The frequency and outcome of lupus nephritis: results from an international inception cohort study

• Published in: Rheumatology (Oxford, England) Vol. 55; no. 2; pp. 252 - 262
• Main Authors: Hanly, John G., O’Keeffe, Aidan G., Su, Li, Urowitz, Murray B., Romero-Diaz, Juanita, Gordon, Caroline, Bae, Sang-Cheol, Bernatsky, Sasha, Clarke, Ann E., Wallace, Daniel J., Merrill, Joan T., Isenberg, David A., Rahman, Anisur, Ginzler, Ellen M., Fortin, Paul, Gladman, Dafna D., Sanchez-Guerrero, Jorge, Petri, Michelle, Bruce, Ian N., Dooley, Mary Anne, Ramsey-Goldman, Rosalind, Aranow, Cynthia, Alarcón, Graciela S., Fessler, Barri J., Steinsson, Kristjan, Nived, Ola, Sturfelt, Gunnar K., Manzi, Susan, Khamashta, Munther A., van Vollenhoven, Ronald F., Zoma, Asad A., Ramos-Casals, Manuel, Ruiz-Irastorza, Guillermo, Lim, S. Sam, Stoll, Thomas, Inanc, Murat, Kalunian, Kenneth C., Kamen, Diane L., Maddison, Peter, Peschken, Christine A., Jacobsen, Soren, Askanase, Anca, Theriault, Chris, Thompson, Kara, Farewell, Vernon
• Format: Journal Article
• Language: English
• Published: England Oxford University Press 01.02.2016
• Subjects: Adult; Clinical Medicine; Clinical Science; Disease Progression; Ethnicity; Female; Follow-Up Studies; Global Health; Humans; Incidence; Klinisk medicin; Lupus Nephritis - diagnosis; Lupus Nephritis - ethnology; Male; Medical and Health Sciences; Medicin och hälsovetenskap; Outcome Assessment, Health Care; Prospective Studies; Quality of Life; Risk Factors; Surveys and Questionnaires; Survival Rate - trends; nephritis; systemic lupus erythematosus; outcomes research; inception cohort; lupus
• DOI: 10.1093/rheumatology/kev311
• ISSN: 1462-0324; 1462-0332

To determine nephritis outcomes in a prospective multi-ethnic/racial SLE inception cohort. Patients in the Systemic Lupus International Collaborating Clinics inception cohort (≤15 months of SLE diagnosis) were assessed annually for estimated glomerular filtration rate (eGFR), proteinuria and end-stage renal disease (ESRD). Health-related quality of life was measured by the Short Form (36 questions) health survey questionnaire (SF-36) subscales, mental and physical component summary scores. There were 1827 patients, 89% females, mean (s.d.) age 35.1 (13.3) years. The mean (s.d.) SLE duration at enrolment was 0.5 (0.3) years and follow-up 4.6 (3.4) years. LN occurred in 700 (38.3%) patients: 566/700 (80.9%) at enrolment and 134/700 (19.1%) during follow-up. Patients with nephritis were younger, more frequently men and of African, Asian and Hispanic race/ethnicity. The estimated overall 10-year incidence of ESRD was 4.3% (95% CI: 2.8%, 5.8%), and with nephritis was 10.1% (95% CI: 6.6%, 13.6%). Patients with nephritis had a higher risk of death (HR = 2.98, 95% CI: 1.48, 5.99; P = 0.002) and those with eGFR <30 ml/min at diagnosis had lower SF-36 physical component summary scores (P < 0.01) and lower Physical function, Physical role and Bodily pain scores. Over time, patients with abnormal eGFR and proteinuria had lower SF-36 mental component summary (P ≤ 0.02) scores compared to patients with normal values. LN occurred in 38.3% of SLE patients, frequently as the initial presentation, in a large multi-ethnic inception cohort. Despite current standard of care, nephritis was associated with ESRD and death, and renal insufficiency was linked to lower health-related quality of life. Further advances are required for the optimal treatment of LN.