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Original Article
Available online 4 May 2022
Predictive factors for the development of lupus nephritis after diagnosis of systemic lupus erythematosus
Factores predictores del desarrollo de nefritis lúpica después del diagnóstico de lupus eritematoso sistémico
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Miguel Estévez del Toro
Corresponding author
director@hha.sld.cu

Corresponding author.
, Iter Varela Ceballos, Araceli Chico Capote, Elena Kokuina, Yeniset Sánchez Bruzón, Nelsa Casas Figueredo
Servicio de Reumatología, Hospital Hermanos Ameijeiras, La Habana, Cuba
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Table 1. Characteristics at diagnosis of SLE patients who did and who did not develop lupus nephritis at follow-up (univariate analysis).
Table 2. Predictors of the development of lupus nephritis (multivariate analysis).
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Abstract
Objectives

To determine predictive factors for the development of lupus nephritis (LN) at the time of diagnosis of systemic lupus erythematosus (SLE).

Methods

A case-control study was carried out in a single center, 595 patients with a diagnosis of SLE without LN participated by clinical or laboratory parameters at diagnosis, they were followed for a mean of 6.8 (+4.5) years, conforming to the data of their files two groups: with NL (cases) and without NL (controls) at the end of the follow-up. Sociodemographic, clinical, serological, immunological variables and the albumin – globulin ratio (AGR), calculated as albumin/total protein-albumin at diagnosis, were compared between both groups. A univariate and multivariate analysis was carried out.

Results

124 (20.8%) patients had LN during follow-up and 471 (79.2%) did not develop LN. Univariate analysis: variables significantly associated with the development of LN: smoking, oral ulcers, serositis, more than four classification criteria, abrupt onset of SLE, higher SLEDAI value, low AGR, low C3 levels, high anti-titers. –Double stranded DNA (anti-dc DNA), anti-nucleosomes and positivity of immunofluorescence in skin. Multivariate analysis: predictors of developing LN: elevated serum levels of anti-dc DNA (odds ratio (OR): 15.82; confidence interval (CI): 1.08−1.22, P < .0001), decrease in the C3 fraction (OR: 36.50; CI: 13.52–81.91, P < .0001) and the RAG < 1 (OR: 47.58; CI: 11.85−79.17, P < .0001).

Conclusion

The AGR below one was the greatest predictor of the appearance of LN, together with the low levels of C3 and high levels of anti-dc DNA antibodies, they may contribute to identifying patients with a higher risk of presenting LN.

Keywords:
Systemic lupus erythematosus
Lupus nephritis
Albumin globulin ratio
Resumen
Objetivos

Determinar factores predictores de desarrollo de nefritis lúpica (NL) al momento del diagnóstico del lupus eritematoso sistémico (LES).

Métodos

Se realizó un estudio de casos y controles en un único centro, participaron 595 pacientes con diagnóstico de LES sin NL por parámetros clínicos o de laboratorio al diagnosticarlos, fueron seguidos durante una media de 6,8 (±4,5) años, conformándose de los datos de sus expedientes dos grupos: con NL (casos) y sin NL (controles) al final del seguimiento. Se compararon entre ambos grupos variables sociodemográficas, clínicas, serológicas, inmunológicas y la relación albumina–globulina (RAG), calculada como la albumina/proteínas totales-albumina al diagnóstico. Se efectuó un análisis univariado y multivariado.

Resultados

En el seguimiento presentaron NL 124 (20,8%) pacientes y no desarrollaron NL 471 (79, 2%). Análisis univariado: variables asociadas significativamente al desarrollo de NL: hábito de fumar, ulceras orales, serositis, más de cuatro criterios de clasificación, inicio abrupto del LES, mayor valor de SLEDAI, baja la RAG, bajos niveles de C3, títulos elevados de anti–DNA doble cadena (anti-DNA dc), anti nucleosomas y positividad de la inmunoflurescencia en piel. Análisis multivariado: factores predictores de desarrollar NL: niveles séricos elevados de anti-DNA dc (odds ratio (OR):15, 82; intervalo de confianza (IC):1,08–1,22, P < ,0001), disminución de la fracción C3 (OR: 36, 50; IC: 13,52 – 81,91, P < ,0001) y la RAG < 1 (OR: 47,58; IC: 11,85–79,17, P < ,0001).

Conclusión

La RAG por debajo de uno fue el mayor predictor de aparición de la NL, conjuntamente con los niveles bajos de C3 y elevados de anticuerpos anti-DNA dc, pueden contribuir a identificar pacientes con mayor riesgo de presentar NL.

Palabras clave:
Lupus eritematoso sistémico
Nefritis lúpica
Relación albúmina globulina

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