Long-term outcome of biopsy-proven lupus nephritis in Iran

Abstract

Introduction: This study was conducted to evaluate the survival of patients with lupus nephritis (LN) in two different lupus clinics in Iran.

Methods: This was a retrospective cohort study covering 82 patients diagnosed with biopsy-proven LN hospitalized between 1994 until 2010. Demographic, clinical, laboratory, therapeutic and end-point data were collected. Renal biopsies were categorized according to the 2004 classification of the International Society of Nephrology/Renal Pathology Society (ISN/RPS). Survival plots, univariate and multivariate Cox regression analyses were applied.

Results: Female/male ratio was 65/17. Mortality rate was 6.1% (five patients). Fifty-five (67%), 18 (22%), and four (4.9%) patients had complete/partial remission, chronic renal failure (CRF) and end-stage renal disease (ESRD), respectively. Renal biopsies showed 0, three (3.7%), 18 (22%), 58 (70.7%), two (2.4%) and 0 patients with ISN/RPS classes I, II, III, IV, V and VI, respectively, and one patient (1.2%) with mixed class (IV and V). The 5, 10 and 15 year survival rates for living patients were 97%, 92% and 69%, respectively. When CRF, ESRD and death were considered as one category of poor patient outcome, the 5, 10 and 15 year survival rates for remission were 87%, 47% and 35%, respectively. Multivariate analysis demonstrated the following independent protectives against poor outcome: class II nephritis (hazards ratio [HR] = 0.67; 95% confidence interval [CI], 0.57-0.85), class III nephritis (HR = 0.002; 95% CI, 0-0.036) and time passed since SLE diagnosis (HR = 0.006; 95% CI, 0-0.1).

Conclusion: Survival rates of Iranian patients with LN were comparable with those of developed countries.

Keywords: Iran; lupus nephritis; outcome.