The role for renal histology as predictor for outcome in lupus nephritis in Western Australia

Research output: Contribution to journalAbstract/Meeting Abstract

Abstract

Objectives: Continuous demographic change with new mechanistic insights and treatment options necessitate regular updating of our knowledge on Lupus Nephritis (LN). We investigated the current role of demographic, clinical and histological characteristics as outcome predictors in LN patients in Western Australia (WA). Method: A retrospective single centre study of all adult SLE patients with a first renal biopsy compatible with LN between 1997–2017 seen at a metropolitan tertiary hospital in WA. Demographic, laboratory, renal biopsy (ISN class) and treatment data were collected at baseline. Annual incidence rates per 100.000 population used ABS 2006 census and country of origin data. Kaplan Meyer survival estimates with Cox regression analysis identified independent predictors. Result: The annualised LN incidence rate was 3.3, 3.1 1.9 and 0.4 for Asian (n = 29), Indigenous Australian (IA) (n = 11), other (n = 9), and Caucasians (n = 43) (all P < 0.01 vs Caucasian). There was no significant difference between ethnic groups regarding ISN class (proliferative 66%, membranous19% or mesangial 15%), proteinuria (median PCR 300 mg/mmol), increased serum creatinine (31%), renal (median 8) and non‐renal SLEDAI (median 4), anti‐dsDNA antibodies (89%) or hypocomplementemia (88%). Treatment included corticos- teroids (91%), cyclophosphamide (30%), mycophenolate (67%) and antihypertensive drugs (67%). Five and ten years survival was 95% % at both time points for Caucasians and Asians and 81% and 70% in IA (P = 0.016). Five and ten‐year renal survival (endpoint RRT) was 100% for Asian, 100% and 96% for Caucasian, vs 86% and 64% for IA (P = 0.02). Ethnic background was the only independent pre- dictor for poor patient survival and together with male gender also predictive of poor renal survival. Conclusion: The majority of adult LN patients in WA now are non‐ Caucasian. Despite a high incidence of LN, Asian LN patients have similar favourable outcomes as Caucasians, while the outlook is much bleaker for IA patients. As histological and clinical findings did not predict outcome, other factors are responsible for this disparity.
Original languageEnglish
Pages (from-to)164
Number of pages1
JournalInternational Journal of Rheumatic Diseases
Volume21
Issue numbersuppl 1
Publication statusPublished - 1 Sep 2018
EventAPLAR 2018 Congress - Kaohsiung, Taiwan, Taiwan, Province of China
Duration: 6 Sep 20189 Sep 2018

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Western Australia
Lupus Nephritis
Histology
Kidney
Demography
Survival
Incidence
Biopsy
Urban Hospitals
Proteinuria
Ethnic Groups
Tertiary Care Centers
Cyclophosphamide
Creatinine
Therapeutics
Polymerase Chain Reaction
Antibodies
Serum
Pharmaceutical Preparations
Population

Cite this

@article{6ee190791167455cbaf275c66534672a,
title = "The role for renal histology as predictor for outcome in lupus nephritis in Western Australia",
abstract = "Objectives: Continuous demographic change with new mechanistic insights and treatment options necessitate regular updating of our knowledge on Lupus Nephritis (LN). We investigated the current role of demographic, clinical and histological characteristics as outcome predictors in LN patients in Western Australia (WA). Method: A retrospective single centre study of all adult SLE patients with a first renal biopsy compatible with LN between 1997–2017 seen at a metropolitan tertiary hospital in WA. Demographic, laboratory, renal biopsy (ISN class) and treatment data were collected at baseline. Annual incidence rates per 100.000 population used ABS 2006 census and country of origin data. Kaplan Meyer survival estimates with Cox regression analysis identified independent predictors. Result: The annualised LN incidence rate was 3.3, 3.1 1.9 and 0.4 for Asian (n = 29), Indigenous Australian (IA) (n = 11), other (n = 9), and Caucasians (n = 43) (all P < 0.01 vs Caucasian). There was no significant difference between ethnic groups regarding ISN class (proliferative 66{\%}, membranous19{\%} or mesangial 15{\%}), proteinuria (median PCR 300 mg/mmol), increased serum creatinine (31{\%}), renal (median 8) and non‐renal SLEDAI (median 4), anti‐dsDNA antibodies (89{\%}) or hypocomplementemia (88{\%}). Treatment included corticos- teroids (91{\%}), cyclophosphamide (30{\%}), mycophenolate (67{\%}) and antihypertensive drugs (67{\%}). Five and ten years survival was 95{\%} {\%} at both time points for Caucasians and Asians and 81{\%} and 70{\%} in IA (P = 0.016). Five and ten‐year renal survival (endpoint RRT) was 100{\%} for Asian, 100{\%} and 96{\%} for Caucasian, vs 86{\%} and 64{\%} for IA (P = 0.02). Ethnic background was the only independent pre- dictor for poor patient survival and together with male gender also predictive of poor renal survival. Conclusion: The majority of adult LN patients in WA now are non‐ Caucasian. Despite a high incidence of LN, Asian LN patients have similar favourable outcomes as Caucasians, while the outlook is much bleaker for IA patients. As histological and clinical findings did not predict outcome, other factors are responsible for this disparity.",
author = "Johannes Nossent and Warren Raymond and Milica Ognjenovic and A. Kang and {Wong Chung Lung}, Daniel and Aron Chakera",
year = "2018",
month = "9",
day = "1",
language = "English",
volume = "21",
pages = "164",
journal = "International Journal of Rheumatic Diseases",
issn = "1756-1841",
publisher = "John Wiley & Sons",
number = "suppl 1",

}

TY - JOUR

T1 - The role for renal histology as predictor for outcome in lupus nephritis in Western Australia

AU - Nossent, Johannes

AU - Raymond, Warren

AU - Ognjenovic, Milica

AU - Kang, A.

