Risk Factors for Renal Failure in Patients with Lupus Nephritis: Data from the Spanish Registry of Glomerulonephritis

Abstract

Background: Lupus nephritis (LN) is a severe complication of systemic lupus erythematosus. Data from national registries based on renal biopsies are scarce. The aim of our study was to analyze the demographic characteristics, clinicopathological correlations, and risk factors associated with renal failure in patients with LN at the time of renal biopsy. Methods: We performed a cross-sectional observational study based on data from the Spanish Registry of Glomerulonephritis for the years 1994–2009. The outcome measure was the presence of renal failure (eGFR <60 ml/min/1.73 m²). We also recorded age, gender, proteinuria levels, hypertension, and histological class. Results: We collected 17,525 native renal biopsies, of which 1,648 biopsies showed LN lesions. In total, 609 patients (37%) showed renal failure at the time of renal biopsy. The univariate analysis showed that these patients were older, had higher levels of proteinuria, and a higher prevalence of hypertension than the group with eGFR ≥60 ml/min/ 1.73 m². The histological class of LN was recorded for 566 patients, and multivariate logistic regression analysis showed that the independent risk factors for renal failure at the time of renal biopsy were age (OR 1.03; 95% CI 1.01–1.04), male gender (OR 1.94; 95% CI 1.12–3.10), hypertension (OR 3.18; 95% CI 2.16–4.67), proteinuria (OR 1.15; 95% CI 1.08–1.24), and histological classes III and IV (OR 1.82; 95% CI 1.16–2.87). Conclusions: Data from the Spanish Registry of Glomerulonephritis provide valuable information about risk factors for renal failure in patients with LN at the time of renal biopsy.

Clinicopathological and outcome analysis of adult lupus nephritis patients in China

“…In multivariants survival analysis, we found that SBP, Scr, hypocomplementemia, severe proliferative lesion (LN IV or VI) and SLEDAI score are independent indicators of poor renal outcome in LN patients. Our findings were somewhat different to those reported [10,15,16]. Although hypocomplementemia and SLEDAI score are commonly assumed as indicators of active lupus [17], our study is the first one that identifies them as independent risk factor for poor renal outcome.…”

“…Despite the opinion that outcome of LN was related to renal pathological lesions, only few studies were performed to clarify this hypothesis [9,10]. In this study, we found that disease severity and organ damage in LN II were mild.…”

“…In this study, we found that LN V is totally different to LN III and IV both in pathologic changes and clinical features. Large amount of proteinuria, severe hypoalbuminemia with normal renal function, similar to IMN [9][10][11][12], is the main characteristics of LN V. Renal outcome of LN VI patients is very poor; all the patients progressed to ESRD during follow-up in spite of treatment applied. Therefore, no immunosuppressive therapy should be initiated in these patients.…”

LUPUS NEPHRITIS- A STUDY ON CLINICAL & HISTOMORPHOLOGICAL VARIABLES IN RELATION TO PROGNOSIS, IN NORTH KERALA

“…However, in the same study initial elevation of serum creatinine concentration did not influence the prognosis. 12 Initial heavy proteinuria or even nephrotic syndrome did not have bearing on ultimate prognosis in our series. The levels of serum creatinine on the other hand were found to affect prognosis.…”

“…12,[17][18][19] Of these the Chronicity index and its components have been more consistently found to correlate with long term prognosis. 20 In our study Chronicity indices and two of its componentstubular dilatation and interstitial fibrosis were found to be significant.…”