Factors associated with poor outcomes in patients with lupus nephritis

Gabriel Contreras, Victoriano Pardo, C. Cely, E. Borja, A. Hurtado, C. De La Cuesta, K. Iqbal, O. Lenz, A. Asif, N. Nahar, B. Leclerq, C. Leon, I. Schulman, F. Ramirez-Seijas, A. Paredes, A. Cepero, T. Khan, F. Pachon, E. Tozman, G. BarretoD. Hoffman, M. Almeida Suarez, J. C. Busse, M. Esquenazi, A. Esquenazi, L. Garcia Mayol, H. Garcia Estrada

Research output: Contribution to journalArticle

130 Scopus citations

Abstract

The objective of this study was to identify the factors associated with important clinical outcomes in a case-control study of 213 patients with lupus nephritis. Included were 47% Hispanics, 44% African Americans and 9% Caucasians with a mean age of 28 years. Fifty-four (25%) patients reached the primary composite outcome of doubling serum creatinine, end-stage renal disease or death during a mean follow-up of 37 months. Thirty-four percent African Americans, 20% Hispanics and 10% Caucasians reached the primary composite outcome (P < 0.05). Patients reaching the composite outcome had predominantly proliferative lupus nephritis (WHO classes: 30% III, 32% IV, 18% V and 5% II, P < 0.025) with higher activity index score (7 ± 6 versus 5 ± 5, P < 0.05), chronicity index (CI) score (4 ± 3 versus 2 ± 2 unit, P < 0.025), higher baseline mean arterial pressure (MAP) (111 ± 21 versus 102 ± 14 mmHg, P < 0.025) and serum creatinine (1.9 ± 1.3 versus 1.3 ± 1.0 mg/dL, P < 0.025), but lower baseline hematocrit (29 ± 6 versus 31 + 5%, P < 0.025) and complement C3 (54 ± 26 versus 65 + 33 mg/dL, P < 0.025) compared to controls. More patients reaching the composite outcome had nephrotic range proteinuria compared to controls (74% versus 56%, P < 0.025). By multivariate analysis, CI (hazard ratio [95% CI] 1.18 [1.07-1.30] per point), MAP (HR 1.02 [1.00-1.03] per mmHg), and baseline serum creatinine (HR 1.26 [1.04-1.54] per mg/dL) were independently associated with the composite outcome. We concluded that hypertension and elevated serum creatinine at the time of the kidney biopsy as well as a high CI are associated with an increased the risk for chronic renal failure or death in patients with lupus nephritis.

Original languageEnglish (US)
Pages (from-to)890-895
Number of pages6
JournalLupus
Volume14
Issue number11
DOIs
StatePublished - Dec 12 2005

Keywords

  • Chronic renal failure
  • Death and predictors
  • Lupus nephritis

ASJC Scopus subject areas

  • Rheumatology
  • Immunology

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    Contreras, G., Pardo, V., Cely, C., Borja, E., Hurtado, A., De La Cuesta, C., Iqbal, K., Lenz, O., Asif, A., Nahar, N., Leclerq, B., Leon, C., Schulman, I., Ramirez-Seijas, F., Paredes, A., Cepero, A., Khan, T., Pachon, F., Tozman, E., ... Estrada, H. G. (2005). Factors associated with poor outcomes in patients with lupus nephritis. Lupus, 14(11), 890-895. https://doi.org/10.1191/0961203305lu2238oa