Persistent proteinuria and dyslipidemia increase the risk of progressive chronic kidney disease in lupus erythematosus.
Advances in immunotherapy have improved survival of patients with systemic lupus erythematosus who now face an increasing burden of chronic diseases including that of the kidney. As systemic inflammation is also thought to contribute directly to the progression of chronic kidney disease (CKD), we assessed this risk in patients with lupus, with and without a diagnosis of nephritis, and also identified modifiable risk factors. Accordingly, we enrolled 631 patients (predominantly Caucasian), of whom 504 were diagnosed with lupus within the first year and followed them an average of 11 years. Despite the presence of a chronic inflammatory disease, the rate of decline in renal function of 238 patients without nephritis was similar to that described for non-lupus patient cohorts. Progressive loss of kidney function developed exclusively in patients with lupus nephritis who had persistent proteinuria and dyslipidemia, although only six required dialysis or transplantation. The mortality rate was 16% with half of the deaths attributable to sepsis or cancer. Thus, despite the presence of a systemic inflammatory disease, the risk of progressive CKD in this lupus cohort was relatively low in the absence of nephritis. Hence, as in idiopathic glomerular disease, persistent proteinuria and dyslipidemia (modifiable risks) are the major factors for CKD progression in lupus patients with renal involvement.
Division of Nephrology, Department of Medicine, University Health Network and University of Toronto, Toronto, ON, Canada. heather.reich@uhn.on.ca
Heather N
HN
Reich
Dafna D
DD
Gladman
Murray B
MB
Urowitz
Joanne M
JM
Bargman
Michelle A
MA
Hladunewich
Wendy
W
Lou
Steve C P
SC
Fan
Jiandong
J
Su
Andrew M
AM
Herzenberg
Daniel C
DC
Cattran
Joan
J
Wither
Carol
C
Landolt-Marticorena
James W
JW
Scholey
Paul R
PR
Fortin
D000328:Adult; D000368:Aged; D015331:Cohort Studies; D018450:Disease Progression; D050171:Dyslipidemias / Q000150:complications*; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D053208:Kaplan-Meier Estimate; D008180:Lupus Erythematosus, Systemic / Q000150:complications* / Q000401:mortality / Q000503:physiopathology; D008181:Lupus Nephritis / Q000209:etiology / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D009864:Ontario / Q000453:epidemiology; D011446:Prospective Studies; D011507:Proteinuria / Q000150:complications*; D051436:Renal Insufficiency, Chronic / Q000209:etiology* / Q000401:mortality / Q000503:physiopathology; D012307:Risk Factors; D055815:Young Adult