A Systematic Review and Meta-analysis of Prevalence of Biopsy-Proven Lupus Nephritis

Abstract

Objectives: This study aims to conduct a meta-analysis to clarify the epidemiologic characteristics of biopsy-proven lupus nephritis (BPLN), including those relating to its prevalence and prognosis. Patients and methods: A literature search for relevant studies was conducted in the electronic databases of PubMed, Google Scholar, Embase, and Cochrane trial register. The following search terms were used for original articles published between January 1982 and April 2016: "lupus nephritis" or systemic lupus erythematosus ('SLE') or 'systemic lupus erythematous' and "pathology" or 'epidemiology' or prevalence or incidence. Pooled estimates with 95% confidence intervals were calculated. Results: Nineteen studies were included (mean age of SLE patients at renal biopsy: ~30 years). Of total BPLN patients, 85% were females. BPLN developed in 29% of SLE patients, and accounted for 60% of secondary glomerular diseases in renal biopsy databases. BPLN prevalence among SLE patients was higher in Saudi Arabia compared with pooled Europe/USA data (43% vs 26%, p<0.05). Pooled BPLN prevalence among secondary glomerular diseases patients was higher in Asian/Latin American countries than in Europe (63% vs 34%, p<0.05). Overall five-, 10-and 20-year survival rates of BPLN patients were 94%, 86%, and 71%, respectively, which were higher than those before 1995 (84%, 72%, and 52%, respectively) and lower than those after 1995 (96%, 89%, and 80%, respectively) (all p<0.05). Class IV nephritis, present in 40% of BPLN patients, was a risk factor for renal failure that contributed to poor prognosis. Conclusion: Lupus nephritis is a common complication of young female patients with SLE, and the most prevalent etiology of secondary glomerular diseases. Attention should be paid to class IV nephritis due to its high frequency and association with poor prognosis.

Lupus nephritis: correlation of immunohistochemical expression of C4d, CD163-positive M2c-like macrophages and Foxp3-expressing regulatory T cells with disease activity and chronicity

“…These results coincide with the meta-analysis study of Wang et al. 34 that indicated that class IV LN was the most frequent pathological type in all their examined studies.…”

“…A meta-analysis conducted by Wang et al. 34 also revealed that the majority of patients were middle-aged females. A female preponderance could be explained by the effect of sex hormones, which have immune-modulating and cellular protective effects following tissue damage.…”

Treatment of Rare Inflammatory Kidney Diseases: Drugs Targeting the Terminal Complement Pathway

“…Renal involvement in the chronic autoimmune disease systemic lupus erythematosus (SLE), manifesting as lupus nephritis, is common, with a prevalence of up to 48% of SLE patients ( 67 ), and is usually associated with poor outcome. Pathological features consist of glomerulonephritis and glomerular crescents, infiltration of inflammatory cells in the kidney’s epithelium, podocyte injury, immune complex deposition on mesangial cells, and vascular and tubulointerstitial lesions ( 68 ).…”

Lupus nephritis: clinical presentations and outcomes in the 21st century

“…Class III and IV LN (Focal and Diffuse LN) bear the most severe prognosis and require prompt immunosuppressive treatment. A metanalysis evaluating the prevalence of biopsy-proven LN [ 37 ] identified class IV as the most prevalent and the one associated with the highest risk of progression to ESRD. A total of 15–30% of patents with class IV do not reach remission and 15–30% of those reaching remission will develop a relapse.…”