A descriptive study of the factors associated with damage in Malaysian patients with lupus nephritis

Lupus. 2014 Apr;23(4):436-42. doi: 10.1177/0961203313518624. Epub 2014 Jan 7.


Introduction: Renal involvement is the most common serious complication in patients with systemic lupus erythematosus (SLE).

Objective: The objective of this article is to investigate and determine the associated factors of disease damage among lupus nephritis (LN) patients.

Methods: Medical records of LN patients who attended regular follow-up for at least one year in the Nephrology/SLE Clinic, Universiti Kebangsaan Malaysia Medical Centre (UKMMC), were reviewed. Their Systemic Lupus International Collaborating Clinics/American College of Rheumatology (SLICC/ACR) Damage Index scores were noted. Univariate analysis and multivariable regression analysis were performed to determine the independent factors of disease damage in LN.

Results: A total of 150 patients were included and their follow-up duration ranged from one to 20 years. Sixty (40%) LN patients had disease damage (SDI ≥1). In the univariate analysis, it was associated with age, longer disease duration, antiphospholipid syndrome (APS), higher maximum daily oral prednisolone dose (mg/day), lower mean C3 and C4, higher chronicity index and global sclerosis on renal biopsies (p < 0.05). Patients who received early (≤3 months after the SLE diagnosis) hydroxychloroquine (HCQ), optimum HCQ dose at 6.5 mg/kg/day and achieved early complete remission (CR) were less likely to have disease damage (p < 0.05). After adjustment for age, gender, disease duration and severity, multivariable regression analysis revealed that a higher maximum daily dose of oral prednisolone was independently associated with disease damage while early HCQ and CR were associated with lower disease damage.

Conclusion: Higher maximum daily prednisolone dose predicted disease damage whereas treatment with early HCQ and early CR had a protective role against disease damage.

Keywords: Antiphospholipid syndrome; lupus nephritis; systemic lupus erythematosus.

MeSH terms

  • Adult
  • Antiphospholipid Syndrome / epidemiology*
  • Dose-Response Relationship, Drug
  • Female
  • Follow-Up Studies
  • Humans
  • Hydroxychloroquine / administration & dosage
  • Hydroxychloroquine / therapeutic use*
  • Lupus Nephritis / epidemiology
  • Lupus Nephritis / physiopathology*
  • Malaysia / epidemiology
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Prednisolone / administration & dosage
  • Prednisolone / therapeutic use*
  • Regression Analysis
  • Remission Induction
  • Retrospective Studies
  • Risk Factors
  • Severity of Illness Index
  • Time Factors


  • Hydroxychloroquine
  • Prednisolone