Late-onset biopsy-proven lupus nephritis without other associated autoimmune diseases: severity and long-term outcome

Abstract

Background/Purpose Lupus nephritis (LN) usually develops within the first years of systemic lupus erythematosus (SLE) onset and rarely after that. There are scarce studies comparing early- versus late-onset nephritis (before versus after five years of SLE diagnosis). The aim of this study was to compare the severity and long-term outcome (after 7 years) in these two, late-onset and early-onset, nephritis groups. Methods This study included 93 patients from rheumatology tertiary centers from Brazil and Italy, all of them with biopsy-proven LN with > 7 years follow-up. Patients were divided in two groups: early-onset nephritis ( n = 75) and late-onset nephritis ( n = 18). Clinical and laboratorial data were obtained using a standardized electronic chart database protocol carried out at 1–6 months interval and established in 2000. Patients >50 years or with concomitant autoimmune diseases were excluded. Variables evaluated at the LN presentation were Systemic Lupus Erythematosus Disease Activity Index (SLEDAI), creatinine, albumin, anti-DNA positivity and nephritis class. Variables evaluated at the long-term outcome (after 7 years) were Systemic Lupus International Collaborating Clinics Damage Index (SDI), creatinine, dialysis and mortality. Results The average time of LN presentation was 10.94 ± 3.73 years for the late-onset and 1.20 ± 1.60 years for the early-onset group. Their similar nephritis duration (12.44 ± 3.2 versus 13.28 ± 4.03 years, p = 0.41) and comparable mean ages (49.17 ± 9.9 versus 44.11 ± 10.8 years old, p = 0.06) allow a more accurate comparison. Regarding severity, late-onset was similar to early-onset group: SLEDAI (8 (range: 6–22) versus 12 (range: 2–24), p = 0.47), creatinine (1.36 ± 0.94 versus 1.36 ± 1.13 mg/dl, p = 0.99); albumin (2.84 ± 0.65 versus 2.59 ± 0.84 mg/dl, p = 0.30); proteinuria (3.77 ± 2.18 versus 5.01 ± 4.51 g/vol, p = 0.26); proliferative nephritis (44% ( n = 8) versus 60% ( n = 45), p = 0.23). There was also no difference in the long-term outcomes between groups: SDI (1 (range: 0–5) versus 0.5 (range: 0–5), p = 0.27); creatinine (2.04 ± 2.38 versus 1.69 ± 2.26 mg/dl, p = 0.56); dialysis (22% ( n = 4) versus 13% ( n = 10), p = 0.46) and mortality (0% ( n = 0) versus 12% ( n = 9), p = 0.19). Conclusion This study provides novel evidence of comparable long-term outcomes between late-onset and early-onset nephritis, which is most likely explained by the observation that at presentation, the clinical, laboratorial and histological features of late-onset and early-onset nephritis are similar. This suggests that there should be no distinct treatment targets and therapeutic interventions for the late- and early-onset groups.

Comparison of complete renal response and mortality in early- and late-onset lupus nephritis: A multicenter retrospective study of a Japanese cohort

“…The studies' conclusions varied and are controversial; Varela et al compared early-onset and late-onset LN and reported no signi cant difference in nephritis development or histological type [10], and Ugolini-Lopes et al observed no differences in serum Cr levels or the prevalence of ESKD or mortality after 7 years of follow-up [11]. A recent investigation comparing the disease pro les and outcomes of early-onset and late-onset LN patients did not reveal any signi cant differences [17].…”

“…5%-15% of LN cases developing later [2,26,27]. There are no standardized de nitions of early-onset and late-onset LN, but several studies made clinical comparisons separated by 5 years [10,11,17], and we followed that approach in the present work.…”

“…We divided the 201 patients into two groups: early-onset LN and late-onset LN. As in previous studies [10,11,17], early-onset was de ned as the development of LN within 5 years of the patient's SLE diagnosis, and late-onset was de ned as the development of LN >5 years after the patient's SLE diagnosis. Some of the patients provided written informed consent for the use of their data, and the opt-out strategy was used by the remainder of the patients.…”

“…Only a few studies have compared early-onset LN (occurring <5 years after the diagnosis of SLE) with late-onset LN (occurring >5 years post-diagnosis) [10,11]. A recent report showed no difference in severity or long-term prognosis between early-and late-onset LN patients [11]. African and Hispanic patients are known to have poorer renal outcomes and mortality than Caucasian patients, and there are differences in prognosis among ethnicities.…”

Comparison of lupus patients with early and late onset nephritis: a study in 71 patients from a single referral center

“…It usually occurs within the first years after diagnosis [10] although some patients do develop this complication later on. Few studies [11,12] address to the characteristics of patients with late onset of nephritis that could allow an early identification and treatment.…”