Outcome and Predictors of Kidney Disease Progression in Puerto Ricans With Systemic Lupus Erythematosus Initially Presenting With Mild Renal Involvement

Abstract

Objectives The aims of this study were to determine the outcome and predictors of renal disease progression in Puerto Ricans with systemic lupus erythematosus (SLE) initially presenting mild renal involvement. Methods A retrospective cohort of 61 SLE patients (per American College of Rheumatology classification) with mild renal involvement was studied. Mild renal disease was defined as glomerular filtration rate (GFR) ≥ 90 ml/min in the presence of proteinuria (> 0.25g/day, but < 3.5 g/day), hematuria, and/or urinary cellular casts. Demographic parameters, clinical manifestations, serologic markers, comorbidities, pharmacologic treatments, disease activity and damage accrual were determined at onset of renal disease. Factors associated with renal disease progression were evaluated using recurrent event survival analysis. Results Of 61 patients, 55(90.2%) were women. The mean [standard deviation (SD)] age at renal onset was 29(11.2) and the mean (SD) follow-up period was 5.1(3.4) years. Thirty-eight patients had a decline in GFR: Thirty-two had a mild decline (GFR = 60–89 ml/min), five developed moderate to severe renal insufficiency (GFR = 15–59 ml/min), and one evolved to end-stage renal disease (GFR< 15 ml/min). In the Cox model, low C4 levels and proteinuria > 0.5g/day were associated with an earlier decline in GFR. Conclusions The majority of SLE Puerto Rican patients initially presenting with mild renal involvement had a decrease in GFR after an average of five years of kidney disease, although most had a mild dysfunction. Low C4 levels and proteinuria were predictors of an earlier decline in GFR. The awareness of these factors may contribute to early identification of individuals at risk of renal deterioration.

Time to Recovery from Proteinuria in Patients with Lupus Nephritis Receiving Standard Treatment

“…In our study we showed that normal complement levels were associated with a higher probability of achieving complete recovery in proteinuria as compared to low complement levels. Nieves-Plaza, et al, showed that low C4 levels were predictors of an earlier decline in renal function as determined by GFR 14 . Further, our analysis showed that males had lower probability of achieving complete remission of proteinuria than female patients.…”

Long-term renal outcomes in a cohort of 1814 Chinese patients with biopsy-proven lupus nephritis

“…There are racial differences in the renal outcomes of patients with LN. [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22] . However, few studies on the long-term renal outcomes of Chinese patients have been reported, all of which were derived from small patient cohorts.…”

Predictors of survival in Chinese patients with lupus nephritis

“…Various prognostic factors have been reported in patients with LN in western countries, such as ethnicity, age at LN onset, gender, unfavourable histological features, increased levels of serum creatinine, anti-double-stranded DNA antibodies (anti-dsDNA), a low level of C 4 , poor socioeconomic status and psychosocial factors. [6][7][8][9][10][11][12] These results showed that predictors associated with poor outcome in LN varied with different cohorts, making it difficult to extrapolate findings from one centre to another, even in the same geographic region. In China, which accounted for 19% of the world's population, the LN cumulative incidence was higher than other populations.…”