Kidney outcomes and risk factors for nephritis (flare/de novo) in a multiethnic cohort of pregnant patients with lupus

Jill P. Buyon, Mimi Y. Kim, Marta M. Guerra, Sifan Lu, Emily Reeves, Michelle Petri, Carl A. Laskin, Michael D. Lockshin, Lisa R. Sammaritano, D. Ware Branch, T. Flint Porter, Allen Sawitzke, Joan T. Merrill, Mary D. Stephenson, Elisabeth Cohn, Jane E. Salmon

Research output: Contribution to journalArticle

Abstract

Background and objectives Kidney disease is a critical concern in counseling patients with lupus considering pregnancy. This study sought to assess the risk of renal flares during pregnancy in women with previous lupus nephritis inpartial or complete remission, particularly in those with anti double-stranded DNA antibodies and low complement levels, and the risk of new-onset nephritis in patients with stable/mildly active SLE. Design, setting, participants, & measurements We assessed active nephritis (renal flares and de novo kidney disease) and associated predictors during pregnancy in patients with lupus with urine protein ≤1000 mg and serum creatinine <1.2 mg/dl at baseline; 373 patients (52% ethnic/racial minorities) enrolled between 2003 and 2012 were prospectively followed in the Predictors of Pregnancy Outcome: Biomarkers in Antiphospholipid Syndrome and Systemic Lupus Erythematosus Study. Active nephritis was defined by proteinuria increase of >500 mg and/or red blood cell casts. Results Of 118 patients with previous kidney disease, 13 renal flares (11%) occurred (seven of 89 in complete remission and six of 29 in partial remission) compared with four with de novo kidney involvement (2%) in 255 patients without past kidney disease (P<0.001). Active nephritis was not associated with ethnicity, race, age, create nine, BP, or antihypertensive and other medications. In multivariable logistic regression analyses, patients with past kidney disease in complete or partial remission more often experienced active nephritis (adjusted odds ratio, 6.88; 95% confidence interval, 1.84 to 25.71; P=0.004 and adjusted odds ratio, 20.98; 95% confidence interval, 4.69 to 93.98; P<0.001, respectively) than those without past kidney disease. Low C4 was associated with renal flares/de novo disease (adjusted odds ratio, 5.59; 95% confidence interval, 1.64 to 19.13; P<0.01) but not low C3 or positive anti-dsDNA alone. Conclusions De novo kidney involvement in SLE, even in ethnic/racial minorities, is uncommon during pregnancy. Past kidney disease and low C4 at baseline independently associate with higher risk of developing active nephritis. Antibodies to dsDNA alone should not raise concern, even in patients with past kidney disease, if in remission.

Original languageEnglish (US)
Pages (from-to)940-946
Number of pages7
JournalClinical Journal of the American Society of Nephrology
Volume12
Issue number6
DOIs
StatePublished - 2017

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Nephritis
Kidney Diseases
Kidney
Pregnancy
Odds Ratio
Confidence Intervals
Lupus Nephritis
Antibodies
Antihypertensive Agents
Counseling
Creatinine
Erythrocytes
Logistic Models
Regression Analysis
Urine
DNA
Serum

Keywords

  • Antihypertensive Agents
  • Antiphospholipid Syndrome
  • Biomarkers
  • blood pressure
  • Counseling
  • creatinine
  • Erythrocytes
  • Female
  • Humans
  • Kidney Diseases
  • Logistic Models
  • Lupus Erythematosus, Systemic
  • lupus nephritis
  • Pregnancy
  • Pregnancy Outcome
  • proteinuria
  • risk factors
  • systemic lupus erythematosus

ASJC Scopus subject areas

  • Epidemiology
  • Critical Care and Intensive Care Medicine
  • Nephrology
  • Transplantation

Cite this

Kidney outcomes and risk factors for nephritis (flare/de novo) in a multiethnic cohort of pregnant patients with lupus. / Buyon, Jill P.; Kim, Mimi Y.; Guerra, Marta M.; Lu, Sifan; Reeves, Emily; Petri, Michelle; Laskin, Carl A.; Lockshin, Michael D.; Sammaritano, Lisa R.; Branch, D. Ware; Porter, T. Flint; Sawitzke, Allen; Merrill, Joan T.; Stephenson, Mary D.; Cohn, Elisabeth; Salmon, Jane E.

In: Clinical Journal of the American Society of Nephrology, Vol. 12, No. 6, 2017, p. 940-946.