AU - Wong Chung Lung, Daniel

AU - Chakera, Aron

PY - 2018/9/1

Y1 - 2018/9/1

N2 - Objectives: Continuous demographic change with new mechanistic insights and treatment options necessitate regular updating of our knowledge on Lupus Nephritis (LN). We investigated the current role of demographic, clinical and histological characteristics as outcome predictors in LN patients in Western Australia (WA). Method: A retrospective single centre study of all adult SLE patients with a first renal biopsy compatible with LN between 1997–2017 seen at a metropolitan tertiary hospital in WA. Demographic, laboratory, renal biopsy (ISN class) and treatment data were collected at baseline. Annual incidence rates per 100.000 population used ABS 2006 census and country of origin data. Kaplan Meyer survival estimates with Cox regression analysis identified independent predictors. Result: The annualised LN incidence rate was 3.3, 3.1 1.9 and 0.4 for Asian (n = 29), Indigenous Australian (IA) (n = 11), other (n = 9), and Caucasians (n = 43) (all P < 0.01 vs Caucasian). There was no significant difference between ethnic groups regarding ISN class (proliferative 66%, membranous19% or mesangial 15%), proteinuria (median PCR 300 mg/mmol), increased serum creatinine (31%), renal (median 8) and non‐renal SLEDAI (median 4), anti‐dsDNA antibodies (89%) or hypocomplementemia (88%). Treatment included corticos- teroids (91%), cyclophosphamide (30%), mycophenolate (67%) and antihypertensive drugs (67%). Five and ten years survival was 95% % at both time points for Caucasians and Asians and 81% and 70% in IA (P = 0.016). Five and ten‐year renal survival (endpoint RRT) was 100% for Asian, 100% and 96% for Caucasian, vs 86% and 64% for IA (P = 0.02). Ethnic background was the only independent pre- dictor for poor patient survival and together with male gender also predictive of poor renal survival. Conclusion: The majority of adult LN patients in WA now are non‐ Caucasian. Despite a high incidence of LN, Asian LN patients have similar favourable outcomes as Caucasians, while the outlook is much bleaker for IA patients. As histological and clinical findings did not predict outcome, other factors are responsible for this disparity.

AB - Objectives: Continuous demographic change with new mechanistic insights and treatment options necessitate regular updating of our knowledge on Lupus Nephritis (LN). We investigated the current role of demographic, clinical and histological characteristics as outcome predictors in LN patients in Western Australia (WA). Method: A retrospective single centre study of all adult SLE patients with a first renal biopsy compatible with LN between 1997–2017 seen at a metropolitan tertiary hospital in WA. Demographic, laboratory, renal biopsy (ISN class) and treatment data were collected at baseline. Annual incidence rates per 100.000 population used ABS 2006 census and country of origin data. Kaplan Meyer survival estimates with Cox regression analysis identified independent predictors. Result: The annualised LN incidence rate was 3.3, 3.1 1.9 and 0.4 for Asian (n = 29), Indigenous Australian (IA) (n = 11), other (n = 9), and Caucasians (n = 43) (all P < 0.01 vs Caucasian). There was no significant difference between ethnic groups regarding ISN class (proliferative 66%, membranous19% or mesangial 15%), proteinuria (median PCR 300 mg/mmol), increased serum creatinine (31%), renal (median 8) and non‐renal SLEDAI (median 4), anti‐dsDNA antibodies (89%) or hypocomplementemia (88%). Treatment included corticos- teroids (91%), cyclophosphamide (30%), mycophenolate (67%) and antihypertensive drugs (67%). Five and ten years survival was 95% % at both time points for Caucasians and Asians and 81% and 70% in IA (P = 0.016). Five and ten‐year renal survival (endpoint RRT) was 100% for Asian, 100% and 96% for Caucasian, vs 86% and 64% for IA (P = 0.02). Ethnic background was the only independent pre- dictor for poor patient survival and together with male gender also predictive of poor renal survival. Conclusion: The majority of adult LN patients in WA now are non‐ Caucasian. Despite a high incidence of LN, Asian LN patients have similar favourable outcomes as Caucasians, while the outlook is much bleaker for IA patients. As histological and clinical findings did not predict outcome, other factors are responsible for this disparity.

M3 - Abstract/Meeting Abstract

VL - 21

SP - 164

JO - International Journal of Rheumatic Diseases

JF - International Journal of Rheumatic Diseases

SN - 1756-1841

IS - suppl 1

ER -