title: Renal outcomes among Egyptian lupus nephritis patients: a retrospective analysis of 135 cases from a single centre.
abstract: OBJECTIVE
  The objective of this paper is to describe renal outcomes in a group of Egyptian patients with lupus nephritis and to identify variable prognostic factors.
  
  
  METHODS
  The records of 135 patients (129 females, six males) with biopsy-proven lupus nephritis seen between 1999 and 2011 at Kasr Al-Aini Hospital, Cairo University, were reviewed and included in a retrospective analysis. Biopsies were classified according to the WHO classification. Renal outcomes were defined according to the Renal Subcommittee of Renal Insufficiency of the American College of Rheumatology.
  
  
  RESULTS
  The mean follow-up period was 55.64 ± 25.68 (range 4-156) months. Thirty-nine patients (29.9%) developed an adverse final outcome. This composite outcome, defined as persistent elevation of serum creatinine ≥ 1.2 mg/dl, chronic renal insufficiency, end-stage renal disease or death, was seen in 12 (8.9%), seven (5.2%), three (2.2%) and 17 (12.6%) patients, respectively. The overall patient survival was 93.5% and 87.5% at five and 10 years, respectively. Factors associated with an adverse outcome included male gender (p = 0.037), hypertension at nephritis onset (p = 0.001), serum creatinine ≥1.2 mg/dl (p < 0.001), urinary casts (p = 0.006), anticardiolipin antibodies (p = 0.03), class IV nephritis (p < 0.001), hyaline thrombosis (0.003), glomerular sclerosis (p = 0.002), tubular atrophy(p < 0.001), interstitial fibrosis (p < 0.001) and a higher chronicity index (p = 0.006). Time-dependent factors associated with an adverse outcome included failure to achieve remission within the first year, uncontrolled hypertension, persistently low C3 and development of flares (p = 0.003, < 0.001, = 0.004, = 0.003, respectively).
  
  
  CONCLUSIONS
  The association of several adverse prognostic factors with the development of poor renal outcome has been confirmed in this study.
authors.affiliation: Rheumatology and Rehabilitation Department, Faculty of Medicine, Cairo University, Egypt.
authors.forename: G A
authors.initials: GA
authors.lastname: Mahmoud
authors.affiliation: Rheumatology and Rehabilitation Department, Faculty of Medicine, Cairo University, Egypt hania.zayed@kasralainy.edu.eg haniasalah@yahoo.com.
authors.forename: H S
authors.initials: HS
authors.lastname: Zayed
authors.affiliation: Rheumatology and Rehabilitation Department, Faculty of Medicine, Cairo University, Egypt.
authors.forename: S A
authors.initials: SA
authors.lastname: Ghoniem
mesh_terms: D000293:Adolescent; D000328:Adult; D004534:Egypt / Q000453:epidemiology; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008181:Lupus Nephritis / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology*; D008297:Male; D011241:Prednisone / Q000627:therapeutic use; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D007166:Immunosuppressive Agents; D011241:Prednisone
keywords: Egyptians; Lupus nephritis; outcome; prognostic factors