Renal Outcomes Among Egyptian Lupus Nephritis Patients: A Retrospective Analysis of 135 Cases From a Single Centre

Lupus. 2015 Mar;24(3):331-8. doi: 10.1177/0961203314567751. Epub 2015 Jan 20.

Abstract

Objectives: The objective of this paper is to describe renal outcomes in a group of Egyptian patients with lupus nephritis and to identify variable prognostic factors.

Patients and methods: The records of 135 patients (129 females, six males) with biopsy-proven lupus nephritis seen between 1999 and 2011 at Kasr Al-Aini Hospital, Cairo University, were reviewed and included in a retrospective analysis. Biopsies were classified according to the WHO classification. Renal outcomes were defined according to the Renal Subcommittee of Renal Insufficiency of the American College of Rheumatology.

Results: The mean follow-up period was 55.64 ± 25.68 (range 4-156) months. Thirty-nine patients (29.9%) developed an adverse final outcome. This composite outcome, defined as persistent elevation of serum creatinine ≥ 1.2 mg/dl, chronic renal insufficiency, end-stage renal disease or death, was seen in 12 (8.9%), seven (5.2%), three (2.2%) and 17 (12.6%) patients, respectively. The overall patient survival was 93.5% and 87.5% at five and 10 years, respectively. Factors associated with an adverse outcome included male gender (p = 0.037), hypertension at nephritis onset (p = 0.001), serum creatinine ≥1.2 mg/dl (p < 0.001), urinary casts (p = 0.006), anticardiolipin antibodies (p = 0.03), class IV nephritis (p < 0.001), hyaline thrombosis (0.003), glomerular sclerosis (p = 0.002), tubular atrophy(p < 0.001), interstitial fibrosis (p < 0.001) and a higher chronicity index (p = 0.006). Time-dependent factors associated with an adverse outcome included failure to achieve remission within the first year, uncontrolled hypertension, persistently low C3 and development of flares (p = 0.003, < 0.001, = 0.004, = 0.003, respectively).

Conclusion: The association of several adverse prognostic factors with the development of poor renal outcome has been confirmed in this study.

Keywords: Egyptians; Lupus nephritis; outcome; prognostic factors.

MeSH terms

  • Adolescent
  • Adult
  • Egypt / epidemiology
  • Female
  • Humans
  • Immunosuppressive Agents / therapeutic use
  • Lupus Nephritis / complications
  • Lupus Nephritis / drug therapy
  • Lupus Nephritis / epidemiology*
  • Male
  • Prednisone / therapeutic use
  • Retrospective Studies
  • Young Adult

Substances

  • Immunosuppressive Agents
  • Prednisone