Severe infections in patients with lupus nephritis treated with immunosuppressants: A retrospective cohort study

Lim, Cynthia Ciwei; Liu, Pei Yun; Tan, Hui Zhuan; Lee, Peishan; Chin, Yok Mooi; Mok, Irene; Chan, Choong Meng; Choo, Jason

doi:10.1111/nep.12809

Cited by 24 publications

(21 citation statements)

References 30 publications

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“…32 It is thus important to minimise occurrence and duration of flares with adequate immunosuppressive therapy, balanced against the risk of immunosuppressant-related complications such as infections. 33 Other studies also identified gender, 13,26,34 proteinuria 13,26,29 and histological class 25 to affect renal progression. Among the eight patients seronegative for both ANA and anti-dsDNA, four had membranous lupus nephropathy.…”

Section: Discussionmentioning

confidence: 99%

“…The Ohio SLE study found that renal flare for more than 30% of the follow‐up duration was independently associated with developing new or progressive CKD (odds ratio 20, 95% confidence interval 4.6–91.3) . It is thus important to minimise occurrence and duration of flares with adequate immunosuppressive therapy, balanced against the risk of immunosuppressant‐related complications such as infections …”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Long‐term renal outcomes in multi‐ethnic Southeast Asians with lupus nephritis: a retrospective cohort study

Lim

Tan

Ying

et al. 2018

Internal Medicine Journal

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Long‐term renal outcomes in multi‐ethnic Southeast Asians with lupus nephritis: a retrospective cohort study

Lim

Tan

Ying

et al. 2018

Internal Medicine Journal

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“…The observed increased risk of infection has been attributed to both SLE itself and the use of immunosuppressant therapies . It has been noted that those with lupus nephritis (LN) may be at higher risk of infection compared to SLE patients without LN . Our prior work has demonstrated that infections were very common and associated with high mortality among adults with SLE enrolled in Medicaid in the US between 2000–2006, and that infection was the second most common cause of death among children with LN‐associated end‐stage renal disease in the US from 1995 to 2006 .…”

Section: Introductionmentioning

confidence: 99%

Serious Infection Rates Among Children With Systemic Lupus Erythematosus Enrolled in Medicaid

Hiraki

Feldman

Marty

et al. 2017

Arthritis Care & Research

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Objective To investigate the nationwide prevalence and incidence of serious infections among children with systemic lupus erythematosus (SLE) enrolled in Medicaid, the U.S. health insurance program for low-income patients. Methods From Medicaid claims (2000–2006) we identified children 5 to <18 years old with SLE (≥3 ICD-9 codes of 710.0, each >30 days apart) and lupus nephritis (LN; ≥2 ICD-9 codes for kidney disease on/after SLE codes). From hospital discharge diagnoses, we identified infection subtypes (bacterial, fungal, viral). We calculated incidence rates (IR) per 100 person-years (PY), mortality rates, and hazard ratios adjusted for sociodemographic factors, medications, and preventive care. Results Among 3,500 children with SLE identified, 1,053 serious infections occurred over 10,108 person-years; the IR was 10.42/100 PY (95% CI 9.80, 11.07) among all those with SLE and 17.65/100 PY (95% CI 16.29, 19.09) among those with LN. Bacterial infections were most common (87%; of which 39% were bacterial pneumonias). In adjusted models, African Americans and Native Americans had higher rates of infections compared with white children, and those with comorbidities or receiving corticosteroids had higher infection rates than those without. Males had lower rates of serious infections compared to females. The 30-day post-discharge mortality rate was 4.4%. Conclusions Overall, hospitalized infections were very common in children with SLE, with bacterial pneumonia being the most common infection. Highest infection risks were among African and Native American children, those with LN, comorbidities, and those taking corticosteroids.

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“…However, intrinsic factors related to the pathophysiology of SLE are implicated in susceptibility to infection in patients with SLE. For example, relapse of lupus nephritis [63] and exacerbation of SLE [64] were demonstrated to be risk factors for infection. Zonana-Nacach et al investigated the risk factors for infection in 200 outpatients with SLE over an average follow-up period of 22 months [65].…”

Section: Risk Factors For Infection In Slementioning

confidence: 99%

Systemic lupus erythematosus and immunodeficiency

Sawada

Fujimori

Yamamoto

2019

Immunological Medicine

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Systemic lupus erythematosus (SLE) is a prototypic systemic autoimmune disease that develops in genetically susceptible individuals in response to environmental factors. SLE and primary immunodeficiency disease (PID) share some clinical manifestations in that certain PIDs present with autoimmune phenomena. Patients with SLE become susceptible to infection via three pathways. First, SLE and PID share some genetic factors, such as complement and mannose-binding lectin genes, which predispose patients to infection. Second, patients with SLE have an inherently high risk of infection because of their intrinsic immunological abnormalities induced by SLE. Third, patients with SLE receiving immunosuppressive treatment are at high risk of infection. Further studies delineating the abnormalities related to both autoimmunity and immunodeficiency would be warranted to identify a new potential drug target for SLE.

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Severe infections in patients with lupus nephritis treated with immunosuppressants: A retrospective cohort study

Abstract: Serious infections are common among patients with LN and are associated with mortality.

Cited by 24 publications

References 30 publications

Long‐term renal outcomes in multi‐ethnic Southeast Asians with lupus nephritis: a retrospective cohort study

Long‐term renal outcomes in multi‐ethnic Southeast Asians with lupus nephritis: a retrospective cohort study

Serious Infection Rates Among Children With Systemic Lupus Erythematosus Enrolled in Medicaid

Systemic lupus erythematosus and immunodeficiency

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