Causes and predictors of mortality in biopsy-proven lupus nephritis: the Sarawak experience

Abstract

BackgroundLupus nephritis (LN) is a serious manifestation of systemic lupus erythematosus that can be fatal if left untreated. The causes and prognostic predictors of mortality in LN have been well studied in developed countries but evidence is lacking for developing countries. The objective of this study was to investigate the causes and predictors of mortality in a cohort of Malaysian patients with biopsy-proven LN.MethodsWe retrospectively studied all patients with biopsy-proven LN treated in Sarawak General Hospital during the period of 2000–15. Demographic data, clinical features and outcomes were collected. Cox regression analysis was carried out to determine the independent predictors of mortality.ResultsThere was a total of 250 patients with 259 renal biopsies available for our analysis. Our patients were of multi-ethnic origins with a female predominance (90%). Their mean ± standard deviation age was 37.7 ± 12.8 years. The patients had a mean disease duration of 135.6 ± 81.9 months. Nephrotic syndrome was the most common presentation (29.6%) and acute renal failure was evident at initial presentation in 16% of patients. Class IV LN was the predominant biopsy class within the cohort (66.8%). The majority of patients achieved remission (81.2%) and had normal renal function (83.9%) at the last follow-up. The 5-, 10-, 15- and 20-year survival rates for our cohort were 93%, 88%, 82% and 77%, respectively. There were 37 deaths (14.8%), of which the main causes were: infection and flare (52.7%), infection alone (25.0%) and other causes (22.3%). Independent predictors of mortality in our cohort of LN patients were: the presence of acute kidney injury at presentation [hazard ratio (HR) 3.41; confidence interval (CI) 1.50–7.76], failure to achieve remission at 1-year post-induction therapy (HR 2.99; CI 1.35–6.65) and non-compliance with treatment (HR 1.89; CI 1.22–2.96). Age, ethnicity, class of LN and type of immunosuppressant used were not predictive of mortality.ConclusionsSurvival and renal outcomes in our LN cohort were comparable to most LN studies reported worldwide. Both flare and infection remained the main causes of death. The presence of acute renal failure at presentation, failure to achieve remission at 1 year post-treatment and non-compliance with treatment were independent prognostic predictors of mortality in LN.

Factors predictive of long-term mortality in lupus nephritis: a multicenter retrospective study of a Japanese cohort

“…However, few studies have examined the long-term prognosis in LN (i.e., over a follow-up period >10 years). 5,[17][18][19][20][21][22][23][24] To our knowledge, the present study is the first to show an association between the long-term survival rate and therapeutic responses in a cohort of Japanese patients with LN. We found that the 5-, 10-, 15-and 20-year survival rates in our cohort were 99.3%, 94.6%, 92.0% and 85.4%, respectively, which were comparable to the previously reported survival rates.…”

“…We found that the 5-, 10-, 15-and 20-year survival rates in our cohort were 99.3%, 94.6%, 92.0% and 85.4%, respectively, which were comparable to the previously reported survival rates. 2,5,19 The survival rate of our LN patients was significantly correlated with the achievement of CR at 12 months after induction therapy. A previous study found that the survival rate was greater in patients who achieved CR or PR than in those with no remission.…”

The long-term outcomes and histological transformation in class II lupus nephritis

“…Between 25% and 50% of SLE patients will have evidence of LN at disease onset, and up to 60% may later develop renal disease, which is considered to be a major contributor to morbidity and mortality. 1 , 2 Patients with class II LN have excellent prognosis and outcomes compared to other classes (III, IV, and V). 3 However, there are discrepancies in the guidelines on the treatment of class II LN due to a lack of evidence.…”

Retinoic Acid Exerts Disease Stage-Dependent Effects on Pristane-Induced Lupus

“…Lupus nephritis affects about 50 to 60% of SLE patients and could be fatal if left without an effective treatment (69,70). Glomerulonephritis could result from increased proliferation of mesangial cells (the cells forming the glomerulus) and accumulation of extracellular matrix (ECM) that could lead to tissue scarring and loss of renal functionality (71).…”