Clinical and Histopathologic Characteristics Associated with Renal Outcomes in Lupus Nephritis
The prognostic significance of histopathologic (sub)classes in the current classification of lupus nephritis (LN) is controversial. We analyzed clinical and histopathologic predictors of renal outcome in LN outside the framework of the classification. Variables (50 histopathologic and ten clinical)...
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| Veröffentlicht in: | Clinical journal of the American Society of Nephrology 2017-05, Vol.12 (5), p.734-743 |
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| creator | Rijnink, Emilie C Teng, Y K Onno Wilhelmus, Suzanne Almekinders, Mathilde Wolterbeek, Ron Cransberg, Karlien Bruijn, Jan A Bajema, Ingeborg M |
| description | The prognostic significance of histopathologic (sub)classes in the current classification of lupus nephritis (LN) is controversial. We analyzed clinical and histopathologic predictors of renal outcome in LN outside the framework of the classification.
Variables (50 histopathologic and ten clinical) were tested in mixed, linear, and Cox regression models for their association with renal flare, ESRD, and eGFR during follow-up (1, 5, and 10 years) in 105 patients with LN who underwent biopsy from 1987 to 2011. The Cockcroft-Gault (normalized to a body surface area of 1.73 m
) and Schwartz formulas were used to calculate eGFR for adults and children, respectively.
During median follow-up of 9.9 years (25th-75th percentile, 5.9-13.8), 47 patients experienced a renal flare and 21 progressed to ESRD. Renal flare was predicted by fibrinoid necrosis (hazard ratio [HR], 1.04 per %; 95% confidence interval [95% CI], 1.00 to 1.07) and nonwhite race (HR, 2.23; 95% CI, 1.23 to 4.04). ESRD was predicted by fibrinoid necrosis (HR, 1.08 per %; 95% CI, 1.02 to 1.13), fibrous crescents (HR, 1.09 per %; 95% CI, 1.02 to 1.17), interstitial fibrosis/tubular atrophy (IF/TA) ≥25% (HR, 3.89; 95% CI, 1.25 to 12.14), eGFR at baseline (HR, 0.98 per ml/min per 1.73 m
; 95% CI, 0.97 to 1.00), and nonwhite race (HR, 7.16; 95% CI, 2.34 to 21.91). A higher mean eGFR during follow-up was associated with normal glomeruli (+0.2 ml/min per 1.73 m
per %; 95% CI, 0.1 to 0.4). Like ESRD, a lower eGFR during follow-up was associated with fibrous crescents, IF/TA≥25%, and nonwhite race, as well as with cellular/fibrocellular crescents (-0.4 ml/min per 1.73 m
per %; 95% CI, -0.6 to -0.2) and age (-0.8 ml/min per 1.73 m
per year; 95% CI, -1.2 to -0.4).
The LN classification should include an index of evidence-based prognosticators. Awaiting validation of a formal index, we suggest that at least fibrinoid necrosis, fibrous crescents, and IF/TA warrant explicit independent scoring to assess the risk of progressive renal dysfunction in conjunction with clinical findings. |
| doi_str_mv | 10.2215/CJN.10601016 |
| format | Article |
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Variables (50 histopathologic and ten clinical) were tested in mixed, linear, and Cox regression models for their association with renal flare, ESRD, and eGFR during follow-up (1, 5, and 10 years) in 105 patients with LN who underwent biopsy from 1987 to 2011. The Cockcroft-Gault (normalized to a body surface area of 1.73 m
) and Schwartz formulas were used to calculate eGFR for adults and children, respectively.
