Outcomes in biopsy-proven lupus nephritis: evaluation of 190 white patients from a single center.
We describe the natural history of lupus nephritis (LN) in a historical cohort of 190 white patients with the diagnosis of biopsy-proven LN followed in a single reference center.We evaluated 670 patients with systemic lupus erythematosus (SLE) consecutively followed in our department from 1970 until 2006. All patients fulfilled the 1997 revised criteria for the classification of SLE. White patients (Spanish-born) with biopsy-proven LN were selected as the study population.The cohort included 190 patients (170 female patients and 20 male) with a mean age at LN diagnosis of 31 years. Renal biopsy revealed type I LN in 8 (4%) patients, type II in 33 (17%), type III in 46 (24%), type IV in 72 (38%), type V in 28 (15%), and type VI in 3 (2%) patients. Induction remission was achieved in 85% of patients with types I and II, 78% with type III, 70% with type IV, and 32% of patients with type V. After a mean follow-up of 2391 patient-years, 62 (33%) patients developed chronic renal failure and 18 (9%) evolved to end-stage renal disease. Adjusted multivariate Cox regression analysis identified male sex (hazard ratio [HR], 4.33) and elevated creatinine at LN diagnosis (HR, 5.18) as independent variables for renal failure. Survival was 92% at 10 years of follow-up, 80% after 20 years, and 72% after 30 years.Our results suggest that biopsy-proven LN in white patients has an excellent prognosis. Ethnicity should be considered a key factor when evaluating the prognosis and therapeutic response to different agents in patients with LN.
Sisó
Antoni
A
From Laboratory of Autoimmune Diseases "Josep Font," Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Department of Autoimmune Diseases (AS, MRC, AB, PBZ, NS, NN, AT, MPL, CDL, AD), and Hypertension Unit, Department of Internal Medicine (AC), Institut Clínic de Medicina i Dermatologia, Hospital Clínic, Barcelona; Nephrology Service (AD), Hospital Clínic, Department of Medicine, University of Barcelona, Barcelona; Statistical Unit, Department of Public Health, School of Medicine, University of Barcelona (JS), Barcelona; and Centre de Salut Les Corts, Primary Care Research Group (IDIBAPS), Department of Medicine, University of Barcelona, GesClinic (AS), Barcelona, Spain.
Ramos-Casals
Manuel
M
Bové
Albert
A
Brito-Zerón
Pilar
P
Soria
Natalia
N
Nardi
Norma
N
Testi
Adriana
A
Perez-de-Lis
Marta
M
Díaz-Lagares
Cándido
C
Darnell
Alejandro
A
Sentís
Juan
J
Coca
Antonio
A
D000328:Adult; D000893:Anti-Inflammatory Agents / Q000009:adverse effects; D001424:Bacterial Infections / Q000453:epidemiology; D001706:Biopsy; D015897:Comorbidity; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects; D007668:Kidney / Q000473:pathology; D007676:Kidney Failure, Chronic / Q000188:drug therapy / Q000453:epidemiology / Q000473:pathology; D008017:Life Expectancy; D008181:Lupus Nephritis / Q000188:drug therapy / Q000453:epidemiology* / Q000473:pathology*; D008297:Male; D016896:Treatment Outcome; D014777:Virus Diseases / Q000453:epidemiology; D044465:White People / Q000706:statistics & numerical data*
D000893:Anti-Inflammatory Agents; D007166:Immunosuppressive Agents
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