The current role for clinical and renal histological findings as predictor for outcome in Australian patients with lupus nephritis

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Abstract

Objectives: To investigate the current demographic, clinical and histological characteristics of patients with lupus nephritis (LN) in Western Australia (WA) with regards to their predictive value for patient and renal outcome. Methods: Retrospective study of adult systemic lupus erythematosus (SLE) patients with a first renal biopsy demonstrating LN between 1997 and 2017 at a metropolitan tertiary hospital in WA. Clinical data were collected at baseline and last follow-up with renal biopsy findings classified by International Society of Nephrology (ISN) criteria. Annual incidence rates (AIRs)/100,000, Kaplan–Meyer curves and Cox regression hazard ratio for independent predictors for patient and renal survival were applied. Results: The AIR was 3.3, 3.1 and 0.4 for Asian (n = 29), Indigenous Australian (IA) (n = 11) and Caucasian (n = 43) patients, respectively (p < 0.01). There was no significant subgroup difference regarding ISN class (proliferative 66%, membranous 19%, mesangial 15%), levels of proteinuria (median PCR 300 mg/mmol) or frequency of raised creatinine (31%), anti-dsDNA antibody (89%) or hypocomplementaemia (88%). Treatment included corticosteroids (91%), cyclophosphamide (30%), mycophenolate (67%) and antihypertensive drugs (67%). Five- (81%) and 10-year (70%) survival was lower for IAs than for Caucasians and Asians (95% each at both time points) (p = 0.016). Five- and 10-year renal survival (endpoint renal replacement therapy (RRT)) was 86% and 64% for IA vs 100% for Asian, 100% and 96% for Caucasian patients (p = 0.02). IA background was the only independent predictor for poor patient survival and together with male gender also for renal survival. Only 25% of all patients remained free of any organ damage with non-renal damage observed in 53% of survivors. Conclusions: LN incidence in WA was 0.75/100,000 with the lowest rate observed in Caucasians. While Asian patients have the same favourable outlook as Caucasians, the outcome is much bleaker for IA patients. Other clinical and histological findings did not predict outcomes, and importantly more than half of all surviving patients accrued non-renal damage.

Original languageEnglish
Pages (from-to)1838-1846
Number of pages9
JournalLupus
Volume27
Issue number11
DOIs
Publication statusPublished - 1 Oct 2018

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Lupus Nephritis
Kidney
Western Australia
Incidence
Biopsy
Renal Replacement Therapy
Nephrology
Survival
Urban Hospitals
Proteinuria
Tertiary Care Centers
Systemic Lupus Erythematosus
Cyclophosphamide
Antihypertensive Agents
Survivors
Anti-Idiotypic Antibodies
Creatinine
Adrenal Cortex Hormones
Retrospective Studies
Demography

Cite this

@article{16068849df4a44e0bfd97f0cc3726196,
title = "The current role for clinical and renal histological findings as predictor for outcome in Australian patients with lupus nephritis",
abstract = "Objectives: To investigate the current demographic, clinical and histological characteristics of patients with lupus nephritis (LN) in Western Australia (WA) with regards to their predictive value for patient and renal outcome. Methods: Retrospective study of adult systemic lupus erythematosus (SLE) patients with a first renal biopsy demonstrating LN between 1997 and 2017 at a metropolitan tertiary hospital in WA. Clinical data were collected at baseline and last follow-up with renal biopsy findings classified by International Society of Nephrology (ISN) criteria. Annual incidence rates (AIRs)/100,000, Kaplan–Meyer curves and Cox regression hazard ratio for independent predictors for patient and renal survival were applied. Results: The AIR was 3.3, 3.1 and 0.4 for Asian (n = 29), Indigenous Australian (IA) (n = 11) and Caucasian (n = 43) patients, respectively (p < 0.01). There was no significant subgroup difference regarding ISN class (proliferative 66{\%}, membranous 19{\%}, mesangial 15{\%}), levels of proteinuria (median PCR 300 mg/mmol) or frequency of raised creatinine (31{\%}), anti-dsDNA antibody (89{\%}) or hypocomplementaemia (88{\%}). Treatment included corticosteroids (91{\%}), cyclophosphamide (30{\%}), mycophenolate (67{\%}) and antihypertensive drugs (67{\%}). Five- (81{\%}) and 10-year (70{\%}) survival was lower for IAs than for Caucasians and Asians (95{\%} each at both time points) (p = 0.016). Five- and 10-year renal survival (endpoint renal replacement therapy (RRT)) was 86{\%} and 64{\%} for IA vs 100{\%} for Asian, 100{\%} and 96{\%} for Caucasian patients (p = 0.02). IA background was the only independent predictor for poor patient survival and together with male gender also for renal survival. Only 25{\%} of all patients remained free of any organ damage with non-renal damage observed in 53{\%} of survivors. Conclusions: LN incidence in WA was 0.75/100,000 with the lowest rate observed in Caucasians. While Asian patients have the same favourable outlook as Caucasians, the outcome is much bleaker for IA patients. Other clinical and histological findings did not predict outcomes, and importantly more than half of all surviving patients accrued non-renal damage.",
keywords = "end-stage renal disease, histology, incidence, Lupus nephritis, mortality",
author = "J. Nossent and W. Raymond and A. Kang and D. Wong and M. Ognjenovic and A. Chakera",
year = "2018",
month = "10",
day = "1",
doi = "10.1177/0961203318792361",
language = "English",
volume = "27",
pages = "1838--1846",
journal = "Lupus",
issn = "0961-2033",
publisher = "SAGE Publications Ltd",
number = "11",

}

TY - JOUR

T1 - The current role for clinical and renal histological findings as predictor for outcome in Australian patients with lupus nephritis

AU - Nossent, J.

