Survival Disparity of African American Versus Non–African American Patients With ESRD Due to SLE

Nee, Robert; Martinez-Osorio, Jorge; Yuan, Christina M.; Little, Dustin J.; Watson, Maura A.; Agodoa, Lawrence Y.; Abbott, Kevin C.

doi:10.1053/j.ajkd.2015.04.011

Cited by 45 publications

(33 citation statements)

References 24 publications

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“…The UK JSLE Cohort consisted of predominately Caucasian and Indian patients, whereas the ELC cohort comprised mainly African American and Hispanic patients. Notably, African and African American patients often have more severe kidney involvement in SLE [4, 34, 42]. Interestingly, within our study the optimal biomarker panel performed even better in the validation ELC than in the exploratory UK JSLE Cohort.…”

Section: Discussionmentioning

confidence: 63%

“…Since the JSLE phenotype and disease severity varies by ethnicity and race [2, 4, 34], we sought to confirm our results in a validation cohort from the USA [Einstein Lupus Cohort (ELC)] [35] in order to identify a urinary biomarker panel which is internationally applicable. Such a transatlantic comparison of a biomarker panel provides considerable strength to this study and the validation of this panel.…”

Section: Introductionmentioning

confidence: 99%

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International validation of a urinary biomarker panel for identification of active lupus nephritis in children

et al. 2016

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BackgroundConventional markers of juvenile-onset systemic lupus erythematosus (JSLE) disease activity fail to adequately identify lupus nephritis (LN). While individual novel urine biomarkers are good at detecting LN flares, biomarker panels may improve diagnostic accuracy. The aim of this study was to assess the performance of a biomarker panel to identify active LN in two international JSLE cohorts.MethodsNovel urinary biomarkers, namely vascular cell adhesion molecule-1 (VCAM-1), monocyte chemoattractant protein 1 (MCP-1), lipocalin-like prostaglandin D synthase (LPGDS), transferrin (TF), ceruloplasmin, alpha-1-acid glycoprotein (AGP) and neutrophil gelatinase-associated lipocalin (NGAL), were quantified in a cross-sectional study that included participants of the UK JSLE Cohort Study (Cohort 1) and validated within the Einstein Lupus Cohort (Cohort 2). Binary logistic regression modelling and receiver operating characteristic curve analysis [area under the curve (AUC)] were used to identify and assess combinations of biomarkers for diagnostic accuracy.ResultsA total of 91 JSLE patients were recruited across both cohorts, of whom 31 (34 %) had active LN and 60 (66 %) had no LN. Urinary AGP, ceruloplasmin, VCAM-1, MCP-1 and LPGDS levels were significantly higher in those patients with active LN than in non-LN patients [all corrected p values (p c) < 0.05] across both cohorts. Urinary TF also differed between patient groups in Cohort 2 (p c = 0.001). Within Cohort 1, the optimal biomarker panel included AGP, ceruloplasmin, LPGDS and TF (AUC 0.920 for active LN identification). These results were validated in Cohort 2, with the same markers resulting in the optimal urine biomarker panel (AUC 0.991).ConclusionIn two international JSLE cohorts, urinary AGP, ceruloplasmin, LPGDS and TF demonstrate an ‘excellent’ ability for accurately identifying active LN in children.Electronic supplementary materialThe online version of this article (doi:10.1007/s00467-016-3485-3) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 63%

Section: Introductionmentioning

confidence: 99%

International validation of a urinary biomarker panel for identification of active lupus nephritis in children

et al. 2016

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“…31, 32, 47 We found the rate of biopsy proven LN to be 61% in the PULSE cohort. The majority of biopsied patients in the PULSE cohort had Class III-IV lupus nephritis on biopsy at enrollment, while less than half of biopsied CARRA patients had Class III or IV lupus nephritis.…”

