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Multicenter Study
. 2016 Feb;55(2):252-62.
doi: 10.1093/rheumatology/kev311. Epub 2015 Sep 5.

The frequency and outcome of lupus nephritis: results from an international inception cohort study

John G Hanly  1 , Aidan G O'Keeffe  2 , Li Su  3 , Murray B Urowitz  4 , Juanita Romero-Diaz  5 , Caroline Gordon  6 , Sang-Cheol Bae  7 , Sasha Bernatsky  8 , Ann E Clarke  9 , Daniel J Wallace  10 , Joan T Merrill  11 , David A Isenberg  12 , Anisur Rahman  12 , Ellen M Ginzler  13 , Paul Fortin  14 , Dafna D Gladman  4 , Jorge Sanchez-Guerrero  4 , Michelle Petri  15 , Ian N Bruce  16 , Mary Anne Dooley  17 , Rosalind Ramsey-Goldman  18 , Cynthia Aranow  19 , Graciela S Alarcón  20 , Barri J Fessler  20 , Kristjan Steinsson  21 , Ola Nived  22 , Gunnar K Sturfelt  22 , Susan Manzi  23 , Munther A Khamashta  24 , Ronald F van Vollenhoven  25 , Asad A Zoma  26 , Manuel Ramos-Casals  27 , Guillermo Ruiz-Irastorza  28 , S Sam Lim  29 , Thomas Stoll  30 , Murat Inanc  31 , Kenneth C Kalunian  32 , Diane L Kamen  33 , Peter Maddison  34 , Christine A Peschken  35 , Soren Jacobsen  36 , Anca Askanase  37 , Chris Theriault  38 , Kara Thompson  38 , Vernon Farewell  3
Affiliations
Multicenter Study

The frequency and outcome of lupus nephritis: results from an international inception cohort study

John G Hanly et al. Rheumatology (Oxford). 2016 Feb.

Abstract

Objective: To determine nephritis outcomes in a prospective multi-ethnic/racial SLE inception cohort.

Methods: Patients in the Systemic Lupus International Collaborating Clinics inception cohort (≤15 months of SLE diagnosis) were assessed annually for estimated glomerular filtration rate (eGFR), proteinuria and end-stage renal disease (ESRD). Health-related quality of life was measured by the Short Form (36 questions) health survey questionnaire (SF-36) subscales, mental and physical component summary scores.

Results: There were 1827 patients, 89% females, mean (s.d.) age 35.1 (13.3) years. The mean (s.d.) SLE duration at enrolment was 0.5 (0.3) years and follow-up 4.6 (3.4) years. LN occurred in 700 (38.3%) patients: 566/700 (80.9%) at enrolment and 134/700 (19.1%) during follow-up. Patients with nephritis were younger, more frequently men and of African, Asian and Hispanic race/ethnicity. The estimated overall 10-year incidence of ESRD was 4.3% (95% CI: 2.8%, 5.8%), and with nephritis was 10.1% (95% CI: 6.6%, 13.6%). Patients with nephritis had a higher risk of death (HR = 2.98, 95% CI: 1.48, 5.99; P = 0.002) and those with eGFR <30 ml/min at diagnosis had lower SF-36 physical component summary scores (P < 0.01) and lower Physical function, Physical role and Bodily pain scores. Over time, patients with abnormal eGFR and proteinuria had lower SF-36 mental component summary (P ≤ 0.02) scores compared to patients with normal values.

Conclusion: LN occurred in 38.3% of SLE patients, frequently as the initial presentation, in a large multi-ethnic inception cohort. Despite current standard of care, nephritis was associated with ESRD and death, and renal insufficiency was linked to lower health-related quality of life. Further advances are required for the optimal treatment of LN.

Keywords: inception cohort; lupus; nephritis; outcomes research; systemic lupus erythematosus.

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Figures

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Fig. 1
Onset of lupus nephritis following enrolment into the SLICC cohort
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Fig. 2
Estimated cumulative incidence of end-stage renal disease and death End-stage renal disease (all causes) in the total SLICC cohort (A) and in those with (B) and without (C) LN. The estimated cumulative incidence of death (all causes) for those with LN at enrolment and those who never developed nephritis (D). ESRD: end stage renal disease.
F<sc>ig</sc>. 3
Fig. 3
Spidergram of SF-36 subscale scores at diagnosis of lupus nephritis in three eGFR states PF: physical functioning; RP: role physical; BP: bodily pain; GH: general health; VT: vitality; SF: social functioning; RE: role emotional; MH: mental health; eGFR: estimated glomerular filtration rate.
See this image and copyright information in PMC

Comment in

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