Clinical and Prognostic Factors in Patients with IgG4-Related Kidney Disease.
Обработка статьи · этапы, ошибки и управление
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Chaba Anis, Devresse Arnaud, Audard Vincent, Boffa Jean Jacques, Karras Alexandre, Cartery Claire, Deltombe Clément, Chemouny Jonathan, Contamin Claudine, Courivaud Cecile, Duquennoy Simon, Garcia Hugo, Joly Dominique, Goumri Nabila, Hanouna Guillaume, Halimi Jean Michel, Plaisier Emmanuelle, Hamidou Mohamed, Landron Cédric, Launay David, Lebas Celine, Legendre Mathieu, Masseau Agathe, Mathian Alexis, Mercadal Lucile, Morel Nathalie, Mutinelli-Szymanski Prisca, Palat Sylvain, Pennaforte Jean-Loup, Peraldi Marie Noelle, Pozdzik Agnieszka, Schleinitz Nicolas, Thaunat Olivier, Titeca-Beauport Dimitri, Mussini Charlotte, Touati Sonia, Prinz Eric, Faller Anne Laure, Richter Sarah, Vilaine Eve, Ferlicot Sophie, Von-Kotze Clarissa, Belliere Julie, Olagne Jerome, Mesbah Rafik, Snanoudj Renaud, Nouvier Mathilde, Ebbo Mikael, Zaidan Mohamad
Аннотация
METHODS: We conducted an observational cohort study using data from 35 sites in two European countries. Clinical, biologic, imaging, and histopathologic data; treatment modalities; and outcomes were collected from medical records. Logistic regression was performed to identify the possible factors related to an eGFR ≤30 ml/min per 1.73 m 2 at the last follow-up. Cox proportional hazards model was performed to assess the factors associated with the risk of relapse.
RESULTS: We studied 101 adult patients with IgG4-related disease with a median follow-up of 24 (11-58) months. Of these, 87 (86%) patients were male, and the median age was 68 (57-76) years. Eighty-three (82%) patients had IgG4-related kidney disease confirmed by kidney biopsy, with all biopsies showing tubulointerstitial involvement and 16 showing glomerular lesions. Ninety (89%) patients were treated with corticosteroids, and 18 (18%) patients received rituximab as first-line therapy. At the last follow-up, the eGFR was below 30 ml/min per 1.73 m 2 in 32% of patients; 34 (34%) patients experienced a relapse, while 12 (13%) patients had died. By Cox survival analysis, the number of organs involved (hazard ratio [HR], 1.26; 95% confidence interval [CI], 1.01 to 1.55) and low C3 and C4 concentrations (HR, 2.31; 95% CI, 1.10 to 4.85) were independently associated with a higher risk of relapse, whereas first-line therapy with rituximab was protective (HR, 0.22; 95% CI, 0.06 to 0.78). At their last follow-up, 19 (19%) patients had an eGFR ≤30 ml/min per 1.73 m 2 . Age (odd ratio [OR], 1.11; 95% CI, 1.03 to 1.20), peak serum creatinine (OR, 2.74; 95% CI, 1.71 to 5.47), and serum IgG4 level ≥5 g/L (OR, 4.46; 95% CI, 1.23 to 19.40) were independently predictive for severe CKD.
CONCLUSIONS: IgG4-related kidney disease predominantly affected middle-aged men and manifested as tubulointerstitial nephritis with potential glomerular involvement. Complement consumption and the number of organs involved were associated with a higher relapse rate, whereas first-line therapy with rituximab was associated with lower relapse rate. Patients with high serum IgG4 concentrations (≥5 g/L) had more severe kidney disease.