Chronic kidney disease in patients with lupus nephritis—Important but underrecognized

Abstract

Chronic kidney disease in patients with lupus nephritis-Important but underrecognizedLupus nephritis (LN) affects 30%-60% of patients with systemic lupus erythematosus (SLE) and is a leading cause of severe acute glomerulonephritis among Asians. Despite significant advances in LN management over the past decades, progression to end-stage kidney disease (ESKD) has remained largely unchanged over the last two decades and still occurs in 10%-20% of LN patients. 1 As LN has a relapsing cause, chronic kidney disease (CKD) is prevalent due to repeated episodes of acute nephritis, which lead to progressive attrition of kidney reserve. CKD in LN is often underrecognized since serum creatinine can remain within the "normal range" despite significant reduction in kidney function, especially in Asian females with small body size. Additionally, the presence of CKD has important implications on clinical management, including the choice and optimum dose of immunosuppressive medications. | CK D PRE VALEN CE IN LNThe reported prevalence of CKD in LN patients ranges from around 10% to approaching 50%. [2][3][4][5][6][7][8][9] Multiple factors contribute to the marked variation in reported prevalence rates, including variations in the duration of follow-up (4-14 years), differences in baseline patient characteristics, different definitions of abnormal kidney function, and different treatments. As CKD is progressive, longer follow-up durations are associated with higher prevalence rates. Reports on Caucasian patients stated seemingly lower CKD prevalence rates of 19%-24%, 2,7,8 compared with 11.5%-47.6% in reports from Asia, Middle East, and South America. [3][4][5][6]9 In addition to differences in genetic background and disease severity, access to health care and medications, and socioeconomic factors including adherence to clinical management, are likely confounding factors.