LUPUS NEPHRITIS: THE RESPONSE TO A PROTEIN OVERLOAD IS DIFFERENT IN GLOMERULAR VERSUS INTERSTITIAL SCLEROSIS AND MAY HELP TO IDENTIFY PATIENTS WITH POOR KIDNEY PROGNOSIS
Notice bibliographique
Résumé
PV128 / #610 Poster Topic: AS15 - Lupus Nephritis-Clinical Background/Purpose The kidney response to protein overload (PO) has major diagnostic and prognosis implications in the evaluation of progressive kidney diseases, a frequent finding in patients (Pts) with lupus nephritis (LN). The contribution of the tubulo-interstitial damage (more than the glomerular sclerosis) to the progression toward severe kidney failure is well known. Given that creatinine undergoes considerable tubular secretion, the assessment of sequential glomerular filtration rate (eGFR) after a PO could be used as a test detector of the tubular functional mass. The aim of this trial was to evaluate the kidney response to PO in LN pts with mainly glomerular (GS) vs tubulo-interstitial (TIS) sclerosis and their long follow-up. Time to achieve the composite event (CE), decrease of the eGFR ≥40% or needed of renal replacement therapy, was compared among both groups Methods All LN biopsies performed in Pts with pure Class III (n: 6) and Class IV (n: 20) LN from Jan 2011 up to Jun 2012 before withdrawing immunosuppression, were included. A total of 26 pts (14 with predominant GS and 12 with predominant TIS) underwent a protein load test to assess the functional kidney reserve (FKR). Test: After an overnight fast all the pts received an oral water load (20 ml/kg BW) and the urinary output was then replaced orally with equal volumes of water. In the morning, a 1.5 g/kg BW PO was provided. GFR was measured every 30 min. from 1 h before and up to 4 h following PO. The FKR index was calculated as the quotient between peak and baseline GFR. Variation of the eGFR by 30% from baseline was considered as a positive test or sufficient KFR meanwhile less than 30% was a negative one. Log-rank test was used to compare FKR test results. The Kaplan-Meier product-limit estimator was used and the survival curves, showing the response to the previously performed renal reserve study were compared using the log-rank test. P-values < 0.05 were accepted as statistically significant. All data is expressed as media± SD. Results Both groups (GS and TIS) were homogeneous about demographic characteristics at baseline. Pre PO media GFR (ml/min) was similar in GS and TIS (100.6 ± 11.4 and 99.5 ± 10.8; respectively). GFR rose after PO to a peak of 135 ±22.0 and to 125 ±27.5 ml/min in GS and TIS groups respectively. The FKR index was lower in TIS than in GS and CG (1.22 0.04 and 1.42 0.06 respectively (p-value < 0.05)). Time to the CE was 136.4 ±14 months in pts showing a positive test vs 89.9 ± 19 months in those with a negative test. (P-value < 0.05). Conclusions The results from this study suggest that in LN patients the presence of tubulo-interstitial damage drastically reduces the renal response to a protein overload in contrast with the almost normal response obtained in patients with predominant glomerular involvement. This lack of response to a protein overload is related to poor long-term evolution. The assessment of the functional kidney reserve may help to balance the decision whether to start/continue /enhance immunosuppression in those patients with kidney sclerosis.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,001 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,003 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».