Skip to main content

Renal flare as a biomarker of incident and progressive chronic kidney disease in patients with lupus nephritis

Introduction

Flares of lupus nephritis (LN) cause acute kidney injury (AKI), even if serum creatinine (SCr) does not increase. Although classic forms of AKI, such as ischemia, have long been thought to heal without long-term sequelae, it is now clear that AKI events predispose patients to chronic kidney disease (CKD). It was therefore postulated that renal flare (RF) in LN patients promotes CKD.

Methods

To determine whether RF frequency and duration can be used as markers of new CKD or progression of established CKD, we correlated RF with starting and ending SCr levels in the Ohio SLE Study (OSS) cohort.

Results

New-onset CKD occurred in 12/41 patients over a median follow-up of 4.5 years. The CKD group had more RF events than the non-CKD group: 31 (2.59/patient) versus 17 (0.59/patient), respectively, and spent more time in RF (Table 1). Only 8% of the CKD group versus 59% of the non-CKD group had no RF. In OSS patients with established CKD, those who progressed had more RF events than nonprogressors: 13 (1.63/patient) versus 2 (0.29/patient), respectively. In the nonprogressor group 71% had no RF, compared with 37.5% of progressors. Progressors had a significant change in SCr over the study period (P = 0.0078). Differences in number of RF and RF duration were not significant between the two groups but tended to be higher in the progressors (Table 2).

Table 1
Table 2

Conclusion

In patients with LN, the frequency and duration of RF are biomarkers of new CKD and progression of existing CKD. As new LN therapeutic regimens are developed, targeting RF prevention should be an important goal.

Author information

Affiliations

Authors

Corresponding author

Correspondence to BH Rovin.

Rights and permissions

This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and Permissions

About this article

Cite this article

Parikh, S., McKinley, A. & Rovin, B. Renal flare as a biomarker of incident and progressive chronic kidney disease in patients with lupus nephritis. Arthritis Res Ther 14, A45 (2012). https://doi.org/10.1186/ar3979

Download citation

Keywords

  • Ischemia
  • Creatinine
  • Chronic Kidney Disease
  • Nephritis
  • Acute Kidney Injury