Long‐term mortality and renal outcome in a cohort of 100 patients with Lupus Nephritis

Abstract

Objective. To evaluate the long-term mortality and renal outcome in a cohort of Danish patients with lupus nephritis (LN) and to identify outcome predictors among findings registered at the time of the first renal biopsy. Methods. The cohort consisted of 100 patients diagnosed with LN (World Health Organization classes I-VI) between 1971 and 1995 and followed for a median duration of 14.7 years (range 0.01-36.9 years). Standardized mortality ratios (SMRs) were calculated on the basis of national age-, sex-, and calendar-year period-specific death rates. Results. Thirty-seven deaths occurred in the cohort, corresponding to an overall SMR of 6.8 (95% confidence interval [95% CI] 4.9 -9.4). Excess mortality was observed throughout followup. The SMR estimates were 9.0 (95% CI 4.7-17.1), 6.2 (95% CI 4.0 -9.5), and 6.6 (95% CI 3.1-13.8) for patients diagnosed during the calendar-year periods 1971-1979, 1980 -1989, and 1990 -1995, respectively. The cumulative renal survival after 5, 10, and 20 years of followup was 87%, 83%, and 73%, respectively. The risk of end-stage renal disease (ESRD) did not decrease significantly across calendaryear periods. Systolic blood pressure >180 mm Hg, focal segmental nephritis, and advanced sclerosing nephritis were identified as baseline predictors of death in multivariate regression analyses, while systolic blood pressure >180 mm Hg, serum creatinine level >140 moles/liter, and diagnostic delay predicted progression to ESRD. Conclusion. LN is associated with excess long-term mortality, and patients may progress to ESRD even after prolonged followup. Our analyses indicate that focal segmental histopathology at disease onset constitutes an important risk factor for death among LN patients. Moreover, our data underscore the importance of early intervention, blood pressure control, and long-term followup in LN.

Long‐term outcome of lupus nephritis in Asian Indians

“…The majority had nephritis soon after the onset of lupus (median 1 year), similar to other studies reporting 50 -68% as having nephritis at diagnosis of lupus (2,4,5,18,20). The most common histologic class was class IV, present in almost one-half of the patients, which is similar to other centers, including those in India (2,8,10,11,21-23).…”

“…These figures in the worst-case scenario were 79%, 70%, and 66%, respectively. These are 10% lower compared to studies from the westerndeveloped nations as well as Asian-developed countries such as Hong Kong and Japan (2,3,(5)(6)(7)(8). However, these are much better than those reported from our country previously.…”

“…However, we did not find male sex, age at onset, or number of nephritic flares to be significant, unlike some studies (4,5). In addition, we did not evaluate factors such as hematocrit, discoid lupus erythematosus, anti-Ro, and activity and chronicity scores found in other studies (2,4,5,8,10).…”

“…This is contrary to the traditional view of a worse prognosis for proliferative nephritis, with an increasing risk from class I to class VI, with the exception of class V (28,29). Indeed, many studies have found proliferative lesions on biopsy or class IV to have a worse prognosis (2,8,10,30,31). However, there have been some studies that also did not find any differences in outcomes by class of nephritis (11,21,32).…”

“…Impressive gains in outcome have been possible with immunosuppressive regimens, with recent studies from North America and Europe reporting a 10-year renal survival of 80 -90%, and some even maintaining normal renal function in 90% (2)(3)(4)(5). Developed countries in Asia, in particular Japan and Hong Kong, have matched these outcomes (6 -8).…”