Section: Discussionmentioning

confidence: 75%

“…29 In high income countries, patients of African ancestry are two to three times more likely to develop LN with a more severe renal disease course, 30 and those with end-stage renal disease (ESRD) have higher mortality rates than Caucasians with ESRD. 31, 32 Furthermore, lupus nephritis is common in children. 33 PSLE patients have higher rates of renal damage and proceed to ESRD more frequently than their adult counterparts.…”

Section: Introductionmentioning

confidence: 99%

Severe disease presentation and poor outcomes among pediatric systemic lupus erythematosus patients in South Africa

Lewandowski

Schanberg

Thielman

et al. 2016

Lupus

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Background Systemic Lupus Erythematosus (SLE) is a life-threatening multisystem autoimmune disease that is more severe in patients of African ancestry and children, yet pediatric SLE (pSLE) on the African continent has been understudied. This study describes a cohort of pediatric SLE (PULSE) patients in South Africa (SA). Methods Patients with a diagnosis of SLE (1997 American College of Rheumatology criteria) diagnosed prior to age 19 years in Cape Town, South Africa, were enrolled in this cross-sectional study from September 2013 to December 2014. Information on clinical and serologic characteristics was extracted from medical records. Results were compared to a well-described North American pSLE cohort. Results Seventy-two SA patients were enrolled in the study; mean age 11.5 years, 82% female. The racial distribution was 68% Coloured, 24% Black, 5% White, and 3% Asian/Indian. Most patients presented with severe lupus nephritis (LN) documented by renal biopsy (61%). Of patients with LN, 63% presented with International Society of Nephrology/Renal Pathology Society (ISN/RPS) class III or IV. Patients in the PULSE cohort were more likely to be treated with cyclophosphamide, methotrexate, and azathioprine. The PULSE cohort had high disease activity at diagnosis (mean Systemic Lupus Erythematosus Disease Activity Index-2K [SLEDAI-2K] 20.6). The SLEDAI-2K at enrollment in the PULSE cohort (5.0) did not differ from the North American pSLE cohort (4.8). Sixty three % of PULSE cohort had end organ damage with System Lupus International Collaborating Clinic-Damage Index (SLICC-DI) score >0 (mean SLICC-DI 1.9), compared to 23% in a previously reported US cohort. Within the PULSE cohort, 9 (13%) developed ESRD with 6 (8%) requiring transplant, strikingly higher than North American peers (transplant rate <1%). Conclusions The PULSE cohort had highly active multiorgan disease at diagnosis and significant disease damage at enrollment in the SA registry. SA patients have severe lupus nephritis and poor renal outcomes compared to North American peers. Our study reveals a severe disease phenotype in the PULSE cohort resulting in poor outcomes in this high-risk population.

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“…Additionally, black and Hispanic SLE patients develop LN earlier (16), and have worse outcomes than white patients with SLE, including death and ESRD (10). This might explain why black individuals account for nearly half of those with ESRD due to LN (17). The more aggressive disease course in black individuals might be the result of a higher incidence of diffuse proliferative LN, or the presence of more high-risk features within the same LN histologic class when compared with white individuals (18).…”

Section: Epidemiologymentioning

confidence: 99%

Update on Lupus Nephritis

Almaani

Meara

Rovin

2016

CJASN

678

535

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SLE is a chronic inflammatory disease that affects the kidneys in about 50% of patients. Lupus nephritis is a major risk factor for overall morbidity and mortality in SLE, and despite potent anti-inflammatory and immunosuppressive therapies still ends in CKD or ESRD for too many patients. This review highlights recent updates in our understanding of disease epidemiology, genetics, pathogenesis, and treatment in an effort to establish a framework for lupus nephritis management that is patient-specific and oriented toward maintaining long-term kidney function in patients with lupus.

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Survival Disparity of African American Versus Non–African American Patients With ESRD Due to SLE

Cited by 45 publications

References 24 publications

International validation of a urinary biomarker panel for identification of active lupus nephritis in children

International validation of a urinary biomarker panel for identification of active lupus nephritis in children

Severe disease presentation and poor outcomes among pediatric systemic lupus erythematosus patients in South Africa

Update on Lupus Nephritis

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