The frequency and outcome of lupus nephritis: results from an international inception cohort study.
Hanly JG., O'Keeffe AG., Su L., Urowitz MB., Romero-Diaz J., Gordon C., Bae S-C., Bernatsky S., Clarke AE., Wallace DJ., Merrill JT., Isenberg DA., Rahman A., Ginzler EM., Fortin P., Gladman DD., Sanchez-Guerrero J., Petri M., Bruce IN., Dooley MA., Ramsey-Goldman R., Aranow C., Alarcón GS., Fessler BJ., Steinsson K., Nived O., Sturfelt GK., Manzi S., Khamashta MA., van Vollenhoven RF., Zoma AA., Ramos-Casals M., Ruiz-Irastorza G., Lim SS., Stoll T., Inanc M., Kalunian KC., Kamen DL., Maddison P., Peschken CA., Jacobsen S., Askanase A., Theriault C., Thompson K., Farewell V.
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.