Mestizos with systemic lupus erythematosus develop renal disease early while antimalarials retard its appearance: Data from a Latin American cohort

Abstract

Objectives To assess the predictors of time-to-lupus renal disease in Latin American patients. Methods SLE patients (n=1480) from GLADEL’s (Grupo Latino Americano De Estudio de Lupus) longitudinal inception cohort were studied. Endpoint was ACR renal criterion development after SLE diagnosis (prevalent cases excluded). Renal disease predictors were examined by univariable and multivariable Cox proportional hazards regression analyses. Antimalarials were considered time-dependent in alternative analyses. Results Of the entire cohort, 265 patients (17.9%) developed renal disease after entering the cohort. Of them, 88 (33.2%) developed persistent proteinuria, 44 (16.6%) cellular casts and 133 (50.2%) both; 233 patients (87.9%) were women; mean (± SD) age at diagnosis was 28.0 (11.9) years; 12.8% were African-Latin Americans, 52.5% Mestizos, 34.7% Caucasians (p=0.0016). Mestizo ethnicity (HR 1.61, 95% CI 1.19–2.17), hypertension (HR 3.99, 95% CI 3.02–5.26) and SLEDAI at diagnosis (HR 1.04, 95% CI 1.01–1.06) were associated with a shorter time-to-renal disease occurrence; antimalarial use (HR 0.57, 95% CI 0.43–0.77), older age at onset (HR 0.90, 95% CI 0.85–0.95, for every 5 years) and photosensitivity (HR 0.74, 95% CI 0.56–0.98) were associated with a longer time. Alternative model results were consistent with the antimalarial protective effect (HR 0.70, 95% CI 0.50–0.99). Conclusions Our data strongly support the fact that Mestizo patients are at increased risk of developing renal disease early while antimalarials seem to delay the appearance of this SLE manifestation. These data have important implications for the treatment of these patients regardless of their geographic location.

Management and treatment of glomerular diseases (part 2): conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference

“…Observational and cohort studies have demonstrated that antimalarials reduce the odds of developing LN in patients with SLE and are associated with a higher likelihood of a complete renal response to treatment and a reduced likelihood of developing end-stage kidney disease. [111][112][113][114] Corticosteroids. Corticosteroids, although almost universal in LN regimens, are associated with significant short-and longterm adverse effects.…”

Effect of a Single Apolipoprotein L1 Gene Nephropathy Variant on the Risk of Advanced Lupus Nephritis in Brazilians

“…Relative to Caucasians, African Americans and Hispanics develop more aggressive LN with earlier onset and poorer long-term renal outcomes (9). European ancestry is reportedly protective from LN in patients with SLE (10).…”

“…Another limitation was absence of SLE controls without LN. However, when comparing LN cases with SLE controls lacking LN, it is possible that some "non-nephropathy 12 (8)(9)(10)(11)(12)(13)(14)(15)(16) 18 (…”

Recomendaciones sobre el manejo del compromiso renal del lupus eritematoso sistémico: Documento de Consenso de las Sociedades Chilenas de Nefrología y Reumatología

“…Contribuyen a la mortalidad la mala respuesta terapéutica, infecciones, compromiso cardiovascular y tromboembolismo. Los mestizos latinoamericanos presentan más frecuentemente NL graves y tempranas [4][5][6][7] . En Chile no disponemos de estudios de incidencia o prevalencia.…”