Long-term outcome of lupus nephritis in Asian Indians.
OBJECTIVE
There are sparse data on outcome of lupus nephritis from developing countries. This study looks at outcome in Asian Indians.


METHODS
This retrospective study included patients at a single center over 20 years. Patients were treated as per standard protocols. The primary outcome measure was chronic renal failure or death; the secondary outcome was end-stage renal disease or death. The worst-case scenario was also calculated, considering those lost to followup in the first year as events. Kaplan-Meier survival curves and the log rank test were used for survival analysis. Data are shown as the mean ± SD.


RESULTS
We included 188 patients with lupus nephritis, with a female:male ratio of 11:1, a mean ± SD age at onset of 23.6 ± 10.5 years, and a median followup time of 6 years (interquartile range 3-9 years). Of 136 patients with a biopsy sample, the distribution was as follows: class II in 22, class III in 36, class IV in 61, class V in 16, and class VI in 1. Survival with normal renal function was 84%, 69%, and 57% at 5, 10, and 15 years, respectively; in the worst-case scenario, survival was 77%, 63%, and 51%, respectively. There was no difference in survival by histologic class; however, nonbiopsied patients had lower survival. Renal survival was 91%, 81%, and 76% at 5, 10, and 15 years, respectively; in the worst-case scenario, survival was 79%, 70%, and 66%, respectively. Risk factors for poor outcome were low C3, hematuria, hypertension, creatinine, lack of remission, and occurrence of major infection. There was a high rate of major infections of 42.3%, with tuberculosis at 11.5%. Infections caused one-half of all deaths.


CONCLUSIONS
The outcome of lupus nephritis in Asian Indians with standard immunosuppressive regimens is reasonable, but immunosuppression is associated with a high rate of infection.
Department of Immunology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India.
Varun
V
Dhir
Amita
A
Aggarwal
Able
A
Lawrence
Vikas
V
Agarwal
Ramnath
R
Misra
D000293:Adolescent; D000328:Adult; D044466:Asian People / Q000208:ethnology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use; D007194:India / Q000208:ethnology; D008181:Lupus Nephritis / Q000188:drug therapy / Q000208:ethnology* / Q000401:mortality; D008297:Male; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D016896:Treatment Outcome; D014397:Tuberculosis, Pulmonary / Q000208:ethnology / Q000209:etiology / Q000401:mortality; D055815:Young Adult
D007166:Immunosuppressive Agents