SUN-038 RECOVERY OF KIDNEY FUNCTION IN GLOMERULONEPHRITIS WITH RAPIDLY PROGRESSIVE RENAL FAILURE AT CHO RAY HOSPITAL

Abstract

It is uncommon for patients with glomerulonephritis (GN) who require hemodialysis (HD) to recover renal function. Lupus nephritis (LN) is one of the common GN in Vietnam. Our aim was to describe the renal outcome of 64 GN patients with rapidly progressive renal failure (RPRF) on HD at Cho Ray Hospital, Ho Chi Minh City, Vietnam. A prospective study was conducted in 64 GN patients with RPRF requiring HD from 2014 to 2018. RPRF was defined as a progression to renal failure within a period of 1 week to three months. A definitive diagnosis of the kidney disease was established by history, clinical examination, lab tests, and renal biopsy. The patients had received standard therapy for their primary medical condition. We followed the patients after initiation of HD (3 months min, 18 months max) to evaluate recovery sufficient to discontinue HD Patient median age 25 (Inter-quartile range 21,32); 49 females; 59/64 pts with lupus nephritis (LN) (54 class III or IV, 1 class V, and 1 unclassified). 3 patients had IgA nephropathy; 1 Anti-glomerular basement membrane GN; 1 idiopathic membranoproliferative GN. Thrombotic microangiopathy (TMA) was clinically diagnosed based on Coombs negative hemolytic anemia, thrombocytopenia, D-Dimer >600 ng/mL, LDH >600 U/L, schistocytes on blood smear, with or without kidney biopsy. TMA was found in 56 pts, of which 19 were biopsy proven. Six LN patients with TMA were tested for ADAMTS13, all of whom were negative. Patients with TMA were treated with therapeutic plasma exchange (26 cases) or plasma infusion (30 cases) and heparin anticoagulation. All 64 pts were on oral methylprednisolone (median 32mg/day, IQR 16, 48mg) for the first month then tapered. 41 pts (39 LN, 2 non Lupus GN) received median of 6 doses of monthly intravenous cyclophosphamide 0.5g/m2 over median 12 months follow up. 36/59 (61%) of LN pts recovered kidney function, and discontinued HD after median 39 days (IQR 24;72 days). They remained dialysis independent for a median of 10 months (IQR 6 ,11 months) follow up. Median of the last serum creatinine in patients who recovered function was 1.4 mg/dL (IQR 1.2; 1.7 mg/dL). In the 28 patients who failed to recover kidney function, 4 died and 24 continued HD after median 4 months. Recovery of renal function was more common in LN pts with TMA or patients with length on HD of less than 3. Recovery of function was not associated with age, gender, body mass index, hypertension, 24h proteinuria, hematuria, isolated TMA diagnosis, anemia, or serum albumin on admission). TableComparison between patients who recovered and failed to recover functionTotal (N=64)Recovered kidney function (N=36)Non recovered kidney function (N=28)pLupus nephritis5936 (61%)230.03Nonlupus GN50 (0%)5TMAneg/LNpos85 (62.5%)30.01TMApos/LNpos5131(60.7%)20TMApos/LNneg50(0%)5Length on HD ≤ 3 months4632(69.5%)140.005Length on HD > 3 months184(22.2%)14 Open table in a new tab RPRF in lupus nephritis patients with or without TMA had a good likelihood of function recovery after requiring hemodialysis.