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. 2025 Feb 24;5(1):109-118.
doi: 10.1159/000543706. eCollection 2025 Jan-Dec.

Late-Onset Lupus Nephritis: Clinical-Epidemiological, Histological, Prognostic, and Therapeutic Implications: A Single-Center Experience from Northeastern Spain

Jorge González Rodríguez  1   2 , Elías Jatem Escalante  1   2 , Juan Carlos Buil Campo  3 , Miquel Pinyol Ribas  4 , Maria Luisa Martín Conde  1   2   3
Affiliations

Late-Onset Lupus Nephritis: Clinical-Epidemiological, Histological, Prognostic, and Therapeutic Implications: A Single-Center Experience from Northeastern Spain

Jorge González Rodríguez et al. Glomerular Dis. .

Abstract

Introduction: Systemic lupus erythematosus (SLE), as an autoimmune disease, and lupus nephritis (LN), are typically diagnosed in women at fertile age. Late-onset SLE is defined as a disease onset over 45-50 years. Our main objective was to analyze the clinical, histological, prognostic, and therapeutic features related to LN in our late-onset SLE population.

Methods: A single-center and retrospective study was performed comparing clinical-demographic, histological, prognostic, and therapeutic features of 45 LN patients from 1994 to 2023. We divided the study population according to the age of onset of LN into classic onset (<45 years) and late onset (≥45 years).

Results: Late-onset LN patients showed a higher association with Sjögren's and antiphospholipid syndrome, more cardiovascular comorbidities at presentation, poorer renal function at diagnosis, and higher Systemic Lupus Damage Index (SDI) score. Histology showed more nonproliferative LN classes (II and V). Late-onset LN responders, compared to those with classic onset, achieved response later. Nonresponsive patients had a higher incidence of acute kidney injury (AKI), more glomerulosclerosis and interstitial fibrosis-tubular atrophy (IFTA) at presentation, and a higher frequency for renal replacement therapy (RRT) at diagnosis and during follow-up. The main independent variables associated with relapse were younger age at SLE diagnosis and initial partial renal response (PRR).

Conclusions: Late-onset LN is often accompanied by other systemic autoimmune diseases such as Sjögren's and antiphospholipid syndrome. These patients have major cardiovascular comorbidities, poor estimated glomerular filtration rate (eGFR) at diagnosis, and increased chronicity index in histology. A tailored approach in this fragile population in order to avoid unnecessary immunosuppression is of critical interest.

Keywords: Acute kidney injury; Age; Interstitial fibrosis-tubular atrophy; Late-onset lupus nephritis; Systemic lupus erythematosus.

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Conflict of interest statement

The authors have no conflicts of interest to declare.

Figures

Fig. 1.
Fig. 1.
Time to first LN relapse and time to initial renal response and study group. a Time to first LN relapse (months) and study group. b Time to initial renal response (months) and study group.
Fig. 2.
Fig. 2.
Renal and patient survival and study group. a Renal survival and study group. b Patient survival and study group.
See this image and copyright information in PMC

References

    1. Prevete I, Iuliano A, Cauli A, Piga M, Iannone F, Coladonato L, et al. Similarities and differences between younger and older disease onset patients with newly diagnosed systemic lupus erythematosus. Clin Exp Rheumatol. 2023;41(1):145–50. - PubMed
    1. Ho CT, Mok CC, Lau CS, Wong RW. Late onset systemic lupus erythematosus in southern Chinese. Ann Rheum Dis. 1998;57(7):437–40. - PMC - PubMed
    1. Boddaert J, Huong DLT, Amoura Z, Wechsler B, Godeau P, Piette JC. Late-onset systemic lupus erythematosus: a personal series of 47 patients and pooled analysis of 714 cases in the literature. Medicine. 2004;83(6):348–59. - PubMed
    1. Maddison PJ. Systemic lupus erythematosus in the elderly. J Rheumatol Suppl. 1987;14(Suppl 13):182–7. - PubMed
    1. Font J, Pallarés L, Cervera R, López-Soto A, Navarro M, Bosch X, et al. Systemic lupus erythematosus in the elderly: clinical and immunological characteristics. Ann Rhem Dis. 1991;50(10):702–5. - PMC - PubMed