AU - Raymond, W.

AU - Kang, A.

AU - Wong, D.

AU - Ognjenovic, M.

AU - Chakera, A.

PY - 2018/10/1

Y1 - 2018/10/1

N2 - Objectives: To investigate the current demographic, clinical and histological characteristics of patients with lupus nephritis (LN) in Western Australia (WA) with regards to their predictive value for patient and renal outcome. Methods: Retrospective study of adult systemic lupus erythematosus (SLE) patients with a first renal biopsy demonstrating LN between 1997 and 2017 at a metropolitan tertiary hospital in WA. Clinical data were collected at baseline and last follow-up with renal biopsy findings classified by International Society of Nephrology (ISN) criteria. Annual incidence rates (AIRs)/100,000, Kaplan–Meyer curves and Cox regression hazard ratio for independent predictors for patient and renal survival were applied. Results: The AIR was 3.3, 3.1 and 0.4 for Asian (n = 29), Indigenous Australian (IA) (n = 11) and Caucasian (n = 43) patients, respectively (p < 0.01). There was no significant subgroup difference regarding ISN class (proliferative 66%, membranous 19%, mesangial 15%), levels of proteinuria (median PCR 300 mg/mmol) or frequency of raised creatinine (31%), anti-dsDNA antibody (89%) or hypocomplementaemia (88%). Treatment included corticosteroids (91%), cyclophosphamide (30%), mycophenolate (67%) and antihypertensive drugs (67%). Five- (81%) and 10-year (70%) survival was lower for IAs than for Caucasians and Asians (95% each at both time points) (p = 0.016). Five- and 10-year renal survival (endpoint renal replacement therapy (RRT)) was 86% and 64% for IA vs 100% for Asian, 100% and 96% for Caucasian patients (p = 0.02). IA background was the only independent predictor for poor patient survival and together with male gender also for renal survival. Only 25% of all patients remained free of any organ damage with non-renal damage observed in 53% of survivors. Conclusions: LN incidence in WA was 0.75/100,000 with the lowest rate observed in Caucasians. While Asian patients have the same favourable outlook as Caucasians, the outcome is much bleaker for IA patients. Other clinical and histological findings did not predict outcomes, and importantly more than half of all surviving patients accrued non-renal damage.

AB - Objectives: To investigate the current demographic, clinical and histological characteristics of patients with lupus nephritis (LN) in Western Australia (WA) with regards to their predictive value for patient and renal outcome. Methods: Retrospective study of adult systemic lupus erythematosus (SLE) patients with a first renal biopsy demonstrating LN between 1997 and 2017 at a metropolitan tertiary hospital in WA. Clinical data were collected at baseline and last follow-up with renal biopsy findings classified by International Society of Nephrology (ISN) criteria. Annual incidence rates (AIRs)/100,000, Kaplan–Meyer curves and Cox regression hazard ratio for independent predictors for patient and renal survival were applied. Results: The AIR was 3.3, 3.1 and 0.4 for Asian (n = 29), Indigenous Australian (IA) (n = 11) and Caucasian (n = 43) patients, respectively (p < 0.01). There was no significant subgroup difference regarding ISN class (proliferative 66%, membranous 19%, mesangial 15%), levels of proteinuria (median PCR 300 mg/mmol) or frequency of raised creatinine (31%), anti-dsDNA antibody (89%) or hypocomplementaemia (88%). Treatment included corticosteroids (91%), cyclophosphamide (30%), mycophenolate (67%) and antihypertensive drugs (67%). Five- (81%) and 10-year (70%) survival was lower for IAs than for Caucasians and Asians (95% each at both time points) (p = 0.016). Five- and 10-year renal survival (endpoint renal replacement therapy (RRT)) was 86% and 64% for IA vs 100% for Asian, 100% and 96% for Caucasian patients (p = 0.02). IA background was the only independent predictor for poor patient survival and together with male gender also for renal survival. Only 25% of all patients remained free of any organ damage with non-renal damage observed in 53% of survivors. Conclusions: LN incidence in WA was 0.75/100,000 with the lowest rate observed in Caucasians. While Asian patients have the same favourable outlook as Caucasians, the outcome is much bleaker for IA patients. Other clinical and histological findings did not predict outcomes, and importantly more than half of all surviving patients accrued non-renal damage.

KW - end-stage renal disease

KW - histology

KW - incidence

KW - Lupus nephritis

KW - mortality

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U2 - 10.1177/0961203318792361

DO - 10.1177/0961203318792361

M3 - Article

VL - 27

SP - 1838

EP - 1846

JO - Lupus

JF - Lupus

SN - 0961-2033

IS - 11

ER -