title: A descriptive study of the factors associated with damage in Malaysian patients with lupus nephritis.
abstract: BACKGROUND
  Renal involvement is the most common serious complication in patients with systemic lupus erythematosus (SLE).
  
  
  OBJECTIVE
  The objective of this article is to investigate and determine the associated factors of disease damage among lupus nephritis (LN) patients.
  
  
  METHODS
  Medical records of LN patients who attended regular follow-up for at least one year in the Nephrology/SLE Clinic, Universiti Kebangsaan Malaysia Medical Centre (UKMMC), were reviewed. Their Systemic Lupus International Collaborating Clinics/American College of Rheumatology (SLICC/ACR) Damage Index scores were noted. Univariate analysis and multivariable regression analysis were performed to determine the independent factors of disease damage in LN.
  
  
  RESULTS
  A total of 150 patients were included and their follow-up duration ranged from one to 20 years. Sixty (40%) LN patients had disease damage (SDI ≥1). In the univariate analysis, it was associated with age, longer disease duration, antiphospholipid syndrome (APS), higher maximum daily oral prednisolone dose (mg/day), lower mean C3 and C4, higher chronicity index and global sclerosis on renal biopsies (p < 0.05). Patients who received early (≤3 months after the SLE diagnosis) hydroxychloroquine (HCQ), optimum HCQ dose at 6.5 mg/kg/day and achieved early complete remission (CR) were less likely to have disease damage (p < 0.05). After adjustment for age, gender, disease duration and severity, multivariable regression analysis revealed that a higher maximum daily dose of oral prednisolone was independently associated with disease damage while early HCQ and CR were associated with lower disease damage.
  
  
  CONCLUSIONS
  Higher maximum daily prednisolone dose predicted disease damage whereas treatment with early HCQ and early CR had a protective role against disease damage.
authors.affiliation: Department of Internal Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia.
authors.forename: S S
authors.initials: SS
authors.lastname: Shaharir
authors.forename: A H Abdul
authors.initials: AH
authors.lastname: Ghafor
authors.forename: M S Mohamed
authors.initials: MS
authors.lastname: Said
authors.forename: N C T
authors.initials: NC
authors.lastname: Kong
mesh_terms: D000328:Adult; D016736:Antiphospholipid Syndrome / Q000453:epidemiology*; D004305:Dose-Response Relationship, Drug; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006886:Hydroxychloroquine / Q000008:administration & dosage / Q000627:therapeutic use*; D008181:Lupus Nephritis / Q000453:epidemiology / Q000503:physiopathology*; D008296:Malaysia / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011239:Prednisolone / Q000008:administration & dosage / Q000627:therapeutic use*; D012044:Regression Analysis; D012074:Remission Induction; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors
chemical_list: D006886:Hydroxychloroquine; D011239:Prednisolone
keywords: Antiphospholipid syndrome; lupus nephritis; systemic lupus erythematosus