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 Dooley & 25 others Rosalind 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
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. / The frequency and outcome of lupus nephritis : results from an international inception cohort study. In: Rheumatology. 2016 ; Vol. 55, No. 2. pp. 252-62.
@article{7c3e4f3c69504296a33e76ee53b74655,
title = "The frequency and outcome of lupus nephritis: results from an international inception cohort study",
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.",
keywords = "Adult, Disease Progression, Ethnic Groups, Female, Follow-Up Studies, Global Health, Humans, Incidence, Lupus Nephritis, Male, Outcome Assessment (Health Care), Prospective Studies, Quality of Life, Risk Factors, Surveys and Questionnaires, Survival Rate, Journal Article, Multicenter Study, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't",
author = "Hanly, {John G.} and O'Keeffe, {Aidan G.} and Li Su and Urowitz, {Murray B.} and Juanita Romero-Diaz and Caroline Gordon and Sang-Cheol Bae and Sasha Bernatsky and Clarke, {Ann E.} and Wallace, {Daniel J.} and Merrill, {Joan T.} and Isenberg, {David A.} and Anisur Rahman and Ginzler, {Ellen M.} and Paul Fortin and Gladman, {Dafna D.} and Jorge Sanchez-Guerrero and Michelle Petri and Bruce, {Ian N.} and Dooley, {Mary Anne} and Rosalind Ramsey-Goldman and Cynthia Aranow and Alarc{\'o}n, {Graciela S} and Fessler, {Barri J.} and Kristjan Steinsson and Ola Nived and Sturfelt, {Gunnar K.} and Susan Manzi and Khamashta, {Munther A.} and {van Vollenhoven}, {Ronald F} and Zoma, {Asad A.} and Manuel Ramos-Casals and Guillermo Ruiz-Irastorza and Lim, {S. Sam} and Thomas Stoll and Murat Inanc and Kalunian, {Kenneth C.} and Kamen, {Diane L.} and Peter Maddison and Peschken, {Christine A.} and Soren Jacobsen and Anca Askanase and Chris Theriault and Kara Thompson and Vernon Farewell",
note = "{\circledC} The Author 2015. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oup.com.",
year = "2016",
month = "2",
doi = "10.1093/rheumatology/kev311",
language = "English",
volume = "55",
pages = "252--62",
journal = "Rheumatology",
issn = "1462-0324",
publisher = "Oxford University Press",
number = "2",

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Hanly, JG, O'Keeffe, AG, Su, L, Urowitz, MB, Romero-Diaz, J, Gordon, C, Bae, S-C, Bernatsky, S, Clarke, AE, Wallace, DJ, Merrill, JT, Isenberg, DA, Rahman, A, Ginzler, EM, Fortin, P, Gladman, DD, Sanchez-Guerrero, J, Petri, M, Bruce, IN, Dooley, MA, Ramsey-Goldman, R, Aranow, C, Alarcón, GS, Fessler, BJ, Steinsson, K, Nived, O, Sturfelt, GK, Manzi, S, Khamashta, MA, van Vollenhoven, RF, Zoma, AA, Ramos-Casals, M, Ruiz-Irastorza, G, Lim, SS, Stoll, T, Inanc, M, Kalunian, KC, Kamen, DL, Maddison, P, Peschken, CA, Jacobsen, S, Askanase, A, Theriault, C, Thompson, K & Farewell, V 2016, 'The frequency and outcome of lupus nephritis: results from an international inception cohort study' Rheumatology, vol. 55, no. 2, pp. 252-62. https://doi.org/10.1093/rheumatology/kev311

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

In: Rheumatology, Vol. 55, No. 2, 02.2016, p. 252-62.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - The frequency and outcome of lupus nephritis

T2 - results from an international inception cohort study

AU - Hanly, John G.

AU - O'Keeffe, Aidan G.

AU - Su, Li

AU - Urowitz, Murray B.

AU - Romero-Diaz, Juanita

AU - Gordon, Caroline

AU - Bae, Sang-Cheol

AU - Bernatsky, Sasha

AU - Clarke, Ann E.

AU - Wallace, Daniel J.

AU - Merrill, Joan T.

AU - Isenberg, David A.

AU - Rahman, Anisur

AU - Ginzler, Ellen M.

AU - Fortin, Paul

AU - Gladman, Dafna D.

AU - Sanchez-Guerrero, Jorge

AU - Petri, Michelle

AU - Bruce, Ian N.

AU - Dooley, Mary Anne

AU - Ramsey-Goldman, Rosalind

AU - Aranow, Cynthia

AU - Alarcón, Graciela S

AU - Fessler, Barri J.

AU - Steinsson, Kristjan

AU - Nived, Ola

AU - Sturfelt, Gunnar K.

AU - Manzi, Susan

AU - Khamashta, Munther A.

AU - van Vollenhoven, Ronald F

AU - Zoma, Asad A.

AU - Ramos-Casals, Manuel

AU - Ruiz-Irastorza, Guillermo

AU - Lim, S. Sam

AU - Stoll, Thomas

AU - Inanc, Murat

AU - Kalunian, Kenneth C.

AU - Kamen, Diane L.

AU - Maddison, Peter

AU - Peschken, Christine A.

AU - Jacobsen, Soren

AU - Askanase, Anca

AU - Theriault, Chris

AU - Thompson, Kara

AU - Farewell, Vernon

N1 - © The Author 2015. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

PY - 2016/2

Y1 - 2016/2

N2 - 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.

AB - 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.

KW - Adult

KW - Disease Progression

KW - Ethnic Groups

KW - Female

KW - Follow-Up Studies

KW - Global Health

KW - Humans

KW - Incidence

KW - Lupus Nephritis

KW - Male

KW - Outcome Assessment (Health Care)

KW - Prospective Studies

KW - Quality of Life

KW - Risk Factors

KW - Surveys and Questionnaires

KW - Survival Rate

KW - Journal Article

KW - Multicenter Study

KW - Research Support, N.I.H., Extramural

KW - Research Support, Non-U.S. Gov't

U2 - 10.1093/rheumatology/kev311

DO - 10.1093/rheumatology/kev311

M3 - Article

VL - 55

SP - 252

EP - 262

JO - Rheumatology

JF - Rheumatology

SN - 1462-0324

IS - 2

ER -