During median follow-up of 9.9 years (25th-75th percentile, 5.9-13.8), 47 patients experienced a renal flare and 21 progressed to ESRD. Renal flare was predicted by fibrinoid necrosis (hazard ratio [HR], 1.04 per %; 95% confidence interval [95% CI], 1.00 to 1.07) and nonwhite race (HR, 2.23; 95% CI, 1.23 to 4.04). ESRD was predicted by fibrinoid necrosis (HR, 1.08 per %; 95% CI, 1.02 to 1.13), fibrous crescents (HR, 1.09 per %; 95% CI, 1.02 to 1.17), interstitial fibrosis/tubular atrophy (IF/TA) ≥25% (HR, 3.89; 95% CI, 1.25 to 12.14), eGFR at baseline (HR, 0.98 per ml/min per 1.73 m
; 95% CI, 0.97 to 1.00), and nonwhite race (HR, 7.16; 95% CI, 2.34 to 21.91). A higher mean eGFR during follow-up was associated with normal glomeruli (+0.2 ml/min per 1.73 m
per %; 95% CI, 0.1 to 0.4). Like ESRD, a lower eGFR during follow-up was associated with fibrous crescents, IF/TA≥25%, and nonwhite race, as well as with cellular/fibrocellular crescents (-0.4 ml/min per 1.73 m
per %; 95% CI, -0.6 to -0.2) and age (-0.8 ml/min per 1.73 m
per year; 95% CI, -1.2 to -0.4).
The LN classification should include an index of evidence-based prognosticators. Awaiting validation of a formal index, we suggest that at least fibrinoid necrosis, fibrous crescents, and IF/TA warrant explicit independent scoring to assess the risk of progressive renal dysfunction in conjunction with clinical findings.</description><identifier>ISSN: 1555-9041</identifier><identifier>EISSN: 1555-905X</identifier><identifier>DOI: 10.2215/CJN.10601016</identifier><identifier>PMID: 28473317</identifier><language>eng</language><publisher>United States: American Society of Nephrology</publisher><subject>Adolescent ; Adult ; Biopsy ; Disease Progression ; Female ; Fibrosis ; Glomerular Filtration Rate ; Humans ; Immunosuppressive Agents - therapeutic use ; Kidney - drug effects ; Kidney - pathology ; Kidney - physiopathology ; Kidney Failure, Chronic - etiology ; Kidney Failure, Chronic - pathology ; Kidney Failure, Chronic - physiopathology ; Kidney Failure, Chronic - therapy ; Linear Models ; Lupus Nephritis - complications ; Lupus Nephritis - pathology ; Lupus Nephritis - physiopathology ; Lupus Nephritis - therapy ; Male ; Multivariate Analysis ; Necrosis ; Original ; Predictive Value of Tests ; Proportional Hazards Models ; Renal Dialysis ; Retrospective Studies ; Risk Assessment ; Risk Factors ; Time Factors ; Young Adult</subject><ispartof>Clinical journal of the American Society of Nephrology, 2017-05, Vol.12 (5), p.734-743</ispartof><rights>Copyright © 2017 by the American Society of Nephrology.</rights><rights>Copyright © 2017 by the American Society of Nephrology 2017</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c384t-16c45a755d4169f76a610116b63a28dc774992e836b8b6e4ce107bd6bb2158773</citedby><cites>FETCH-LOGICAL-c384t-16c45a755d4169f76a610116b63a28dc774992e836b8b6e4ce107bd6bb2158773</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC5477219/pdf/$$EPDF$$P50$$Gpubmedcentral$$H</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC5477219/$$EHTML$$P50$$Gpubmedcentral$$H</linktohtml><link.rule.ids>230,315,728,781,785,886,27929,27930,53796,53798</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/28473317$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Rijnink, Emilie C</creatorcontrib><creatorcontrib>Teng, Y K Onno</creatorcontrib><creatorcontrib>Wilhelmus, Suzanne</creatorcontrib><creatorcontrib>Almekinders, Mathilde</creatorcontrib><creatorcontrib>Wolterbeek, Ron</creatorcontrib><creatorcontrib>Cransberg, Karlien</creatorcontrib><creatorcontrib>Bruijn, Jan A</creatorcontrib><creatorcontrib>Bajema, Ingeborg M</creatorcontrib><title>Clinical and Histopathologic Characteristics Associated with Renal Outcomes in Lupus Nephritis</title><title>Clinical journal of the American Society of Nephrology</title><addtitle>Clin J Am Soc Nephrol</addtitle><description>The prognostic significance of histopathologic (sub)classes in the current classification of lupus nephritis (LN) is controversial. We analyzed clinical and histopathologic predictors of renal outcome in LN outside the framework of the classification.
