Nephrology Medical News about renal damage;lupus nephritis;protective effect of hydroxychloroquine

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Protective effect of hydroxychloroquine on renal damage in patients with lupus nephritis: LXV, data from a multiethnic US cohort
Arthritis Care and Research , 06/03/09

Pons-Estel GJ et al. – Study demonstrates that after adjusting for possible confounding factors, the protective effect of hydroxychloroquine in retarding renal damage occurrence in systemic lupus erythematosus is still evident.

Methods

Aim was to assess whether hydroxychloroquine can delay renal damage development in lupus nephritis pts
256 pts; a multiethnic cohort of African Americans, Hispanics, and Caucasians; age: ≥16 yrs; disease duration: ≤5 yrs at baseline (T0)
Renal damage was defined as ≥1 of the following lasting at least 6 mo:
- estimated/measured glomerular filtration rate <50%
- 24-hour proteinuria ≥3.5 gm and/or
- end-stage renal disease, regardless of dialysis or transplantation
Pts with renal damage before T0 were excluded (n=53)
Association between hydroxychloroquine use and renal damage was estimated using Cox proportional regression analyses adjusting for potential confounders
Kaplan-Meier survival curves based on hydroxychloroquine intake or the WHO class glomerulonephritis were also derived

Results

63/203 (31.0%) pts included developed renal damage over a mean disease duration of 5.2 yrs
Most frequent renal damage domain item was proteinuria
Pts who received hydroxychloroquine (79.3%) exhibited:
- a lower frequency of WHO class IV glomerulonephritis
- had lower disease activity, and
- received lower glucocorticoid doses
  than those who did not take hydroxychloroquine
After adjusting for confounders, hydroxychloroquine was protective of renal damage occurrence in full and reduced models
Omitting proteinuria provided comparable results
Cumulative probability of renal damage occurrence was higher in those:
- who did not take hydroxychloroquine and
- those classified as WHO class IV glomerulonephritis