Initial renal histology and early response predict outcomes of Brazilian lupus nephritis patients

Abstract

Objective We analyzed baseline and follow-up characteristics related to poorer renal outcomes in a Brazilian cohort of admixture race patients with lupus nephritis. Methods Overall, 280 outpatients with a diagnosis of systemic lupus erythematosus and previous kidney biopsy of lupus nephritis were recruited from August 2015 to December 2018 and had baseline laboratory and histologic data retrospectively analyzed; patients were then followed-up and data were recorded. The main outcome measure was the estimated glomerular filtration rate at last follow-up. Secondary analyses assessed the impact of initial kidney histology and treatment in long-term kidney survival. Results Median duration of lupus nephritis was 60 months (interquartile range: 27–120); 40 (14.3%) patients presented progressive chronic kidney disease (estimated glomerular filtration rate <30 and ≥10 ml/min/1.73 m2) or end-stage kidney disease at last visit. Adjusted logistic regression analysis showed that class IV lupus nephritis (odds ratio 14.91; 95% confidence interval 1.77–125.99; p = 0.01) and interstitial fibrosis ≥25% at initial biopsy (odds ratio 5.87; 95% confidence interval 1.32–26.16; p = 0.02), lack of complete or partial response at 12 months (odds ratio 16.3; 95% confidence interval 3.74–71.43; p < 0.001), and a second renal flare (odds ratio 4.49; 95% confidence interval 1.10–18.44; p = 0.04) were predictors of progressive chronic kidney disease. In a Kaplan-Meier survival curve we found that class IV lupus nephritis and interstitial fibrosis ≥25% were significantly associated with end-stage kidney disease throughout follow-up (hazard ratio 2.96; 95% confidence interval 1.3–7.0; p = 0.036 and hazard ratio 4.96; 95% confidence interval 1.9–12.9; p < 0.0001, respectively). Conclusion In this large cohort of admixture race patients, class IV lupus nephritis and chronic interstitial damage at initial renal biopsy together with non-response after 1 year of therapy and relapse were associated with worse long-term renal outcomes.

Differences and similarities of proliferative and non-proliferative forms of biopsy-proven lupus nephritis: Single centre, cross-disciplinary experience

“…Recent studies indicated that the rate of CRR varied between 20 and 65%, and the rate of PRR is between 18 and 27%. 10 , 21 , 28 Renal response rates obtained in our study were rather consistent with previous reports. Factors predicting CRR during the 2-year follow-up were also analyzed.…”

“… 30 In a study regarding the histopathologic findings of LN, class IV and chronic interstitial damage at initial renal biopsy were associated with worse renal outcomes. 21 In our study, although all patients who did not respond to treatment, developed ESRD, and died during the 2-year follow-up were in the proliferative LN group, the complete or partial renal response rates were similar in both groups. This situation may be explained by the small number of patients in the non-proliferative group.…”

“…In previous studies, the age at SLE diagnosis and the age at LN diagnosis were usually in the third and fourth decades. [19][20][21][22] However, these studies did not include the patients with juvenile-onset LN while our cohort was younger, which was associated with the presence of juvenile-onset LN patients.…”

The landscape of systemic lupus erythematosus in Brazil: An expert panel review and recommendations

“…39 In Brazil, chronic glomerulopathies represent a major cause of ESRD, accounting for 11% of dialysis patients. 40 A study conducted in the northeastern region demonstrated that secondary glomerulopathies, including LN, were present in 42% of cases.…”

Predictors of Early Response, Flares, and Long-Term Adverse Renal Outcomes in Proliferative Lupus Nephritis: A 100-Month Median Follow-Up of an Inception Cohort

“…In our study, 22% of patients reached the composite renal outcome (stage 3–4 CKD or ESRD) in a median follow-up time of 100 months. Several studies have identified baseline parameters as predictors of long-term renal prognosis, such as creatinine, proteinuria, hypertension, activity and chronicity index [ 43 , 44 ], while others [ 15 , 16 , 18 , 28 , 40 , 44 , 45 ] highlight the importance of renal parameters at 12 months as single variables (i.e., proteinuria <0.7 g/day or <0.8 g/day) or as composite endpoint (i.e., renal response). Renal response definition, however, is not uniform across studies.…”