Variables (50 histopathologic and ten clinical) were tested in mixed, linear, and Cox regression models for their association with renal flare, ESRD, and eGFR during follow-up (1, 5, and 10 years) in 105 patients with LN who underwent biopsy from 1987 to 2011. The Cockcroft-Gault (normalized to a body surface area of 1.73 m
) and Schwartz formulas were used to calculate eGFR for adults and children, respectively.
During median follow-up of 9.9 years (25th-75th percentile, 5.9-13.8), 47 patients experienced a renal flare and 21 progressed to ESRD. Renal flare was predicted by fibrinoid necrosis (hazard ratio [HR], 1.04 per %; 95% confidence interval [95% CI], 1.00 to 1.07) and nonwhite race (HR, 2.23; 95% CI, 1.23 to 4.04). ESRD was predicted by fibrinoid necrosis (HR, 1.08 per %; 95% CI, 1.02 to 1.13), fibrous crescents (HR, 1.09 per %; 95% CI, 1.02 to 1.17), interstitial fibrosis/tubular atrophy (IF/TA) ≥25% (HR, 3.89; 95% CI, 1.25 to 12.14), eGFR at baseline (HR, 0.98 per ml/min per 1.73 m
; 95% CI, 0.97 to 1.00), and nonwhite race (HR, 7.16; 95% CI, 2.34 to 21.91). A higher mean eGFR during follow-up was associated with normal glomeruli (+0.2 ml/min per 1.73 m
per %; 95% CI, 0.1 to 0.4). Like ESRD, a lower eGFR during follow-up was associated with fibrous crescents, IF/TA≥25%, and nonwhite race, as well as with cellular/fibrocellular crescents (-0.4 ml/min per 1.73 m
per %; 95% CI, -0.6 to -0.2) and age (-0.8 ml/min per 1.73 m
per year; 95% CI, -1.2 to -0.4).
The LN classification should include an index of evidence-based prognosticators. Awaiting validation of a formal index, we suggest that at least fibrinoid necrosis, fibrous crescents, and IF/TA warrant explicit independent scoring to assess the risk of progressive renal dysfunction in conjunction with clinical findings.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Biopsy</subject><subject>Disease Progression</subject><subject>Female</subject><subject>Fibrosis</subject><subject>Glomerular Filtration Rate</subject><subject>Humans</subject><subject>Immunosuppressive Agents - therapeutic use</subject><subject>Kidney - drug effects</subject><subject>Kidney - pathology</subject><subject>Kidney - physiopathology</subject><subject>Kidney Failure, Chronic - etiology</subject><subject>Kidney Failure, Chronic - pathology</subject><subject>Kidney Failure, Chronic - physiopathology</subject><subject>Kidney Failure, Chronic - therapy</subject><subject>Linear Models</subject><subject>Lupus Nephritis - complications</subject><subject>Lupus Nephritis - pathology</subject><subject>Lupus Nephritis - physiopathology</subject><subject>Lupus Nephritis - therapy</subject><subject>Male</subject><subject>Multivariate Analysis</subject><subject>Necrosis</subject><subject>Original</subject><subject>Predictive Value of Tests</subject><subject>Proportional Hazards Models</subject><subject>Renal Dialysis</subject><subject>Retrospective Studies</subject><subject>Risk Assessment</subject><subject>Risk Factors</subject><subject>Time Factors</subject><subject>Young Adult</subject><issn>1555-9041</issn><issn>1555-905X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpVUctOwzAQtBCIlseNM_KRAyl24kdyQaoioKCqlRBInLAcx22M0jjYDoi_J1UfgtOudmdndncAuMBoFMeY3uRPsxFGDGGE2QEYYkpplCH6drjPCR6AE-8_ECIkiekxGMQp4UmC-RC857VpjJI1lE0JJ8YH28pQ2doujYJ5JZ1UQbu-bpSHY--tMjLoEn6bUMFn3fST8y4ou9IemgZOu7bzcKbbyplg_Bk4Wsja6_NtPAWv93cv-SSazh8e8_E0UklKQoSZIlRySkuCWbbgTLL-HMwKlsg4LRXnJMtinSasSAumidIY8aJkRdF_IOU8OQW3G962K1a6VLoJTtaidWYl3Y-w0oj_ncZUYmm_BCWcxzjrCa62BM5-dtoHsTJe6bqWjbadFzjNGCIIobXW9QaqnPXe6cVeBiOxtkT0loidJT388u9qe_DOg-QXAnCH9A</recordid><startdate>20170508</startdate><enddate>20170508</enddate><creator>Rijnink, Emilie