An assessment of renal failure in an SLE cohort with special reference to ethnicity, over a 25-year period.
OBJECTIVE
Although the prognosis for patients with renal lupus has improved, a small number still progress to renal failure. Studies from the USA have found it difficult to distinguish whether the higher rate of renal failure in African-Americans is due to genetic or socio-economic factors. Our aim was to identify ethnic and other factors in a UK lupus cohort that contribute to renal failure.


METHODS
The University College London (UCL) Hospitals lupus cohort of 401 patients (Whites 64%, Blacks 19%), followed since 1978, has 127 patients with renal disease, of whom 21 have gone into renal failure. We determined the characteristics and possible causes of renal failure in this group. Black patients were disproportionately represented in the renal failure group (62% vs 19% for Whites).


RESULTS
Those in the renal failure group had persistently low C3 compared with the renal disease cohort. A high proportion of patients in the renal failure group were felt to be non-adherent to treatment.


CONCLUSIONS
Given that health-care for patients in the UK is free at the point of delivery, we postulate that in our cohort genetic factors rather than socio-economic status are likely to be more significant in causing renal failure. However, there may be cultural and other reasons for this, which requires further study.
Adler
M
M
Centre for Rheumatology Research, Division of Medicine, University College London, London, UK.
Chambers
S
S
Edwards
C
C
Neild
G
G
Isenberg
D
D
D000293:Adolescent; D000328:Adult; D044466:Asian People; D044383:Black People; D016009:Chi-Square Distribution; D002648:Child; D003520:Cyclophosphamide / Q000627:therapeutic use; D004198:Disease Susceptibility / Q000208:ethnology; D005006:Ethnicity; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000208:ethnology*; D008180:Lupus Erythematosus, Systemic / Q000150:complications* / Q000188:drug therapy / Q000208:ethnology*; D008181:Lupus Nephritis / Q000150:complications / Q000208:ethnology; D008297:Male; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000031:analogs & derivatives / Q000627:therapeutic use; D010349:Patient Compliance; D044465:White People; D001741:Black or African American
D007166:Immunosuppressive Agents; D003520:Cyclophosphamide; D009173:Mycophenolic Acid