Background Lupus nephritis (LN) accounts for most of the morbidity and mortality of patients with systemic lupus erythematosus (SLE). The prevalence of renal involvement in SLE patients was various up to 60%, depending on the ethnicity and geographic origin of those studied.
Despite advances in the management strategies, 5 to 22% of LN patients eventually progress to end-stage renal disease (ESRD), requiring either dialysis or transplantation
Objectives To identify the predictors of ESRD and determine the long-term outcome of ESRD patients according to renal replacement modality in Korean patients with LN.
Methods Between 1985 and 2010, 321 Korean patients with LN were enrolled in this study. We analyzed the clinical and laboratory indices, the treatment responses and the biopsy findings. The events of interest were estimated by the Kaplan-Meier method and the risk factors were assessed by univariate and multivariate Cox proportional hazards regression analyses.
Results The median follow-up time after the diagnosis of LN was 84 months. During follow-up, twenty nine patients evolved to ESRD. Renal survival rate at 5 and 10 years after LN onset was 95.9% and 91.1%, respectively. Deteriorated renal function (estimated glomerular filtration rate <60 ml/min/1.73m2) at LN onset (hazard ratio: 9.223) was found to be an independent risk factor for the development of ESRD. Recurrence of lupus nephritis in renal allograft and flare-ups of lupus activity were not observed among the patients undergoing kidney transplantation (KT) (n=11). In contrast, those with maintenance dialysis (n =18) developed thirteen episodes of lupus flare in ten patients and five died of either infection (n =2) or lupus flare (n=3).
Conclusions The impaired renal function at baseline is an independent predictor of ESRD in Korean patients with LN. The benefits of KT on the control of lupus activity and survival should be emphasized.
Cheigh JS, et al. Systemic lupus erythematosus in patients with end-stage renal disease: long-term follow-up on the prognosis of patients and the evolution of lupus activity. Am J Kidney Dis 1990; 16: 189-95.
Croca SC, et al. Assessment of a lupus nephritis cohort over a 30-year period. Rheumatology (Oxford)2011; 50: 1424-30.
Disclosure of Interest None Declared