[Clinical features and prognosis of patients with lupus nephritis].
OBJECTIVE
To explore the clinical features and prognosis of patients with lupus nephritis (LN) in a large multicenter lupus cohort of Jiangsu Province.


METHODS
Medical records of 2 078 systemic lupus erythematosus (SLE) inpatients from 15 hospitals at the first admission from 1999 to 2012 were reviewed and classified into two groups with LN or without. The clinical features between two groups were compared with Mann-Whitney U or Chi-square test and potentially associated factors tested by Cox regression.


RESULTS
A total of 883 (42.5%) hospitalized lupus patients were diagnosed as LN. And the median age at disease onset of LN patients was lower than that of those without LN [(30 ± 11) vs (32 ± 12) years, P < 0.01]. Cardiopulmonary involvement, neuropsychiatric disorder, gastrointestinal dysfunction, hematologic disease, ophthalmopathy, SLEDAI score > 9 at admission and SLE disease activity index (SLEDAI) score > 9 at discharge were more often seen in patients with LN compared to those without LN (31.5%, 7.9%, 13.9%, 69.0%, 1.5%, 77.4%, 29.8% vs 18.8%, 5.1%, 6.8%, 63.1%, 0.3%, 43.1%, 8.1%, all P < 0.01). The mortality rates at 1 or 5 years after first admission were both significantly higher in LN patients than those without LN (7.2%, 15.0% vs 3.1%, 6.3%, P < 0.01). Independent predictors for mortality in patients with LN were neuropsychiatric involvement[hazard ratio (HR) 2.46], SLEDAI score > 9 at discharge (HR 2.34), increased serum creatinine (HR 2.21) and elevated alanine aminotransferase and (or) aspartate transaminase (HR 2.09) whereas glucocorticosteroid therapy (HR 0.18) was a protective factor.


CONCLUSIONS
LN is one common complication of SLE patients during an early stage. And LN patients are more prone to present other vital organ involvement, higher disease activity and worse treatment outcomes. When accompanied with neuropsychiatric involvement, increased serum creatinine or elevated transaminase, worse prognosis is expected. Glucocorticosteroid treatment may offer some benefits.
Department of Immunology & Rheumatology, Drum Tower Clinical Medical College of Nanjing Medical University, Nanjing 210008, China.
Yile
Y
Ren
Xuebing
X
Feng
Yaohong
Y
Zou
Wenyou
W
Pan
Xiangdang
X
Wang
Jieping
J
Pan
Miaojia
M
Zhang
Juan
J
Tao
Yu
Y
Zhang
Kuilin
K
Tan
Jing
J
Li
Xiang
X
Ding
Xian
X
Qian
Zhanyun
Z
Da
Meimei
M
Wang
Zhiwei
Z
Chen
Email: Lingyunsun@nju.edu.cn.
Lingyun
L
Sun
D000328:Adult; D005260:Female; D006801:Humans; D008180:Lupus Erythematosus, Systemic / Q000175:diagnosis*; D008181:Lupus Nephritis / Q000175:diagnosis*; D008297:Male; D011379:Prognosis; D012189:Retrospective Studies; D055815:Young Adult