title: Long-term renal outcome and complications in South Africans with proliferative lupus nephritis.
abstract: OBJECTIVE
  To report the long-term outcome and complication profile of South African patients with proliferative lupus nephritis (PLN).
  
  
  METHODS
  A retrospective review of 66 patients with biopsy-proven PLN [58 diffuse proliferative LN (Class IV) and 8 focal proliferative LN (Class III)] under our care from January 1995 to December 2009 was done.
  
  
  RESULTS
  Thirty-three (50 %) patients reached the composite end point of doubling of serum creatinine, end-stage renal disease (ESRD) or death. The 5-, 10- and 15-year cumulative event-free survival rates were 54, 34 and 27 %, respectively. Variables associated with the composite end point were simultaneous diagnosis of SLE and LN (p = 0.048); elevated serum creatinine at onset (p = 0.009); elevated systolic blood pressure (SBP) (p < 0.001) and elevated diastolic blood pressure (DBP) (p < 0.001) on follow-up; and non-remission following induction therapy (p < 0.001). The 5-, 10- and 15-year renal survival rates in our patients were 63, 52 and 52 %, respectively. Hypertension at onset of LN (p = 0.037), nephrotic-range proteinuria (p = 0.033), eGFR < 60 ml/min/1.73 m(2) (p = 0.013) and lack of remission following induction therapy (p < 0.001) were all associated with development of end-stage renal disease (ESRD). Elevated SBP on follow-up (95 % CI 1.03-1.34, p = 0.017) was the only factor associated with composite end point while failure to achieve remission following induction therapy was the only factor associated with ESRD on multivariate analysis. Thirty-five (53 %) patients developed complications with persistent leukopenia, gastritis, sepsis, tuberculosis (TB) and herpes zoster being the leading complications. Ovarian failure occurred in 4 (11 %) patients.
  
  
  CONCLUSIONS
  The 5-, 10 and 15-year event-free survival rates were 54, 34 and 27 % and failure to achieve remission following induction therapy predicted poor renal survival on multivariate analysis.
authors.affiliation: Division of Nephrology, Department of Medicine, Ladoke Akintola University of Technology, P.O. Box 710, Ogbomoso, Osogbo, Nigeria, gbengaayox@yahoo.ca.
authors.forename: Olugbenga E
authors.initials: OE
authors.lastname: Ayodele
authors.forename: Ikechi G
authors.initials: IG
authors.lastname: Okpechi
authors.forename: Charles R
authors.initials: CR
authors.lastname: Swanepoel
mesh_terms: D000328:Adult; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D001379:Azathioprine / Q000627:therapeutic use; D001794:Blood Pressure; D003404:Creatinine / Q000097:blood; D003520:Cyclophosphamide / Q000627:therapeutic use; D018450:Disease Progression; D018572:Disease-Free Survival; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D006973:Hypertension / Q000150:complications; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007676:Kidney Failure, Chronic / Q000209:etiology*; D008181:Lupus Nephritis / Q000150:complications* / Q000188:drug therapy* / Q000473:pathology; D008297:Male; D008775:Methylprednisolone / Q000627:therapeutic use; D011241:Prednisone / Q000627:therapeutic use; D011507:Proteinuria / Q000209:etiology; D012074:Remission Induction; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013019:South Africa; D015996:Survival Rate; D013997:Time Factors; D017211:Treatment Failure; D055815:Young Adult
chemical_list: D000893:Anti-Inflammatory Agents; D007166:Immunosuppressive Agents; D003520:Cyclophosphamide; D003404:Creatinine; D001379:Azathioprine; D011241:Prednisone; D008775:Methylprednisolone