Examining Trends of Histologic Presentation, Renal Outcomes in Lupus Nephritis

lupus nephropathy
Investigators sought to evaluate changes in demographic, clinical, and histologic presentation in patients with lupus nephritis between 1970 and 2016.

The clinical presentation of lupus nephritis (LN) has become less severe in recent years and is now characterized by an increase in isolated urinary abnormalities and a decrease in renal insufficiency, leading to improved long-term renal survival, according to the results of a multicenter retrospective cohort study published in Annals of the Rheumatic Diseases.

The investigators sought to evaluate changes in demographic, clinical, and histologic presentation, and the prognosis of patients with LN over time. A total of 499 patients who were diagnosed with LN between 1970 and 2016 were examined. The 46-year follow-up was divided into 3 time periods: 1970 to 1985, 1986 to 2001, and 2002 to 2016. Patients were categorized based on the year of their LN diagnosis.

From 1970 to 2016, a progressive increase in patient age at the time of LN diagnosis (P <.0001) and a significantly longer time between the onset of systemic lupus erythematosus and LN occurrence (P <.0001) were observed. Over the same time period, the prevalence of renal insufficiency at the time of LN presentation decreased progressively (P <.0001), while the prevalence of isolated urinary abnormalities increased (P <.0001).

There were no changes in histologic class and activity index reported, but the chronicity index decreased significantly between 1970 and 2016 (P =.023). Survival without end-stage renal disease (ESRD) at 10 years was 87% from 1970 to 1985, 94% from 1986 to 2001, and 99% from 2002 to 2016. Survival without ESRD at 20 years was 80% from 1970 to 1985 and 90% from 1986 to 2001 (P =.0019). Male gender, arterial hypertension, increased serum creatinine level, absence of maintenance immunosuppressive therapy, and high activity and chronicity index were all independent predictors of ESRD.

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The investigators concluded that the clinical presentation at the time of kidney biopsy for suspected LN has become less severe over the last few years. The progressive improvement in renal survival reported in the study cohort is associated with a comprehensive approach to patient care, including the prompt diagnosis of renal involvement, a wider indication for renal biopsy, and increased clinical experience in the management of LN.

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Moroni G, Vercelloni PG, Quaglini S, et al. Changing patterns in clinical-histological presentation and renal outcome over the last five decades in a cohort of 499 patients with lupus nephritis [published May 5, 2018].  Ann Rheum Dis. doi:10.1136/annrheumdis-2017-212732