Assessment of a lupus nephritis cohort over a 30-year period

Abstract

Objective: LN is a common and potentially severe complication of SLE. Our aim was to characterize a LN cohort followed at a single centre for 30 years and assess its evolution over time.

Methods: Between 1975 and 2005, 156 LN patients were followed up at University College Hospital London. We divided them into three groups depending on the date of recognition of renal involvement (1975-85, 1986-95 and 1996-2005) and compared them in terms of clinical, demographic and serological characteristics and disease outcome.

Results: Clinical characteristics were comparable between groups; however, the proportion of Afro-caribbean (AC) patients and the prevalence of anti-ENA antibodies rose significantly over time. The 5-year mortality rate decreased by 60% between the first and second decades, remaining stable over the third decade. The 5-year end-stage renal disease (ESRD) rate remained constant. An increasing number of renal transplants (RTx) was performed with encouraging results. AC origin was associated with a poorer overall prognosis.

Conclusion: LN, a common complication of SLE, is associated with increased mortality and morbidity, particularly among AC patients. Despite encouraging results for RTx, once ESRD is established the prognosis is relatively poor and no improvement in preventing its development was achieved. Moreover, although a significant decrease in mortality was observed, it has remained stable for 10 years. These results suggest that we have maximized the benefits of conventional therapies and if further improvement is to be achieved, novel drug regimens must be developed.