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; 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

doi:10.1093/rheumatology/kev311

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

Center for Rheumatology and Spine Diseases

272 Citations (Scopus)

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 language	English
Journal	Rheumatology
Volume	55
Issue number	2
Pages (from-to)	252-62
Number of pages	11
ISSN	1462-0324
DOIs	https://doi.org/10.1093/rheumatology/kev311
Publication status	Published - Sep 2016

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Hanly, J. G., O'Keeffe, A. G., Su, L., Urowitz, M. B., Romero-Diaz, J., Gordon, C., Bae, S-C., Bernatsky, S., Clarke, A. E., Wallace, D. J., Merrill, J. T., Isenberg, D. A., Rahman, A., Ginzler, E. M., Fortin, P., Gladman, D. D., Sanchez-Guerrero, J., Petri, M., Bruce, I. N., ... 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, 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

@article{d25ce1048f8d4f53b8be0cab56672dbb,

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.",

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 = "{\textcopyright} 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 = sep,

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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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

PY - 2016/9

Y1 - 2016/9

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.

U2 - 10.1093/rheumatology/kev311

DO - 10.1093/rheumatology/kev311

M3 - Journal article

C2 - 26342222

VL - 55

SP - 252

EP - 262

JO - Rheumatology

JF - Rheumatology

SN - 1462-0324

IS - 2

ER -

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

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