C</creator><creator>Teng, Y K Onno</creator><creator>Wilhelmus, Suzanne</creator><creator>Almekinders, Mathilde</creator><creator>Wolterbeek, Ron</creator><creator>Cransberg, Karlien</creator><creator>Bruijn, Jan A</creator><creator>Bajema, Ingeborg M</creator><general>American Society of Nephrology</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20170508</creationdate><title>Clinical and Histopathologic Characteristics Associated with Renal Outcomes in Lupus Nephritis</title><author>Rijnink, Emilie C ; Teng, Y K Onno ; Wilhelmus, Suzanne ; Almekinders, Mathilde ; Wolterbeek, Ron ; Cransberg, Karlien ; Bruijn, Jan A ; Bajema, Ingeborg M</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c384t-16c45a755d4169f76a610116b63a28dc774992e836b8b6e4ce107bd6bb2158773</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Biopsy</topic><topic>Disease Progression</topic><topic>Female</topic><topic>Fibrosis</topic><topic>Glomerular Filtration Rate</topic><topic>Humans</topic><topic>Immunosuppressive Agents - therapeutic use</topic><topic>Kidney - drug effects</topic><topic>Kidney - pathology</topic><topic>Kidney - physiopathology</topic><topic>Kidney Failure, Chronic - etiology</topic><topic>Kidney Failure, Chronic - pathology</topic><topic>Kidney Failure, Chronic - physiopathology</topic><topic>Kidney Failure, Chronic - therapy</topic><topic>Linear Models</topic><topic>Lupus Nephritis - complications</topic><topic>Lupus Nephritis - pathology</topic><topic>Lupus Nephritis - physiopathology</topic><topic>Lupus Nephritis - therapy</topic><topic>Male</topic><topic>Multivariate Analysis</topic><topic>Necrosis</topic><topic>Original</topic><topic>Predictive Value of Tests</topic><topic>Proportional Hazards Models</topic><topic>Renal Dialysis</topic><topic>Retrospective Studies</topic><topic>Risk Assessment</topic><topic>Risk Factors</topic><topic>Time Factors</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Rijnink, Emilie C</creatorcontrib><creatorcontrib>Teng, Y K Onno</creatorcontrib><creatorcontrib>Wilhelmus, Suzanne</creatorcontrib><creatorcontrib>Almekinders, Mathilde</creatorcontrib><creatorcontrib>Wolterbeek, Ron</creatorcontrib><creatorcontrib>Cransberg, Karlien</creatorcontrib><creatorcontrib>Bruijn, Jan A</creatorcontrib><creatorcontrib>Bajema, Ingeborg M</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Clinical journal of the American Society of Nephrology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Rijnink, Emilie C</au><au>Teng, Y K Onno</au><au>Wilhelmus, Suzanne</au><au>Almekinders, Mathilde</au><au>Wolterbeek, Ron</au><au>Cransberg, Karlien</au><au>Bruijn, Jan A</au><au>Bajema, Ingeborg M</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Clinical and Histopathologic Characteristics Associated with Renal Outcomes in Lupus Nephritis</atitle><jtitle>Clinical journal of the American Society of Nephrology</jtitle><addtitle>Clin J Am Soc Nephrol</addtitle><date>2017-05-08</date><risdate>2017</risdate><volume>12</volume><issue>5</issue><spage>734</spage><epage>743</epage><pages>734-743</pages><issn>1555-9041</issn><eissn>1555-905X</eissn><abstract>The prognostic significance of histopathologic (sub)classes in the current classification of lupus nephritis (LN) is controversial. We analyzed clinical and histopathologic predictors of renal outcome in LN outside the framework of the classification.
