Long-term outcome in Japanese patients with lupus nephritis

• Published in: Lupus Vol. 23; no. 11; pp. 1124 - 1132
• Main Authors: Kono, M, Yasuda, S, Kato, M, Kanetsuka, Y, Kurita, T, Fujieda, Y, Otomo, K, Horita, T, Oba, K, Kondo, M, Mukai, M, Yanai, M, Fukasawa, Y, Atsumi, T
• Format: Journal Article
• Language: English
• Published: London, England SAGE Publications 01-10-2014; Sage Publications Ltd
• Subjects: Adolescent; Adult; Aged; Biopsy; Blood pressure; Child; Creatinine; Endocrinology; Female; Hospitals; Humans; Japan; Kaplan-Meier Estimate; Kidney diseases; Kidney Failure, Chronic - epidemiology; Kidney Failure, Chronic - etiology; Lupus; Lupus Nephritis - mortality; Lupus Nephritis - physiopathology; Male; Medical prognosis; Middle Aged; Mortality; Nephrology; Pathology; Patients; Prognosis; Proportional Hazards Models; Proteinuria - epidemiology; Proteinuria - etiology; Regression analysis; Remission (Medicine); Retrospective Studies; Rheumatology; Risk Factors; Sex Factors; Survival Rate; Time Factors; Young Adult; Japan; renal lupus; Nephritis; systemic lupus erythematosus
• ISSN: 0961-2033; 1477-0962
• DOI: 10.1177/0961203314536246

The objective of this study was to clarify the long-term outcome in patients with lupus nephritis (LN) according to the International Society of Nephrology and Renal Pathology Society classification. This retrospective analysis comprised 186 Japanese patients given a diagnosis of LN by renal specimen with a mean observation period of 12 years. Primary end point was defined as death or end-stage renal disease, and standardized mortality ratios were calculated. Five patients presented with histopathological class I, 62 with II, 21 with III or III+V, 73 with IV or IV+V and 25 with V. Fourteen deaths occurred, corresponding to an overall standardized mortality ratio of 3.59 (95% confidence interval 2.02–5.81, p < 0.0001). Kaplan-Meier analysis revealed a 10-year overall survival of 95.7%. Nephrotic proteinuria (≥3.5 g/day) at baseline was identified as an independent poor prognostic factor for overall survival in Cox regression analysis. Kaplan-Meier analysis revealed a 10-year renal survival as 94.3%. Male gender and nephrotic proteinuria at baseline were identified as independent poor prognostic factors for renal survival in Cox regression analysis. In conclusion, LN was associated with a 3.59-fold increase in mortality compared with the general population. Male gender and nephrotic proteinuria were predictive for poor renal outcome.