Research output: Contribution to journalArticle

Buyon, JP, Kim, MY, Guerra, MM, Lu, S, Reeves, E, Petri, M, Laskin, CA, Lockshin, MD, Sammaritano, LR, Branch, DW, Porter, TF, Sawitzke, A, Merrill, JT, Stephenson, MD, Cohn, E & Salmon, JE 2017, 'Kidney outcomes and risk factors for nephritis (flare/de novo) in a multiethnic cohort of pregnant patients with lupus', Clinical Journal of the American Society of Nephrology, vol. 12, no. 6, pp. 940-946. https://doi.org/10.2215/CJN.11431116
Buyon, Jill P. ; Kim, Mimi Y. ; Guerra, Marta M. ; Lu, Sifan ; Reeves, Emily ; Petri, Michelle ; Laskin, Carl A. ; Lockshin, Michael D. ; Sammaritano, Lisa R. ; Branch, D. Ware ; Porter, T. Flint ; Sawitzke, Allen ; Merrill, Joan T. ; Stephenson, Mary D. ; Cohn, Elisabeth ; Salmon, Jane E. / Kidney outcomes and risk factors for nephritis (flare/de novo) in a multiethnic cohort of pregnant patients with lupus. In: Clinical Journal of the American Society of Nephrology. 2017 ; Vol. 12, No. 6. pp. 940-946.
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title = "Kidney outcomes and risk factors for nephritis (flare/de novo) in a multiethnic cohort of pregnant patients with lupus",
abstract = "Background and objectives Kidney disease is a critical concern in counseling patients with lupus considering pregnancy. This study sought to assess the risk of renal flares during pregnancy in women with previous lupus nephritis inpartial or complete remission, particularly in those with anti double-stranded DNA antibodies and low complement levels, and the risk of new-onset nephritis in patients with stable/mildly active SLE. Design, setting, participants, & measurements We assessed active nephritis (renal flares and de novo kidney disease) and associated predictors during pregnancy in patients with lupus with urine protein ≤1000 mg and serum creatinine <1.2 mg/dl at baseline; 373 patients (52{\%} ethnic/racial minorities) enrolled between 2003 and 2012 were prospectively followed in the Predictors of Pregnancy Outcome: Biomarkers in Antiphospholipid Syndrome and Systemic Lupus Erythematosus Study. Active nephritis was defined by proteinuria increase of >500 mg and/or red blood cell casts. Results Of 118 patients with previous kidney disease, 13 renal flares (11{\%}) occurred (seven of 89 in complete remission and six of 29 in partial remission) compared with four with de novo kidney involvement (2{\%}) in 255 patients without past kidney disease (P<0.001). Active nephritis was not associated with ethnicity, race, age, create nine, BP, or antihypertensive and other medications. In multivariable logistic regression analyses, patients with past kidney disease in complete or partial remission more often experienced active nephritis (adjusted odds ratio, 6.88; 95{\%} confidence interval, 1.84 to 25.71; P=0.004 and adjusted odds ratio, 20.98; 95{\%} confidence interval, 4.69 to 93.98; P<0.001, respectively) than those without past kidney disease. Low C4 was associated with renal flares/de novo disease (adjusted odds ratio, 5.59; 95{\%} confidence interval, 1.64 to 19.13; P<0.01) but not low C3 or positive anti-dsDNA alone. Conclusions De novo kidney involvement in SLE, even in ethnic/racial minorities, is uncommon during pregnancy. Past kidney disease and low C4 at baseline independently associate with higher risk of developing active nephritis. Antibodies to dsDNA alone should not raise concern, even in patients with past kidney disease, if in remission.",
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author = "Buyon, {Jill P.} and Kim, {Mimi Y.} and Guerra, {Marta M.} and Sifan Lu and Emily Reeves and Michelle Petri and Laskin, {Carl A.} and Lockshin, {Michael D.} and Sammaritano, {Lisa R.} and Branch, {D. Ware} and Porter, {T. Flint} and Allen Sawitzke and Merrill, {Joan T.} and Stephenson, {Mary D.} and Elisabeth Cohn and Salmon, {Jane E.}",
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TY - JOUR

T1 - Kidney outcomes and risk factors for nephritis (flare/de novo) in a multiethnic cohort of pregnant patients with lupus

AU - Buyon, Jill P.

AU - Kim, Mimi Y.

AU - Guerra, Marta M.

AU - Lu, Sifan

AU - Reeves, Emily

AU - Petri, Michelle

AU - Laskin, Carl A.

AU - Lockshin, Michael D.

AU - Sammaritano, Lisa R.

AU - Branch, D. Ware

AU - Porter, T. Flint

AU - Sawitzke, Allen

AU - Merrill, Joan T.

AU - Stephenson, Mary D.

AU - Cohn, Elisabeth

AU - Salmon, Jane E.

