Male gender results in more severe lupus nephritis

Abstract

Gender may produce different characteristics in the manifestation of systemic lupus erythematosus (SLE). The present study investigated the influence of gender on clinical, laboratory, autoantibodies and histopathological classes of lupus nephritis (LN). As much as 81 patients diagnosed with SLE (ACR criteria) and active nephritis, who underwent renal biopsy between 1999 and 2004, and who had frozen serum samples and clinical data available from the time of biopsy, were selected for this study. The presence of anti-P and antichromatin antibodies was measured using ELISA, and anti-dsDNA was measured using indirect immunofluorescence. All of the renal biopsies were reviewed in a blinded manner by the same expert renal pathologist. The charts were extensively reviewed for demographic and renal features obtained at the time of the biopsy. Of the 81 patients (13.6%), 11 were male SLE patients. Both male and female lupus patients were of similar age and race, and had similar durations of lupus and renal disease. The female patients had more cutaneous (95.7 vs. 45.5%, P = 0.0001) and haematological (52.9 vs. 18.2%, P = 0.04) involvements than the male SLE patients. In addition, the articular data, central nervous system analyses, serositis findings and SLEDAI scores were similar in both experimental groups. Positivity for anti-dsDNA, anti-ribosomal P and antichromatin did not differ between the two groups, and both groups showed similarly low C3 or C4 serum levels. Our analysis indicated that no histopathological class of LN was predominant in both males and females. Interestingly, the serum creatinine levels were higher in the male SLE patients compared to the female SLE group (3.16 +/- 2.49 vs. 1.99 +/- 1.54 mg/dL, P = 0.03), with an increased frequency of high creatinine (81.8 vs. 47.1%, P = 0.04) as well as renal activity index (7.6 +/- 3.5 vs. 4.8 +/- 3.5, P = 0.02). In addition, whilst the mean levels of proteinuria, cylindruria and serum albumin were markedly altered, they were comparable between both lupus men and women. Moreover, the frequencies of dialysis, renal transplantation and death were similar between the two groups. These data suggest that male patients had a more severe LN compared to women diagnosed with this renal abnormality.

Gender differences in circulating levels of neutrophil extracellular traps in serum of multiple sclerosis patients

“…Interestingly, in SLE, in which women are affected about 10 times more frequently than men, it is interesting to note that male gender has been associated with more severe disease and with higher prevalence of pathogenic anti-dsDNA autoantibodies (Freire de Carvalho et al, 2010;Lu et al, 2010;Molina et al, 1996). Similarly, RRMS affects women about twice as often as men, and overall male gender has also been associated with worse prognosis.…”

Why are kids with lupus at an increased risk of cardiovascular disease?

“…Indeed, men with SLE seem to have a greater risk of developing LN, whether this is due to delayed diagnosis [64] or less aggressive treatment [65] is not yet clear. The long-term outcome in men with LN appears to be worse with men more likely to develop CKD than women [68] and more likely to have higher renal activity index [69]. Wang et al described 415 patients with biopsy-proven LN, of whom 45 were male, showing that men had a later diagnosis and worse renal function than their female counterparts [70].…”

The TLR7 7926A>G polymorphism is associated with susceptibility to systemic lupus erythematosus

“…Findings of several studies have demonstrated that male SLE patients present a typical manifestation, tend to have a significantly worse prognosis and have more serious kidney involvement (41)(42)(43). More specifically, a recent study has addressed the gender-based differences in Brazilian lupus patients and demonstrated that male patients had more severe LN, as indicated by higher creatinine levels and by comparison of the histopathological activity index values when compared to females diagnosed with this renal abnormality (44). Moreover, by promoting the expression of nephritogenic gp70 autoantigen (45)(46)(47), TLR7 is involved in the acute phase expression of serum envelope glycoprotein gp70 in murine lupus.…”