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

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  • 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
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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
Issue number2
Pages (from-to)252-62
Number of pages11
Publication statusPublished - Sep 2016

ID: 46229950