title: Characterization of Patients With Lupus Nephritis Included in a Large Cohort From the Spanish Society of Rheumatology Registry of Patients With Systemic Lupus Erythematosus (RELESSER).
abstract: The aim of the study was to profile those patients included in the RELESSER registry with histologically proven renal involvement in order to better understand the current state of lupus nephritis (LN) in Spain. RELESSER-TRANS is a multicenter cross-sectional registry with an analytical component. Information was collected from the medical records of patients with systemic lupus erythematosus who were followed at participating rheumatology units. A total of 359 variables including demographic data, clinical manifestations, disease activity, severity, comorbidities, LN outcome, treatments, and mortality were recorded. Only patients with a histological confirmation of LN were included. We performed a descriptive analysis, chi-square or Student's t tests according to the type of variable and its relationship with LN. Odds ratio and confidence intervals were calculated by using simple logistic regression. LN was histologically confirmed in 1092/3575 patients (30.5%). Most patients were female (85.7%), Caucasian (90.2%), and the mean age at LN diagnosis was 28.4 ± 12.7 years. The risk for LN development was higher in men (M/F:47.85/30.91%, P < 0.001), in younger individuals (P < 0.001), and in Hispanics (P = 0.03). Complete response to treatment was achieved in 68.3% of patients; 10.35% developed ESRD, which required a kidney transplant in 45% of such cases. The older the patient, the greater was the likelihood of complete response (P < 0.001). Recurrences were associated with persistent lupus activity at the time of the last visit (P < 0.001) and with ESRD (P < 0.001). Thrombotic microangiopathy was a risk factor for ESRD (P = 0.04), as for the necessity of dialysis (P = 0.01) or renal transplantation (P = 0.03). LN itself was a poor prognostic risk factor of mortality (OR 2.4 [1.81-3.22], P < 0.001). Patients receiving antimalarials had a significantly lower risk of developing LN (P < 0.001) and ESRD (P < 0.001), and responded better to specific treatments for LN (P = 0.014). More than two-thirds of the patients with LN from a wide European cohort achieved a complete response to treatment. The presence of positive anti-Sm antibodies was associated with a higher frequency of LN and a decreased rate of complete response to treatment. The use of antimalarials reduced both the risk of developing renal disease and its severity, and contributed to attaining a complete renal response.
authors.affiliation: From the Rheumatology Department, Hospital 12 Octubre, Madrid (MG-I, ER-A); Rheumatology (JMP-R), University Hospital Complex, Instituto de Investigación Biomédica, Vigo, Spain; Rheumatology Department (FJL-L), Gregorio Marañón University Hospital, Madrid; Rheumatology Department (JC-A), Sierrallana Hospital, Torrelavega; Rheumatology Department (AO), Germans Trías i Pujol University Hospital, Badalona; Rheumatology Department (AF-N), Hospital Regional Universitario de Málaga, Málaga; Rheumatology Department (VM-T), Marques de Valdecilla Hospital, Santander; Rheumatology Department (PV-C), Hospital General de Alicante, Alicante; Rheumatology Department (MF), Hospital Universitario Juan Canalejo, Coruña; Rheumatology Department (FJN), Hospital Universitario de Bellvitge, Barcelona; Rheumatology Department (JR), Hospital Marina Baixa, Villajoyosa; Rheumatology Department (MI-B), Hospital Son Llatzer, Palma de Mallorca; Rheumatology Department (EU), Hospital de Donosti, San Sebastián; Rheumatology Department (ET), Hospital Universitario de La Princesa; Rheumatology Department (AZ), Hospital Universitario Ramón y Cajal, Madrid; Rheumatology Department (LH), Complejo Hospitalario de Navarra, Pamplona; Rheumatology Department (VT), Hospital Moisés Broggi; Rheumatology Department (IC), Hospital de la Santa Creu i Sant Pau, Barcelona; Rheumatology Department (JC), Hospital Parc Taulí. Sabadell; Rheumatology Department (RM-A), Hospital de Jerez, Jerez de la Frontera; Rheumatology Department (MAAZ), IMIBIC-Reina Sofia Hospital, Cordoba; Rheumatology Department (ER), University Hospital San Cecilio, Granada; Rheumatology Department (ED-Á), Leon Hospital, Leon; Rheumatology Department (TV-R), Hospital Lucus Augusti, Lugo; Rheumatology Department (PGDlP), Hospital Norte Sanchinarro, Madrid; Rheumatology Department (AM), Hospital Universitario Príncipe de Asturias, Alcalá de Henares; Rheumatology Department (JLA), Hospital Puerta de Hierro, Majadahonda, Madrid; Rheumatology Department (PR), Hospital Infanta Sofía, San Sebastián de los Reyes, Madrid; Rheumatology Department (CM), Hospital Virgen de la Arrixaca, Murcia, Spain; Rheumatology Department (CM-M), Hospital Clínico Universitario de Salamanca, Salamanca; Rheumatology Department (BH-C), University Hospital Virgen Macarena; Rheumatology Department (JLMDlF), Hospital de Valme, Sevilla; Rheumatology Department (MG), Hospital Universitario de Canarias, Tenerife; Rheumatology Department (EÚ), Hospital de Basurto, Bilbao; Rheumatology Department (JJA-S), Hospital Universitario Dr Peset, Valencia; Rheumatology Department (JM), Hospital Miguel Servet Zaragoza; Rheumatology Department (JI-R), Clínica POVISA, Vigo; Rheumatology Department (MR-G), Complejo Hospitalario Universitario de Ourense, Ourense; Rheumatology Department (VQ), Hospital de Monforte, Lugo; Rheumatology Department (JH-B), Hospital Insular de Gran Canaria, Las Palmas de Gran Canaria; Rheumatology Department (LSF), Hospital Universitario de Guadalajara, Guadalajara; Statistical Department (FA, SP), Research Unit, Spanish Society of Rheumatology (SER), Madrid; and Rheumatology Department (IR-F), Doctor Negrín University Hospital, Gran Canaria, Spain.
