examined using the Kaplan-Meier analysis and Cox proportional hazards model. Clinical events were identified.
RESULTS: Of 917 patients with active LN, the mean UPCR in 392 patients with UPCR ≥0.5 g/gCr was 2.7 ± 4.0 g/gCr at LN diagnosis, with a median 1.3 (first quartile, third quartile: 0.6, 3.1) g/gCr, followed by a gradual decline until ≥60 months. GC therapies were provided to up to 53.5% of patients within 2 weeks of LN diagnosis, and the proportion persisted thereafter. The median oral GC dose was 10.0-17.8 mg/day within 2 weeks, 17.0-18.9 mg/day until 2 months, and 11.0 (7.3, 16.9) mg/day at 6 months, followed by continuous use with a slight decline. Female sex and visiting more clinical departments were likely to be associated with renal remission, whereas older age was associated with non-remission. No baseline variables were predictive of flares.
CONCLUSION: Using urine laboratory test results, we presented invaluable data on long-term changes in UPCR, GC use, and clinical events. These reports may serve as a foundation for developing treatment strategies for these patients.
METHODS: Patients aged 18-50 years with active LN (i.e. urine protein/creatinine ratio [UPCR] ≥ 0.5 g/gCr or a qualitative urine protein test result of ≥2+) were identified. Assessment variables included temporal changes in UPCR and glucocorticoid (GC) use/dose. The time to renal remission or flare was examined using the Kaplan-Meier analysis and Cox proportional hazards model. Clinical events were identified.
RESULTS: Of 917 patients with active LN, the mean UPCR in 392 patients with UPCR ≥0.5 g/gCr was 2.7 ± 4.0 g/gCr at LN diagnosis, with a median 1.3 (first quartile, third quartile: 0.6, 3.1) g/gCr, followed by a gradual decline until ≥60 months. GC therapies were provided to up to 53.5% of patients within 2 weeks of LN diagnosis, and the proportion persisted thereafter. The median oral GC dose was 10.0-17.8 mg/day within 2 weeks, 17.0-18.9 mg/day until 2 months, and 11.0 (7.3, 16.9) mg/day at 6 months, followed by continuous use with a slight decline. Female sex and visiting more clinical departments were likely to be associated with renal remission, whereas older age was associated with non-remission. No baseline variables were predictive of flares.
CONCLUSION: Using urine laboratory test results, we presented invaluable data on long-term changes in UPCR, GC use, and clinical events. These reports may serve as a foundation for developing treatment strategies for these patients.