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  1. Esther Rodríguez Almaraz1,
  2. Elena Gutiérrez Solís2,
  3. Elena Rabadan1,
  4. Paola Rodríguez Ramos2,
  5. Enrique Morales Ruiz2,
  6. María Galindo-Izquierdo1
  1. 1Hospital 12 De Octubre, Rheumatology, Madrid, Spain
  2. 2Hospital 12 De Octubre, Nephrology, Madrid, Spain


Background: Lupus nephritis (LN) affects 30-45% of patients with lupus and causes great morbidity and mortality. About 10-25% of patients will develop chronic kidney disease (CKD), and it has been described a mortality of 10-20% at 10 years1-2. Currently there is no ideal biomarker or composite indexes that help us to better assess and monitor.

Objectives: To identify and perform a critical analysis of the prognostic markers and indexes published through a systematic review of the literature in order to subsequently develop an index that helps us to estimate the prognosis of patients with LN.

Methods: We conducted a systematic review and meta-analysis according to the guidelines of the “Cochrane Collaboration” and our results are exposed in accordance with the “Preferred Reporting Items for Systematic Reviews and Meta-Analyzes PRISMA statement”. We did an electronic search in MEDLINE, EMBASE, CINAHL and Web of Science using free text and MeSH terms. The selection was made by 2 independent authors using a bibliographic manager. First, a selection was made by title and if it seemed relevant, a review of the abstract was made. In case of doubt, the full text was evaluated for a possible inclusion. The articles had to fulfill the following criteria: marker or prognostic index of LN, longitudinal studies, to collect the prognostic factor retrospectively without variable biases suitable for good/poor renal prognosis and LN diagnosed by biopsy. Six authors independently extracted data from the articles on previously tested forms to determine their feasibility, and differences were discussed. The data included the general characteristics and results measured. Also adverse events were reported.

Results: We selected 1010 articles initially, of which we discarded 853 per title. Of the 157 remaining, 84 were selected per abstract, and finally, 62 articles were excluded after the review of the full text. In total, the 22 studies included 2301 patients, all older than 18 years. Most were single-center and retrospective (65%). Among the analytical markers, serum creatinine (Cr) was one of the most used variables as a predictor of time to CKD depending on the value, which varied according to the studies. It was also associated as a damage predictor according to the SLICC scale. Proteinuria appears in several studies as a marker of progression of LN, associating the amount with renal response, the development of end-stage renal disease (ESRD), the need for dialysis and the appearance of extrarenal events. Other variables analyzed were: demographic (ethnicity, socioeconomic level), immunological (anti-Ro, anti-DNA, anti-C1q and anti-CRP antibodies with poor renal evolution), histopathological (increased nedd for dialysis in glomerulonephritis IV, thrombotic microangiopathy, C4d deposits or tubular atrophy and association of chronicity index with remission) or therapeutic (hydroxychloroquine with remission).

Conclusion: Altough there are several biomarkers to evaluate the LN prognosis, we have no found indexes for LN prognosis assessment in literature. The development of easily reproducible compound index is necessary for the assessment of the prognosis and the severity of patients with LN on debut and during evolution.

References: [1] Carmona L, Gabriel R, Ballina J, Laffon A. Proyecto EPISER2000: prevalencia de enfermedades reumáticas en la población española. Metodología, resultados del reclutamiento y características de la población. 2001;28:8.

[2] Austin HA, Boumpas DT, Vaughan EM, Balow JE. High-risk features of lupus nephritis: importance of race and clinical and histological factors in 166 patients. Nephrol Dial Transplant Off Publ Eur Dial Transpl Assoc - Eur Ren Assoc. 1995;10(9):1620-8.

Disclosure of Interests: None declared

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