Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Dec;6(3):e001299.
doi: 10.1136/rmdopen-2020-001299.

Predictors of renal damage in systemic lupus erythematous patients: data from a multiethnic, multinational Latin American lupus cohort (GLADEL)

Cristina Reátegui-Sokolova  1   2 , Manuel F Ugarte-Gil  3   4 , Guillermina B Harvey  5 , Daniel Wojdyla  6 , Guillermo J Pons-Estel  7 , Rosana Quintana  7 , Rosa M Serrano-Morales  7 , Mónica P Sacnun  8 , Luis J Catoggio  9 , Enrique R Soriano  9 , Mercedes A García  10 , Verónica Saurit  11 , Alejandro Alvarellos  11 , Francisco Caeiro  11 , Guillermo A Berbotto  12 , Emilia I Sato  13 , Eduardo Ferreira Borba Neto  14 , Eloisa Bonfa  14 , Ana Carolina de Oliveira E Silva Montandon  15 , Nilzio A Da Silva  15 , Fernando Cavalcanti  16 , Gloria Vásquez  17 , Marlene Guibert-Toledano  18 , Gil A Reyes-Llerena  18 , Loreto Massardo  19 , Oscar J Neira  20 , Mario H Cardiel  21 , Leonor A Barile-Fabris  22 , Mary-Carmen Amigo  23 , Luis H Silveira  24 , Margarita Portela-Hernández  25 , Ignacio Garcia de la Torre  26 , María Inés Segami  27 , Rosa Chacón-Diaz  28 , María H Esteva-Spinetti  29 , Graciela S Alarcón  30   31 , Bernardo A Pons-Estel; GLADEL
Affiliations

Predictors of renal damage in systemic lupus erythematous patients: data from a multiethnic, multinational Latin American lupus cohort (GLADEL)

Cristina Reátegui-Sokolova et al. RMD Open. 2020 Dec.

Abstract

Aim: A decrease in proteinuria has been considered protective from renal damage in lupus nephritis (LN), but a cut-off point has yet to be established. The aim of this study was to identify the predictors of renal damage in patients with LN and to determine the best cut-off point for a decrease in proteinuria.

Methods: We included patients with LN defined clinically or histologically. Possible predictors of renal damage at the time of LN diagnosis were examined: proteinuria, low complement, anti-double-stranded DNA antibodies, red cell casts, creatinine level, hypertension, renal activity (assessed by the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI)), prednisone dose, immunosuppressive drugs and antimalarial use. Sociodemographic variables were included at baseline. Proteinuria was assessed at baseline and at 12 months, to determine if early response (proteinuria <0.8 g/day within 12 months since LN diagnosis) is protective of renal damage occurrence. Renal damage was defined as an increase of one or more points in the renal domain of The Systemic Lupus International Collaborating Clinics (SLICC)/American College of Rheumatology (ACR) Damage Index (SDI). Cox regression models using a backward selection method were performed.

Results: Five hundred and two patients with systemic lupus erythematosus patients were included; 120 patients (23.9%) accrued renal damage during their follow-up. Early response to treatment (HR=0.58), antimalarial use (HR=0.54) and a high SES (HR=0.25) were protective of renal damage occurrence, whereas male gender (HR=1.83), hypertension (HR=1.86) and the renal component of the SLEDAI (HR=2.02) were risk factors for its occurrence.

Conclusions: Early response, antimalarial use and high SES were protective of renal damage, while male gender, hypertension and higher renal activity were risk factors for its occurrence in patients with LN.

Keywords: Autoimmune Diseases; Lupus Erythematosus; Lupus Nephritis; Systemic.

PubMed Disclaimer

Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Kaplan-Meier curve: Renal damage-free survival curve. Patients with LN (clinically or biopsy-proven). n=502.
Figure 2
Figure 2
Kaplan-Meier curve: Renal damage-free survival curve. Patients with LN (biopsy-proven). n=241.
See this image and copyright information in PMC

References

    1. Hanly JG, O’Keeffe AG, Su L, et al. The frequency and outcome of lupus nephritis: results from an international inception cohort study. Rheumatology 2016;55:252–62. 10.1093/rheumatology/kev311 - DOI - PMC - PubMed
    1. Danila MI, Pons-Estel GJ, Zhang J, et al. Renal damage is the most important predictor of mortality within the damage index: data from LUMINA LXIV, a multiethnic US cohort. Rheumatology 2008;48:542–5. 10.1093/rheumatology/kep012 - DOI - PMC - PubMed
    1. Mok CC, Kwok RCL, Yip PSF. Effect of renal disease on the standardized mortality ratio and life expectancy of patients with systemic lupus erythematosus. Arthritis Rheum 2013;65:2154–60. 10.1002/art.38006 - DOI - PubMed
    1. Mok CC Is treat-to-target in lupus nephritis realistic in clinical practice? Curr Rheumatol Rev 2018;15:2–6. 10.2174/1573397114666180406100857 - DOI - PubMed
    1. Korbet SM, Lewis EJ, Schwartz MM, et al. Factors predictive of outcome in severe lupus nephritis. Lupus nephritis collaborative study group. Am J Kidney Dis 2000;35:904–14. 10.1016/S0272-6386(00)70262-9 - DOI - PubMed

MeSH terms