Lupus Nephritis at the University Hospital of the West Indies, Kingston, Jamaica: A 10-Year Experience

Abstract

The case records of 75 patients who had systemic lupus erythematosus (SLE) and renal involvement on renal histology were reviewed. There were 70 females and 5 males, with a ratio of 14:1. The majority of the patients were in their second and third decades of life. SLE nephritis was distinctly uncommon in patients below 10 years of age and above 50 years of age. In nearly 80% of the patients, SLE nephritis was diagnosed within the year prior to presentation. The most common presenting clinical features were arthritis in 78% and a rash in 48%. The two most common renal features were proteinuria in 60% and renal failure in 55%. Of these patients, 20%, 12%, 48%, and 17% fell into Class II (mesangial GN), Class III (focal GN), Class IV (diffuse GN), and Class V (membranous GN), respectively, when the renal histological abnormalities were categorized according to the World Health Organization classification. The remaining 3% of patients had sclerosis and as a result were unclassifiable. The two major clinical manifestations in the Class IV patients were an acute nephritis syndrome in 83% and renal failure in 61%. The nephrotic syndrome was seen in 62% of Class V (membranous GN) cases. There was 100% survival in Classes II (mesangial GN) and V (membranous GN), and 62% percent in Classes III (focal GN) and IV (diffuse GN) combined.

Clinical and immunological characteristics of 150 systemic lupus erythematosus patients in Jamaica: a comparative analysis

“…12 This may not fully reflect the gender ratio among SLE patients in Jamaica as our study included only participants who have sought specialist care in urban Jamaica; hence, there may be a selection bias. Although the female to male ratio of 29 to one was unexpected, other studies done in Jamaica do support a high female to male ratio (Williams and Shah) in SLE, 38 albeit these studies were in lupus nephritis cohorts. It has been reported in the literature that males with SLE have more severe disease than females.…”

The epidemiology of systemic lupus erythematosus in populations of African ancestry: A critical review of the ?prevalence gradient hypothesis?

“…S I E in African Caribbeans. Data concerning SLE in the West Indies (40)(41)(42)(43)(44)(45)(46) are limited. Wilson and Hughes (45) showed the relatively high prevalence of SLE in hospitalized patients in Jamaica.…”

Severity of systemic lupus erythematosus with diffuse proliferative glomerulonephritis and the ineffectiveness of standard pulse intravenous cyclophosphamide therapy in Jamaican patients

“…In that study of 75 patients with lupus nephritis where 60% had proliferative GN (classes 3 and 4 combined), the one-and three-year survival rates were 75 and 70%, respectively, when treated with azathioprine and oral prednisone. 13 Because this is not a randomized controlled trial, the improvement in the present series may not be due to pulse cyclophosphamide therapy. The response could be due to earlier diagnosis and treatment, better treatment of hypertension including the use of an ACE inhibitor, and better treatment of infections.…”