The frequency and outcome of lupus nephritis: results from an international inception cohort study.
OBJECTIVE
To determine nephritis outcomes in a prospective multi-ethnic/racial SLE inception cohort.


METHODS
Patients in the Systemic Lupus International Collaborating Clinics inception cohort (≤15 months of SLE diagnosis) were assessed annually for estimated glomerular filtration rate (eGFR), proteinuria and end-stage renal disease (ESRD). Health-related quality of life was measured by the Short Form (36 questions) health survey questionnaire (SF-36) subscales, mental and physical component summary scores.


RESULTS
There were 1827 patients, 89% females, mean (s.d.) age 35.1 (13.3) years. The mean (s.d.) SLE duration at enrolment was 0.5 (0.3) years and follow-up 4.6 (3.4) years. LN occurred in 700 (38.3%) patients: 566/700 (80.9%) at enrolment and 134/700 (19.1%) during follow-up. Patients with nephritis were younger, more frequently men and of African, Asian and Hispanic race/ethnicity. The estimated overall 10-year incidence of ESRD was 4.3% (95% CI: 2.8%, 5.8%), and with nephritis was 10.1% (95% CI: 6.6%, 13.6%). Patients with nephritis had a higher risk of death (HR = 2.98, 95% CI: 1.48, 5.99; P = 0.002) and those with eGFR <30 ml/min at diagnosis had lower SF-36 physical component summary scores (P < 0.01) and lower Physical function, Physical role and Bodily pain scores. Over time, patients with abnormal eGFR and proteinuria had lower SF-36 mental component summary (P ≤ 0.02) scores compared to patients with normal values.


CONCLUSIONS
LN occurred in 38.3% of SLE patients, frequently as the initial presentation, in a large multi-ethnic inception cohort. Despite current standard of care, nephritis was associated with ESRD and death, and renal insufficiency was linked to lower health-related quality of life. Further advances are required for the optimal treatment of LN.
Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada, john.hanly@cdha.nshealth.ca.
John G
JG
Hanly
Department of Statistical Science, University College London, London.
Aidan G
AG
O'Keeffe
MRC Biostatistics Unit, Institute of Public Health, University Forvie Site, Cambridge, UK.
Li
L
Su
Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto, Toronto, ON, Canada.
Murray B
MB
Urowitz
Instituto Nacional de Ciencias Medicas y Nutrición, Mexico City, Mexico.
Juanita
J
Romero-Diaz
Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.
Caroline
C
Gordon
Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea.
Sang-Cheol
SC
Bae
Divisions of Rheumatology and Clinical Epidemiology, McGill University Health Centre.
Sasha
S
Bernatsky
Division of Rheumatology, University of Calgary, Alberta, Canada.
Ann E
AE
Clarke
Cedars-Sinai/David Geffen School of Medicine at UCLA, Los Angeles, CA.
Daniel J
DJ
Wallace
Department of Clinical Pharmacology, Oklahoma Medical Research Foundation, Oklahoma City, OK, USA.
Joan T
JT
Merrill
Centre for Rheumatology, Department of Medicine, University College London, UK.
David A
DA
Isenberg
Centre for Rheumatology, Department of Medicine, University College London, UK.
Anisur
A
Rahman
Department of Medicine, SUNY Downstate Medical Center, Brooklyn, NY, USA.
Ellen M
EM
Ginzler
Division of Rheumatology, Centre Hospitalier Universitaire de Québec et Université Laval, Quebec City, Canada.
Paul
P
Fortin
Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto, Toronto, ON, Canada.
Dafna D
DD
Gladman
Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto, Toronto, ON, Canada.
Jorge
J
Sanchez-Guerrero
Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Michelle
M
Petri
Arthritis Research UK Epidemiology Unit, Institute of Inflammation and Repair, Manchester Academic Health Sciences Centre, The University of Manchester, Manchester, UK, NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK.
Ian N
IN
Bruce
Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, NC.
Mary Anne
MA
Dooley
Northwestern University and Feinberg School of Medicine, Chicago, IL.
Rosalind
R
Ramsey-Goldman
Feinstein Institute for Medical Research, Manhasset, NY.
Cynthia
C
Aranow
Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
Graciela S
GS
Alarcón
Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
Barri J
BJ
Fessler
Center for Rheumatology Research, Landspitali University Hospital, Reykjavik, Iceland.
Kristjan
K
Steinsson
Department of Rheumatology, University Hospital Lund, Lund, Sweden.
Ola
O
Nived
Department of Rheumatology, University Hospital Lund, Lund, Sweden.
Gunnar K
GK
Sturfelt
Division of Rheumatology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
Susan
S
Manzi
Lupus Research Unit, The Rayne Institute, St Thomas' Hospital, King's College London School of Medicine, London, UK.
Munther A
MA
Khamashta
Unit for Clinical Therapy Research, Karolinska Institute, Stockholm, Sweden.
Ronald F
RF
van Vollenhoven
Lanarkshire Centre for Rheumatology, Hairmyres Hospital, East Kilbride, Scotland, UK.
Asad A
AA
Zoma
Josep Font Autoimmune Diseases Laboratory, IDIBAPS, Department of Autoimmune Diseases, Hospital Clínic, Barcelona, Spain.
Manuel
M
Ramos-Casals
Autoimmune Diseases Research Unit, Department of Internal Medicine, BioCruces Health Research Institute, Hospital Universitario Cruces, University of the Basque Country, Barakaldo, Spain.
Guillermo
G
Ruiz-Irastorza
Emory University School of Medicine, Division of Rheumatology, Atlanta, Georgia, USA.
S Sam
SS
Lim
Kantonsspital Geissbergstr, Schaffhausen, Switzerland.
Thomas
T
Stoll
Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey.
Murat
M
Inanc
UCSD School of Medicine, La Jolla, CA.
Kenneth C
KC
Kalunian
Medical University of South Carolina, Charleston, SC, USA.
Diane L
DL
Kamen
Ysbyty Gwynedd Bangor, Gwynedd, North Wales, UK.
Peter
P
Maddison
University of Manitoba, Winnipeg, Manitoba, Canada.
Christine A
CA
Peschken
Department of Rheumatology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
Soren
S
Jacobsen
Hospital for Joint Diseases, NYU, Seligman Centre for Advanced Therapeutics, New York, NY, USA and.
Anca
A
Askanase
Department of Medicine, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada.
Chris
C
Theriault
Department of Medicine, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada.
Kara
K
Thompson
MRC Biostatistics Unit, Institute of Public Health, University Forvie Site, Cambridge, UK.
Vernon
V
Farewell
D000328:Adult; D018450:Disease Progression; D005006:Ethnicity; D005260:Female; D005500:Follow-Up Studies; D014943:Global Health; D006801:Humans; D015994:Incidence; D008181:Lupus Nephritis / Q000175:diagnosis / Q000208:ethnology*; D008297:Male; D017063:Outcome Assessment, Health Care; D011446:Prospective Studies; D011788:Quality of Life; D012307:Risk Factors; D011795:Surveys and Questionnaires; D015996:Survival Rate / Q000639:trends
inception cohort; lupus; nephritis; outcomes research; systemic lupus erythematosus