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

John G. Hanly, Aidan G. O'Keeffe, Li Su, Murray B. Urowitz, Juanita Romero-Diaz, Caroline Gordon, Sang-Cheol Bae, Sasha Bernatsky, Ann E. Clarke, Daniel J. Wallace, Joan T. Merrill, David A. Isenberg, Anisur Rahman, Ellen M. Ginzler, Paul Fortin, Dafna D. Gladman, Jorge Sanchez-Guerrero, Michelle Petri, Ian N. Bruce, Mary Anne DooleyRosalind Ramsey-Goldman, Cynthia Aranow, Graciela S Alarcón, Barri J. Fessler, Kristjan Steinsson, Ola Nived, Gunnar K. Sturfelt, Susan Manzi, Munther A. Khamashta, Ronald F van Vollenhoven, Asad A. Zoma, Manuel Ramos-Casals, Guillermo Ruiz-Irastorza, S. Sam Lim, Thomas Stoll, Murat Inanc, Kenneth C. Kalunian, Diane L. Kamen, Peter Maddison, Christine A. Peschken, Soren Jacobsen, Anca Askanase, Chris Theriault, Kara Thompson, Vernon Farewell

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

OBJECTIVE: To determine nephritis outcomes in a prospective multi-ethnic/racial SLE inception cohort.

METHODS: 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.

RESULTS: 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.

CONCLUSION: 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.

Original languageEnglish
Pages (from-to)252-62
Number of pages11
JournalRheumatology
Volume55
Issue number2
DOIs
Publication statusPublished - Feb 2016

Cite this

Hanly, J. G., O'Keeffe, A. G., Su, L., Urowitz, M. B., Romero-Diaz, J., Gordon, C., ... Farewell, V. (2016). The frequency and outcome of lupus nephritis: results from an international inception cohort study. Rheumatology, 55(2), 252-62. https://doi.org/10.1093/rheumatology/kev311