Why do patients with lupus nephritis die?

Abstract

Over 20 years 42 of 138 patients with systemic lupus erythematosus "died"-that is, suffered actual death or went into terminal renal failure, or both; data from 41 were available for analysis. In most patients the causes of death were multiple. Twenty seven patients went into terminal renal failure, of whom 25 were offered dialysis treatment. Three regained renal function later, 12 survived on dialysis or with functioning kidney allografts-almost ali with inactive lupus-but 13 died after starting dialysis, most within a few weeks or months. The principal causes were active lupus or infection. In those patients with renal failure after rapid deterioration in renal function (n=14) there were nine deaths, while of 10 patients with a slow evolution into renal failure, only four died.Four patients with impaired and 10 with normal renal function died, again most often from complications of lupus or from infection. Vascular disease was a major cause of death in seven patients, all but two of whom were young; of 15 postmortem examinations, eight showed severe coronary artery atheroma, and three surviving patients required coronary bypass operations. Analysis of the timing of death or entry into renal failure showed that in 12 out of 13 patients who died within two years of onset the lupus was judged to be active, while this was true in only eight out of 19 patients who died later. Six of the seven vascular deaths occurred later than two years from onset, while only nine of 26 renal "deaths" occurred before two years; deaths from infections (n=13) were distributed equally. Despite this and aggressive treatment of active disease, the principal cause of actual death was uncontrolled lupus.

Systemic autoimmune disease induced by dendritic cells that have captured necrotic but not apoptotic cells in susceptible mouse strains

“…Glomerulonephritis, a renal involvement caused by immune complex (IC) deposition and complement activation, is a severe complication of lupus disease and represents the major cause of death [19]. We next assessed the renal pathological changes in the DCtreated mice.…”

Renal Transplantation in Systemic Lupus erythematosus: A Single-Center Experience with Sixty-Four Cases

“…The recommended length of this dialy sis period has varied from a minimum of 3 months [28] to as long as 1 year [29], Such a waiting period has been required to exclude patients with acute renal failure. Indeed, 10-28% of patients with lupus nephritis who have progressive renal failure requiring dialysis recover sufficient function to stop dialysis temporarily or for long periods [13,15,30,32,33], This 'cool-ofT period has also been advocated in order to allow the clinical activity of SLE to become inactive so that the posttransplantation course will not be complicated by lupus activity. More over, this waiting period on dialysis may decrease the impact on morbidity of immunosuppressive therapy pro vided for SLE, before the onset of ESRD.…”

“…The outcome for lupus patients undergoing dialysis has been variable. A favorable outcome has been reported in some studies [6,7,13] but not others [14][15][16][17], There are several reports on the outcome of patients with SLE who are treated will renal transplantation [10,11,[18][19][20][21][22][23][24][25][26][27][28][29][30][31]. The population size was small in most of these reports.…”

Development of Systemic Lupus erythematosus in a Patient on Hemodialysis

“…Reports on survival of patients with SLE undergoing hemodialysis are encouraging [2][3][4][5][6]. Al though some papers note high mortality rates in the first months of treatment [7], long-term survival is comparable with that of the general dialysis population [4].…”

“…Al though some papers note high mortality rates in the first months of treatment [7], long-term survival is comparable with that of the general dialysis population [4]. Clinical and immunological features of lupus activity usually dis appear once hemodialysis is started, and immmunosupprcssor treatment can be withdrawn in most cases [4][5][6][7][8],…”