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Glomerulopathies contribute to 10% of the causes of dialysis kidney disease. The objective of the study was to evaluate the profile of patients with glomerulopathy in the Nephrology service of the University Hospital of the Federal University of Juiz de Fora from January/1996 to December/2021 with a focus on lupus nephritis.
Retrospective cohort, inclusion criteria: patients over 18 years old, diagnosed with glomerulopathy with or without biopsy. Study approved by CEP. Results: There were 443 eligible patients, for this purpose we will present data on patients with lupus nephritis (LN) from 2003 to 2022. Sociodemographic, clinical and laboratory variables were evaluated at admission and at the end of the study. Outcome: estimated glomerular filtration rate (eGFR) and proteinuria. Descriptive statistics using SPSS 21.0.
83 patients were evaluated, with a mean age of 33±12 years, 79.5% female and 55.4% white. Follow-up was 1 to 285 months (Median: 40 months). Initial clinical presentations: nephritic-nephrotic syndrome (27.5%), hematuria with subnephrotic proteinuria (27.5%) and nephrotic syndrome (21.7%). 23.2% had rapidly progressive glomerulonephritis, 10.1% requiring dialysis. Most frequent classes: IV (or IV/V) (43.4%); V isolated (25.3%); and III (or III/V) (18.1%). 31.3% had crescents on initial biopsy. 100% used corticosteroids, 94% hydroxychloroquine or chloroquine, 66.3% azathioprine and 50.6% mycophenolate. Regarding intravenous pulse therapies, 75.9% received corticosteroids and 61.5% cyclophosphamide. Monoclonal antibody use was 2.4% for rituximab and 9.6% for belimumab. The mean initial serum albumin was 3.0g/dL±0.7. 96.1% had initial reactive ANA, 68.2% reactive Anti-DNA and 61.3% complement consumption. The initial eGFR was 15 to 145 (Median: 78) and the initial 24-hour proteinuria was 30mg to 11,000mg (Median: 2039.5mg). The final eGFR was 12 to 136 (Median: 82) and the final 24-hour proteinuria was 24mg to 6758mg (Median: 448mg). Predominance of young, female, class IV or IV/V patients throughout the period. We observed variability in clinical and laboratory presentation, including patients who only met criteria for SLE based on renal histology. There was an improvement in GFR and the level of proteinuria, however, many patients persist with proteinuria outside the target after treatment, which may reflect difficulty in accessing medications during the period evaluated. We emphasize that only in 2023 Mycophenolate Mofetil was approved by the regulatory system to be provided free of charge by the Brazilian Unified Health System (SUS).
Early appropriate diagnosis and treatment, knowledge of evolution and outcomes are necessary so that we can provide information to managers in the public system regarding the need to use medications not yet released in the public health system, so that we have better renal outcomes.There was no change in the profile of lupus nephritis during the period, probably due to the bias in the indication of biopsy, as they are performed mainly in classes III and IV.