authors.forename: María
authors.initials: M
authors.lastname: Galindo-Izquierdo
authors.forename: Esther
authors.initials: E
authors.lastname: Rodriguez-Almaraz
authors.forename: José M
authors.initials: JM
authors.lastname: Pego-Reigosa
authors.forename: Francisco J
authors.initials: FJ
authors.lastname: López-Longo
authors.forename: Jaime
authors.initials: J
authors.lastname: Calvo-Alén
authors.forename: Alejandro
authors.initials: A
authors.lastname: Olivé
authors.forename: Antonio
authors.initials: A
authors.lastname: Fernández-Nebro
authors.forename: Víctor
authors.initials: V
authors.lastname: Martinez-Taboada
authors.forename: Paloma
authors.initials: P
authors.lastname: Vela-Casasempere
authors.forename: Mercedes
authors.initials: M
authors.lastname: Freire
authors.forename: Francisco J
authors.initials: FJ
authors.lastname: Narváez
authors.forename: José
authors.initials: J
authors.lastname: Rosas
authors.forename: Mónica
authors.initials: M
authors.lastname: Ibáñez-Barceló
authors.forename: Esther
authors.initials: E
authors.lastname: Uriarte
authors.forename: Eva
authors.initials: E
authors.lastname: Tomero
authors.forename: Antonio
authors.initials: A
authors.lastname: Zea
authors.forename: Loreto
authors.initials: L
authors.lastname: Horcada
authors.forename: Vicenç
authors.initials: V
authors.lastname: Torrente
authors.forename: Iván
authors.initials: I
authors.lastname: Castellvi
authors.forename: Joan
authors.initials: J
authors.lastname: Calvet
authors.forename: Raúl
authors.initials: R
authors.lastname: Menor-Almagro
authors.forename: María A Aguirre
authors.initials: MAA
authors.lastname: Zamorano
authors.forename: Enrique
authors.initials: E
authors.lastname: Raya
authors.forename: Elvira
authors.initials: E
authors.lastname: Díez-Álvarez
authors.forename: Tomás
authors.initials: T
authors.lastname: Vázquez-Rodríguez
authors.forename: Paloma
authors.initials: P
authors.lastname: García de la Peña
authors.forename: Atusa
authors.initials: A
authors.lastname: Movasat
authors.forename: José L
authors.initials: JL
authors.lastname: Andreu
authors.forename: Patricia
authors.initials: P
authors.lastname: Richi
authors.forename: Carlos
authors.initials: C
authors.lastname: Marras
authors.forename: Carlos
authors.initials: C
authors.lastname: Montilla-Morales
authors.forename: Blanca
authors.initials: B
authors.lastname: Hernández-Cruz
authors.forename: José L
authors.initials: JL
authors.lastname: Marenco de la Fuente
authors.forename: María
authors.initials: M
authors.lastname: Gantes
authors.forename: Eduardo
authors.initials: E
authors.lastname: Úcar
authors.forename: Juan J
authors.initials: JJ
authors.lastname: Alegre-Sancho
authors.forename: Javier
authors.initials: J
authors.lastname: Manero
authors.forename: Jesús
authors.initials: J
authors.lastname: Ibáñez-Ruán
authors.forename: Manuel
authors.initials: M
authors.lastname: Rodríguez-Gómez
authors.forename: Víctor
authors.initials: V
authors.lastname: Quevedo
authors.forename: José
authors.initials: J
authors.lastname: Hernández-Beriaín
authors.forename: Lucía
authors.initials: L
authors.lastname: Silva-Fernández
authors.forename: Fernando
authors.initials: F
authors.lastname: Alonso
authors.forename: Sabina
authors.initials: S
authors.lastname: Pérez
authors.forename: Iñigo
authors.initials: I
authors.lastname: Rúa-Figueroa
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D006801:Humans; D008181:Lupus Nephritis / Q000453:epidemiology* / Q000628:therapy; D008297:Male; D012008:Recurrence; D012042:Registries; D012189:Retrospective Studies; D012219:Rheumatology; D013030:Spain / Q000453:epidemiology; D055815:Young Adult