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Methodological Quality of Studies of Endstage Renal Disease in Lupus Nephritis, 1970 to 2015.

ABSTRACT: OBJECTIVE:To examine trends in methodological quality of studies of endstage renal disease risk in lupus nephritis, 1970-2015. METHODS:We assessed quality using the Newcastle-Ottawa scale for observational studies, and the Cochrane Collaboration's risk-of-bias tool for trials. RESULTS:In observational studies, description of enrollment criteria was high but decreased over time. Adequacy of followup was low but improved. Inception cohorts and community-based studies were uncommon. Trials had low risk of bias in blinding and selective outcome reporting but most had unclear risks in sequence generation and allocation concealment. CONCLUSION:Methodological quality was mixed, with limited improvement over time.

SUBMITTER: Tektonidou MG

PROVIDER: S-EPMC5413417 | biostudies-literature | 2017 May

REPOSITORIES: biostudies-literature

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Methodological Quality of Studies of Endstage Renal Disease in Lupus Nephritis, 1970 to 2015.

Tektonidou Maria G MG Ward Michael M MM

The Journal of rheumatology 20170215 5

<h4>Objective</h4>To examine trends in methodological quality of studies of endstage renal disease risk in lupus nephritis, 1970-2015.<h4>Methods</h4>We assessed quality using the Newcastle-Ottawa scale for observational studies, and the Cochrane Collaboration's risk-of-bias tool for trials.<h4>Results</h4>In observational studies, description of enrollment criteria was high but decreased over time. Adequacy of followup was low but improved. Inception cohorts and community-based studies were unc ...[more]

PMID: 28202746

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Project description:INTRODUCTION: Among various lupus renal vascular changes, thrombotic microangiopathy (TMA) presented with the most severe clinical manifestations and high mortality. The pathogenesis of TMA in systemic lupus erythematosus (SLE) was complicated. The aim of this study was to assess clinical manifestations, laboratory characteristics, pathological features and risk factors for clinical outcomes of lupus nephritis patients co-existing with renal TMA in a large cohort in China. METHODS: Clinical and renal histopathological data of 148 patients with biopsy-proven lupus nephritis were retrospectively analyzed. Serum complement factor H, A Disintegrin and Metalloprotease with Thrombospondin type I repeats 13 (ADAMTS-13) activity, antiphospholipid antibodies and C4d deposition on renal vessels were further detected and analyzed. RESULTS: In the 148 patients with lupus nephritis, 36 patients were diagnosed as co-existing with renal TMA based on pathological diagnosis. Among the 36 TMA patients, their clinical diagnoses of renal TMA were as followings: 2 patients combining with thrombotic thrombocytopenic purpura-hemolytic uremic syndrome, 2 patients combining with anti-phospholipid syndrome, 2 patients with malignant hypertension, 1 patient with scleroderma and the other 29 patients presenting with isolated renal TMA. Compared with the non-renal TMA group, patients with renal TMA had significantly higher urine protein (7.09±4.64 vs. 4.75±3.13 g/24h, P=0.007) and serum creatinine (159, 86 to 215 vs. 81, 68 to 112 ?mol/l, P<0.001), higher scores of total activity indices (AI) (P<0.001), endocapillary hypercellularity (P<0.001), subendothelial hyaline deposits (P=0.003), interstitial inflammation (P=0.005), glomerular leukocyte infiltration (P=0.006), total chronicity indices (CI) (P=0.033), tubular atrophy (P=0.004) and interstitial fibrosis (P=0.018). Patients with renal TMA presented with poorer renal outcome (P=0.005) compared with the non-TMA group. Renal TMA (hazard ratio (HR): 2.772, 95% confidence interval: 1.009 to 7.617, P=0.048) was an independent risk factor for renal outcome in patients with lupus nephritis. The renal outcome was poorer for those with both C4d deposition and decreased serum complement factor H in the TMA group (P=0.007). CONCLUSIONS: There were various causes of renal TMA in lupus nephritis. Complement over-activation via both classical and alternative pathways might play an important role in the pathogenesis of renal TMA in lupus nephritis.

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Methodological Quality of Studies of Endstage Renal Disease in Lupus Nephritis, 1970 to 2015.

Publications

Methodological Quality of Studies of Endstage Renal Disease in Lupus Nephritis, 1970 to 2015.

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