Variables (50 histopathologic and ten clinical) were tested in mixed, linear, and Cox regression models for their association with renal flare, ESRD, and eGFR during follow-up (1, 5, and 10 years) in 105 patients with LN who underwent biopsy from 1987 to 2011. The Cockcroft-Gault (normalized to a body surface area of 1.73 m
) and Schwartz formulas were used to calculate eGFR for adults and children, respectively.
During median follow-up of 9.9 years (25th-75th percentile, 5.9-13.8), 47 patients experienced a renal flare and 21 progressed to ESRD. Renal flare was predicted by fibrinoid necrosis (hazard ratio [HR], 1.04 per %; 95% confidence interval [95% CI], 1.00 to 1.07) and nonwhite race (HR, 2.23; 95% CI, 1.23 to 4.04). ESRD was predicted by fibrinoid necrosis (HR, 1.08 per %; 95% CI, 1.02 to 1.13), fibrous crescents (HR, 1.09 per %; 95% CI, 1.02 to 1.17), interstitial fibrosis/tubular atrophy (IF/TA) ≥25% (HR, 3.89; 95% CI, 1.25 to 12.14), eGFR at baseline (HR, 0.98 per ml/min per 1.73 m
; 95% CI, 0.97 to 1.00), and nonwhite race (HR, 7.16; 95% CI, 2.34 to 21.91). A higher mean eGFR during follow-up was associated with normal glomeruli (+0.2 ml/min per 1.73 m
per %; 95% CI, 0.1 to 0.4). Like ESRD, a lower eGFR during follow-up was associated with fibrous crescents, IF/TA≥25%, and nonwhite race, as well as with cellular/fibrocellular crescents (-0.4 ml/min per 1.73 m
per %; 95% CI, -0.6 to -0.2) and age (-0.8 ml/min per 1.73 m
per year; 95% CI, -1.2 to -0.4).
The LN classification should include an index of evidence-based prognosticators. Awaiting validation of a formal index, we suggest that at least fibrinoid necrosis, fibrous crescents, and IF/TA warrant explicit independent scoring to assess the risk of progressive renal dysfunction in conjunction with clinical findings.</abstract><cop>United States</cop><pub>American Society of Nephrology</pub><pmid>28473317</pmid><doi>10.2215/CJN.10601016</doi><tpages>10</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Adolescent Adult Biopsy Disease Progression Female Fibrosis Glomerular Filtration Rate Humans Immunosuppressive Agents - therapeutic use Kidney - drug effects Kidney - pathology Kidney - physiopathology Kidney Failure, Chronic - etiology Kidney Failure, Chronic - pathology Kidney Failure, Chronic - physiopathology Kidney Failure, Chronic - therapy Linear Models Lupus Nephritis - complications Lupus Nephritis - pathology Lupus Nephritis - physiopathology Lupus Nephritis - therapy Male Multivariate Analysis Necrosis Original Predictive Value of Tests Proportional Hazards Models Renal Dialysis Retrospective Studies Risk Assessment Risk Factors Time Factors Young Adult |
| title | Clinical and Histopathologic Characteristics Associated with Renal Outcomes in Lupus Nephritis |
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