Predictors of renal damage in systemic lupus erythematous patients: data from a multiethnic, multinational Latin American lupus cohort (GLADEL)

Abstract

AimA decrease in proteinuria has been considered protective from renal damage in lupus nephritis (LN), but a cut-off point has yet to be established. The aim of this study was to identify the predictors of renal damage in patients with LN and to determine the best cut-off point for a decrease in proteinuria.MethodsWe included patients with LN defined clinically or histologically. Possible predictors of renal damage at the time of LN diagnosis were examined: proteinuria, low complement, anti-double-stranded DNA antibodies, red cell casts, creatinine level, hypertension, renal activity (assessed by the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI)), prednisone dose, immunosuppressive drugs and antimalarial use. Sociodemographic variables were included at baseline. Proteinuria was assessed at baseline and at 12 months, to determine if early response (proteinuria <0.8 g/day within 12 months since LN diagnosis) is protective of renal damage occurrence. Renal damage was defined as an increase of one or more points in the renal domain of The Systemic Lupus International Collaborating Clinics (SLICC)/American College of Rheumatology (ACR) Damage Index (SDI). Cox regression models using a backward selection method were performed.ResultsFive hundred and two patients with systemic lupus erythematosus patients were included; 120 patients (23.9%) accrued renal damage during their follow-up. Early response to treatment (HR=0.58), antimalarial use (HR=0.54) and a high SES (HR=0.25) were protective of renal damage occurrence, whereas male gender (HR=1.83), hypertension (HR=1.86) and the renal component of the SLEDAI (HR=2.02) were risk factors for its occurrence.ConclusionsEarly response, antimalarial use and high SES were protective of renal damage, while male gender, hypertension and higher renal activity were risk factors for its occurrence in patients with LN.

Remission and low disease activity (LDA) prevent damage accrual in patients with systemic lupus erythematosus: results from the Systemic Lupus International Collaborating Clinics (SLICC) inception cohort

“…Remission off-treatment and on-treatment and LDA-TC but not mLLDAS were associated with a lower probability of renal and ophthalmological damage. In the case of renal damage, this may be related to better control of disease activity, as it has been associated with renal damage in other cohorts27 28 and/or to the self-selection of a greater number of non-renal lupus in the remissions and LDA groups. Similar to our results, a longer percentage of the follow-up on remission on-treatment and LLDAS (including remission) were associated with a lower rate of some items of renal damage (end-stage renal disease and glomerular filtration rate <50%) in the Hopkins cohort 9.…”

Evaluating the Construct of Damage in Systemic Lupus Erythematosus

“…Contemporary definitions are required for items such as pulmonary arterial hypertension, interstitial lung disease, renal impairment, osteoporotic fracture, cardiomyopathy, and stroke. For example, persistent proteinuria below the nephrotic range is predictive of a poor renal and overall prognosis (28)(29)(30)(31)(32). From a pediatric viewpoint, the SDI is missing items (e.g., growth restriction, delayed sexual maturation) (5).…”

Clinical and Genetic Risk Factors Associated With the Presence of Lupus Nephritis

“…In another study, complement component 4 genes, near the major histocompatibility complex locus, reportedly generated a seven-fold variation in SLE risk [ 36 ]. Furthermore, studies have reported that anti-Sm antibodies [ 5 ] and low complement [ 37 ] are not only risk factors for LN but might also help to predict treatment response [ 38 , 39 ]. Based on previous research, we could reasonably assume that there is an association between serologic markers, such as anti-Sm antibodies and low complement, and LN.…”