Renal histology in Indigenous Australians with lupus nephritis

Ghazanfari, Farshad; Jabbar, Zulfikar; Nossent, Jiri

doi:10.1111/1756-185x.13147

Cited by 8 publications

(18 citation statements)

References 27 publications

(31 reference statements)

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“…15 This may relate to differences in the ethnicity of the catchment population as the AIR for Caucasians in WA (0.44) is comparable with the incidence range reported both from the UK (0.4), Scandinavia (0.5) and the NT. 15,27,28 . In contrast, the AIR for LN was four to seven times higher in all other ethnic subgroups with the highest incidence observed in Asians and IA, confirming findings in the NT 15 and the over-representation of LN in Asians observed in Melbourne.…”

Section: Discussionsupporting

confidence: 60%

“…The overall AIR for biopsy-proven LN at 0.75 in WA corresponds with the AIR of 0.49 reported by Yong from South West Sydney, 26 while both are lower than the 2.1 AIR reported from the Northern Territory (NT). 15 This may relate to differences in the ethnicity of the catchment population as the AIR for Caucasians in WA (0.44) is comparable with the incidence range reported both from the UK (0.4), Scandinavia (0.5) and the NT. 15,27,28 .…”

Section: Discussionsupporting

confidence: 60%

“…The main feature was an increased frequency of class II lesions in IA (27.3 % vs 5.4% in all other patients) which is nearly similar to the 25% vs 8.5% rate observed in a study from the NT. 15 A large recent study also documented mesangial LN in 7% of Chinese patients where it was found to be a poor prognostic sign, mainly due to its subsequent progression to proliferative disease. This confirms experimental evidence that mesangial abnormalities are a precursor for proliferative LN development 33 and indicates that the finding of class II LN especially in IA patients still requires close monitoring.…”

Section: Discussionmentioning

confidence: 95%

“…15,27,28 . In contrast, the AIR for LN was four to seven times higher in all other ethnic subgroups with the highest incidence observed in Asians and IA, confirming findings in the NT 15 and the over-representation of LN in Asians observed in Melbourne. 17 While these data are not surprising given the overall higher incidence of SLE and LN in other populations worldwide, 14,29 it clearly illustrates how the landscape for LN in (Western) Australia has changed over time.…”

Section: Discussionmentioning

confidence: 99%

“…[11][12][13] Non-Caucasian populations globally demonstrate a higher prevalence and more severe evolution of SLE, 14 and in Australia a higher frequency of LN has been observed especially in Indigenous Australians (IA). 15,16 Asian emigrants to Australia seem to be at similar risk of developing LN as those living in Asia, where improved renal and overall survival rates have been observed over the last decades. 17,18 Whether the discrepancies in LN frequency and severity represent true ethnic differences in the pathogenesis of LN or reflect underlying socioeconomic differences remains under debate.…”

Section: Introductionmentioning

confidence: 98%

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The current role for clinical and renal histological findings as predictor for outcome in Australian patients with lupus nephritis

Nossent

Raymond

Kang

et al. 2018

Lupus

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Objectives To investigate the current demographic, clinical and histological characteristics of patients with lupus nephritis (LN) in Western Australia (WA) with regards to their predictive value for patient and renal outcome. Methods Retrospective study of adult systemic lupus erythematosus (SLE) patients with a first renal biopsy demonstrating LN between 1997 and 2017 at a metropolitan tertiary hospital in WA. Clinical data were collected at baseline and last follow-up with renal biopsy findings classified by International Society of Nephrology (ISN) criteria. Annual incidence rates (AIRs)/100,000, Kaplan-Meyer curves and Cox regression hazard ratio for independent predictors for patient and renal survival were applied. Results The AIR was 3.3, 3.1 and 0.4 for Asian ( n = 29), Indigenous Australian (IA) ( n = 11) and Caucasian ( n = 43) patients, respectively ( p < 0.01). There was no significant subgroup difference regarding ISN class (proliferative 66%, membranous 19%, mesangial 15%), levels of proteinuria (median PCR 300 mg/mmol) or frequency of raised creatinine (31%), anti-dsDNA antibody (89%) or hypocomplementaemia (88%). Treatment included corticosteroids (91%), cyclophosphamide (30%), mycophenolate (67%) and antihypertensive drugs (67%). Five- (81%) and 10-year (70%) survival was lower for IAs than for Caucasians and Asians (95% each at both time points) ( p = 0.016). Five- and 10-year renal survival (endpoint renal replacement therapy (RRT)) was 86% and 64% for IA vs 100% for Asian, 100% and 96% for Caucasian patients ( p = 0.02). IA background was the only independent predictor for poor patient survival and together with male gender also for renal survival. Only 25% of all patients remained free of any organ damage with non-renal damage observed in 53% of survivors. Conclusions LN incidence in WA was 0.75/100,000 with the lowest rate observed in Caucasians. While Asian patients have the same favourable outlook as Caucasians, the outcome is much bleaker for IA patients. Other clinical and histological findings did not predict outcomes, and importantly more than half of all surviving patients accrued non-renal damage.

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