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Changing patterns in clinical–histological presentation and renal outcome over the last five decades in a cohort of 499 patients with lupus nephritis
  1. Gabriella Moroni1,
  2. Paolo Gilles Vercelloni2,
  3. Silvana Quaglini3,
  4. Mariele Gatto4,
  5. Davide Gianfreda5,
  6. Lucia Sacchi3,
  7. Francesca Raffiotta1,
  8. Margherita Zen4,
  9. Gloria Costantini4,
  10. Maria Letizia Urban5,
  11. Federico Pieruzzi2,
  12. Piergiorgio Messa1,
  13. Augusto Vaglio5,
  14. Renato Alberto Sinico2,
  15. Andrea Doria4
  1. 1 Nephrology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
  2. 2 Nephrology Unit, University of Milano Bicocca, Milano, Italy
  3. 3 Department of Electrical, Computer and Biomedical Engineering, University of Pavia, Pavia, Italy
  4. 4 Division of Rheumatology, Department of Medicine, DIMED, University of Padua, Padua, Italy
  5. 5 Nephrology Unit, University Hospital, Parma, Parma, Italy
  1. Correspondence to Dr Gabriella Moroni, Divisione di Nefrologia e Dialisi, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milano 20122, Italy; gmoroni{at}


Objectives To evaluate changes in demographic, clinical and histological presentation, and prognosis of lupus nephritis (LN) over time.

Patients and methods We studied a multicentre cohort of 499 patients diagnosed with LN from 1970 to 2016. The 46-year follow-up was subdivided into three periods (P): P1 1970–1985, P2 1986–2001 and P3 2002–2016, and patients accordingly grouped based on the year of LN diagnosis. Predictors of patient and renal survival were investigated by univariate and multivariate proportional hazards Cox regression analyses. Survival curves were compared using the log-rank test.

Results A progressive increase in patient age at the time of LN diagnosis (p<0.0001) and a longer time between systemic lupus erythematosus onset and LN occurrence (p<0.0001) was observed from 1970 to 2016. During the same period, the frequency of renal insufficiency at the time of LN presentation progressively decreased (p<0.0001) and that of isolated urinary abnormalities increased (p<0.0001). No changes in histological class and activity index were observed, while chronicity index significantly decreased from 1970 to 2016 (p=0.023). Survival without end-stage renal disease (ESRD) was 87% in P1, 94% in P2% and 99% in P3 at 10 years, 80% in P1 and 90% in P2 at 20 years (p=0.0019). At multivariate analysis, male gender, arterial hypertension, absence of maintenance immunosuppressive therapy, increased serum creatinine, and high activity and chronicity index were independent predictors of ESRD.

Conclusions Clinical presentation of LN has become less severe in the last years, leading to a better long-term renal survival.

  • lupus nephritis
  • systemic lupus erythematosus
  • research outcomes
  • treatment

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  • RAS and AD contributed equally.

  • Handling editor Josef S Smolen

  • Contributors GM, AD and RAS contributed to the conception and design of the work, interpreted the data, drafted and revised the manuscript for important intellectual content. SQ and LS contributed to the statistical analysis. PGV, MG, DG, GC, FR, MZ and MLU followed up patients and contributed to the acquisition of data. PM, FP and AV critically revised the final work. All the authors approved the final version of the manuscript and gave their agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval Ethics Committee of the Azienda Ospedaliera–Università degli Studi di Padova, Padua, Italy; Ospedale Maggiore Policlinico, Milan, Italy.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement There are no additional unpublished data from this study to share.