Segmental and global subclasses of class IV lupus nephritis have similar renal outcomes.
SourceJournal of the American Society of Nephrology, 23, 1, (2012), pp. 149-154
1 januari 2012
Article / Letter to editor
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Primary and Community Care
Journal of the American Society of Nephrology
SubjectNCEBP 7: Effective primary care and public health; NCMLS 1: Infection and autoimmunity N4i 4: Auto-immunity, transplantation and immunotherapy; IGMD 9: Renal disorder
Whether renal outcomes differ between the segmental and global subclasses of diffuse proliferative (class IV) lupus nephritis is unknown. In this meta-analysis, we searched the literature in MEDLINE, EMBASE, five registries of clinical trials, and selected cohort studies and randomized, controlled trials that used the 2003 International Society of Nephrology and Renal Pathology Society classification of lupus nephritis in adult patients. Our endpoint was the composite of doubling of serum creatinine concentration or ESRD. In the eight studies included in the final analysis, the incidence of this endpoint varied between 0% and 67%. A funnel plot and Egger's test did not suggest significant heterogeneity. The meta-analysis did not support a significant difference in renal outcome between the segmental (IV-S) and global (IV-G) subclasses (relative risk for class IV-G versus IV-S, 1.08; 95% confidence interval, 0.68-1.70). Meta-regression did not suggest that ethnicity or duration of follow-up influenced the association between histologic class and renal risk. In conclusion, the rate of doubling of serum creatinine concentration or of ESRD did not differ between patients with class IV-S and those with IV-G lupus nephritis.
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