PY - 2017

Y1 - 2017

N2 - Background and objectives Kidney disease is a critical concern in counseling patients with lupus considering pregnancy. This study sought to assess the risk of renal flares during pregnancy in women with previous lupus nephritis inpartial or complete remission, particularly in those with anti double-stranded DNA antibodies and low complement levels, and the risk of new-onset nephritis in patients with stable/mildly active SLE. Design, setting, participants, & measurements We assessed active nephritis (renal flares and de novo kidney disease) and associated predictors during pregnancy in patients with lupus with urine protein ≤1000 mg and serum creatinine <1.2 mg/dl at baseline; 373 patients (52% ethnic/racial minorities) enrolled between 2003 and 2012 were prospectively followed in the Predictors of Pregnancy Outcome: Biomarkers in Antiphospholipid Syndrome and Systemic Lupus Erythematosus Study. Active nephritis was defined by proteinuria increase of >500 mg and/or red blood cell casts. Results Of 118 patients with previous kidney disease, 13 renal flares (11%) occurred (seven of 89 in complete remission and six of 29 in partial remission) compared with four with de novo kidney involvement (2%) in 255 patients without past kidney disease (P<0.001). Active nephritis was not associated with ethnicity, race, age, create nine, BP, or antihypertensive and other medications. In multivariable logistic regression analyses, patients with past kidney disease in complete or partial remission more often experienced active nephritis (adjusted odds ratio, 6.88; 95% confidence interval, 1.84 to 25.71; P=0.004 and adjusted odds ratio, 20.98; 95% confidence interval, 4.69 to 93.98; P<0.001, respectively) than those without past kidney disease. Low C4 was associated with renal flares/de novo disease (adjusted odds ratio, 5.59; 95% confidence interval, 1.64 to 19.13; P<0.01) but not low C3 or positive anti-dsDNA alone. Conclusions De novo kidney involvement in SLE, even in ethnic/racial minorities, is uncommon during pregnancy. Past kidney disease and low C4 at baseline independently associate with higher risk of developing active nephritis. Antibodies to dsDNA alone should not raise concern, even in patients with past kidney disease, if in remission.

AB - Background and objectives Kidney disease is a critical concern in counseling patients with lupus considering pregnancy. This study sought to assess the risk of renal flares during pregnancy in women with previous lupus nephritis inpartial or complete remission, particularly in those with anti double-stranded DNA antibodies and low complement levels, and the risk of new-onset nephritis in patients with stable/mildly active SLE. Design, setting, participants, & measurements We assessed active nephritis (renal flares and de novo kidney disease) and associated predictors during pregnancy in patients with lupus with urine protein ≤1000 mg and serum creatinine <1.2 mg/dl at baseline; 373 patients (52% ethnic/racial minorities) enrolled between 2003 and 2012 were prospectively followed in the Predictors of Pregnancy Outcome: Biomarkers in Antiphospholipid Syndrome and Systemic Lupus Erythematosus Study. Active nephritis was defined by proteinuria increase of >500 mg and/or red blood cell casts. Results Of 118 patients with previous kidney disease, 13 renal flares (11%) occurred (seven of 89 in complete remission and six of 29 in partial remission) compared with four with de novo kidney involvement (2%) in 255 patients without past kidney disease (P<0.001). Active nephritis was not associated with ethnicity, race, age, create nine, BP, or antihypertensive and other medications. In multivariable logistic regression analyses, patients with past kidney disease in complete or partial remission more often experienced active nephritis (adjusted odds ratio, 6.88; 95% confidence interval, 1.84 to 25.71; P=0.004 and adjusted odds ratio, 20.98; 95% confidence interval, 4.69 to 93.98; P<0.001, respectively) than those without past kidney disease. Low C4 was associated with renal flares/de novo disease (adjusted odds ratio, 5.59; 95% confidence interval, 1.64 to 19.13; P<0.01) but not low C3 or positive anti-dsDNA alone. Conclusions De novo kidney involvement in SLE, even in ethnic/racial minorities, is uncommon during pregnancy. Past kidney disease and low C4 at baseline independently associate with higher risk of developing active nephritis. Antibodies to dsDNA alone should not raise concern, even in patients with past kidney disease, if in remission.

KW - Antihypertensive Agents

KW - Antiphospholipid Syndrome

KW - Biomarkers

KW - blood pressure

KW - Counseling

KW - creatinine

KW - Erythrocytes

KW - Female

KW - Humans

KW - Kidney Diseases

KW - Logistic Models

KW - Lupus Erythematosus, Systemic

KW - lupus nephritis

KW - Pregnancy

KW - Pregnancy Outcome

KW - proteinuria

KW - risk factors

KW - systemic lupus erythematosus

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U2 - 10.2215/CJN.11431116

DO - 10.2215/CJN.11431116

M3 - Article

VL - 12

SP - 940

EP - 946

JO - Clinical journal of the American Society of Nephrology : CJASN

JF - Clinical journal of the American Society of Nephrology : CJASN

SN - 1555-9041

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