title: Severe lupus nephritis: racial differences in presentation and outcome.
abstract: This study assessed whether certain clinicopathologic variables could explain the impact of race on outcome in 86 patients who had severe lupus nephritis and were available for long-term follow-up after participating in a prospective, controlled, clinical trial. Fifty-four (63%) patients were white, 21 (24%) were black, and 11 (13%) were categorized as other. The proportion of patients with anti-Ro, anti-nRNP, and anti-Sm was significantly greater among black patients. Biopsies with segmental active proliferative and necrotizing lesions that involved >or=50% of glomeruli +/- membranous glomerulonephritis (class III >or=50%+/-V) were significantly more common (white 44%, black 76%, other 36%; P < 0.05) and diffuse proliferative glomerulonephritis +/- membranous glomerulonephritis (class IV+/-V) was less common (white 54%, black 24%, other 64%) among black patients. Attainment of a remission was greatest among white patients (white 52%, black 29%, other 27%; P = 0.09). Features that were predictive of a remission were white race, baseline serum creatinine, and class IV+/-V lesions. Patient survival at 10 yr (white 81%, black 59%, other 73%; P = 0.029) and renal survival at 10 yr (white 68%, black 38%, other 61%; P = 0.015) were significantly poorer in black patients. Predictors of ESRD were serum creatinine, the presence of anti-Ro antibodies, class III >or=50%+/-V lesions, and failure to achieve a remission. In conclusion, racial differences were observed in the serologic and histologic features at presentation, response to treatment, and outcome of patients with severe lupus nephritis. In a population of patients with severe lupus nephritis, black patients were significantly more likely to have a serologic profile and renal lesions that were associated with more aggressive renal disease and resulted in worse outcomes than white patients.
authors.affiliation: Department of Medicine, Rush-Presbyterian-St. Lukes Medical Center, Chicago, IL 60612, USA. skorbet@aol.com
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Korbet
authors.forename: Melvin M
authors.initials: MM
authors.lastname: Schwartz
authors.forename: Joni
authors.initials: J
authors.lastname: Evans
authors.forename: Edmund J
authors.initials: EJ
authors.lastname: Lewis
mesh_terms: D000328:Adult; D001741:Black or African American; D001323:Autoantibodies / Q000097:blood; D003404:Creatinine / Q000097:blood; D005260:Female; D006801:Humans; D008181:Lupus Nephritis / Q000209:etiology / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D010956:Plasmapheresis; D011379:Prognosis; D011446:Prospective Studies; D015996:Survival Rate; D044465:White People
chemical_list: D001323:Autoantibodies; D003404:Creatinine