Prognostic Aspects of Lupus Nephritis at Aristide Le Dantec University Hospital in Dakar

Abstract

Introduction: Kidney injury is common in the course of lupus and affects the functional and vital prognosis. The risk of progression to end-stage renal failure can reach 40% to 60%. Thus we carried out this work for the purpose of an evaluation of the renal and vital prognosis and to deduce the factors of poor prognosis. Patients and method: This was a retrospective, descriptive and analytical study conducted over a period of 10 years from January 1, 2007 to December 31, 2016, performed in the Nephrology Department of Aristide Le Dantec Hospital in Dakar. Patients with lupus nephritis were included. The studied parameters were epidemiological, clinical, paraclinical and progression. We had done a crossover of the patients to look for the factors of poor renal and vital prognosis. Results: Out of 93 cases of lupus patients, 64 were included, a prevalence of 69%. The mean age of the patients was 31.97 ± 10.44 years old. There were 81% women and 19% men, a sex ratio of 0.23. Class III was found in 24 cases (37.5%), Class IV in 20 cases (31.25%), Class V in 15 cases (23.4%), Class II in 4 cases (6.25%) and Class I in 1 case (1.6%). The combination of corticosteroids and immunosuppressants was used in 56.25% of cases. After a follow-up of six months, 19 patients were in complete remission, 21 had resistance and 9 had partial remission. Of the 21 patients who had resistance, 8 were in chronic renal failure. Death was observed in 5 patients and the causes were in 3 patients: pulmonary embolism, bacterial meningitis and pulmonary tuberculosis. The cause of death was unknown in 2 patients. The factors of poor renal prognosis were lymphopenia, the presence of anti-native DNA antibodies, nephrotic syndrome, microscopic hematuria, tubular atrophy and interstitial fibrosis. Risk factors affecting renal survival were the presence of native anti-DNA antibodies, microscopic hematuria, leukocyturia and the presence of a proliferative class. The factors of poor prognosis were renal failure, lymphopenia, nephrotic syndrome, glo

Management Practice and Treatment Outcomes of Adult Patients with Lupus Nephritis at the Renal Clinic of St. Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia

“…Kidney biopsy was done for 71(62.3%) patients at initial presentation and most of them were classi ed as class IV 28(24.6%) followed by class III 20(17.5%). This is similar to the ndings in India [25], Egypt [34], South Africa [31], Tunisia [28] and Senegal [29] as class IV and class III were the commonest kidney biopsy in LN patients at the initial presentation.…”

“…In addition, 7(6.14%) patients progressed/reached to ESRD and death occurred in 4(3.51%) patients. This is comparable to the ndings of South Africa [39], India [25], Morocco [23], Senegal [29,35] and Eastern India [40]. However, there are slight variations due to different study design, sample size, race of study participants, type of regimen, outcome criteria and diagnostic tests used.…”

“…The study done in India reported 33.3% of the patients had hypertension and 34% nephrotic range proteinuria at the initial presentation [25]. Edema, nephrotic syndrome, hypertension and hematuria, the most common initial clinical presentations in LN patients, were found similar with other studies [28][29][30][31]33].…”

“…The age range in this study was from 18 -63 years and 56.1% of the patients were found below 30 years. The sex ratio is lower compared to studies done in Morocco, 7.8:1 [23], South Africa, 7.4:1 [24], Southern India, 8:1 [25] and Saudi Arabia, 8.3:1 [26] but higher compared to Egypt, 5.4:1 [27], Tunisia, 5.8:1 [28], Senegal, 4.3:1 [29] and Jordan, 6.2:1 [30]. The age distribution is comparable and slightly lower compared to studies from Morocco [23], Jordan [30], South Africa [31], Kenya [32], Saudi Arabia [26] and Senegal [29].…”

“…The sex ratio is lower compared to studies done in Morocco, 7.8:1 [23], South Africa, 7.4:1 [24], Southern India, 8:1 [25] and Saudi Arabia, 8.3:1 [26] but higher compared to Egypt, 5.4:1 [27], Tunisia, 5.8:1 [28], Senegal, 4.3:1 [29] and Jordan, 6.2:1 [30]. The age distribution is comparable and slightly lower compared to studies from Morocco [23], Jordan [30], South Africa [31], Kenya [32], Saudi Arabia [26] and Senegal [29]. But the mean age in this study is slightly higher than the results of a study in Tunisia [28] and Southern India [25].…”