Background Systemic Lupus Erythematosus (SLE) is a chronic autoimmune disease, characterized by multisystemic organ involvement and with a broad spectrum of clinical and laboratory manifestations. Lupus nephritis (LN) is one of the common manifestations of SLE. During the past decades the survival rate in patients with lupus nephritis has improved dramatically mainly because of more sensitive diagnostic tools, the use of corticosteroids and cytotoxic drugs and better supportive treatments.
Objectives The aim of this study was to describe the survival and the causes of death in patients with lupus nephritis in two centers.
Methods 256 patients with biopsy proven LN, diagnosed from 1984 to 2013 year, were enrolled in this study. Renal histopathology was classified according to the International Society of Nephrology/Renal Pathology Society criteria for nephritis in SLE. All data were analyzed using SPSS 15.0.1. Survival rates were estimated using Kaplan-Meier method. Differences in survival between patient groups were determined using the long-rank test. Cox's proportional hazards model was used to examine the independent association of several parameters with the risk of death. The causes of death categorization was based on analysis off all data available from hospital charts, post-mortem findings or primary care physicians, when death had occurred outside the hospital.
Results Mean duration of follow-up of patients with LN was 138,8±69,46 months. During the study period 93 (36,33%) patients died. 14 patients (5,47%) developed end stage renal disease. The most common causes of death are cardiovascular diseases (44 cases), infections (36 cases), including sepsis with multiorgan failure and lung diseases. The 1, 5, 10, 15 and 20 year survival rates are 99,58%, 99,18%, 94,16%, 68,59% and 58,76% respectively. Survival curves differ significantly between sexes with a better prognosis for women. Patients with early onset of the disease presented a poorer survival than patients with a later onset.
Conclusions According to the results of the present study LN patients present relatively high 5-yr, 10-yr and 15-yr survival rates. Our findings exemplify the importance of early diagnosis and early therapy with effective but safe immunosuppression, before the disease activity has culminated in significant irreversible end-organ damage. The variation in immunosuppressive treatments represents only one of many factors than can influence the longitudinal evolution of renal function.
Disclosure of Interest None declared
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