The frequency and outcome of lupus nephritis: results from an international inception cohort study
Rheumatology (Oxford). 2016 Feb;55(2):252-62. doi: 10.1093/rheumatology/kev311. Epub 2015 Sep 5.
John G Hanly 1 , Aidan G O'Keeffe 2 , Li Su 3 , Murray B Urowitz 4 , Juanita Romero-Diaz 5 , Caroline Gordon 6 , Sang-Cheol Bae 7 , Sasha Bernatsky 8 , Ann E Clarke 9 , Daniel J Wallace 10 , Joan T Merrill 11 , David A Isenberg 12 , Anisur Rahman 12 , Ellen M Ginzler 13 , Paul Fortin 14 , Dafna D Gladman 4 , Jorge Sanchez-Guerrero 4 , Michelle Petri 15 , Ian N Bruce 16 , Mary Anne Dooley 17 , Rosalind Ramsey-Goldman 18 , Cynthia Aranow 19 , Graciela S Alarcón 20 , Barri J Fessler 20 , Kristjan Steinsson 21 , Ola Nived 22 , Gunnar K Sturfelt 22 , Susan Manzi 23 , Munther A Khamashta 24 , Ronald F van Vollenhoven 25 , Asad A Zoma 26 , Manuel Ramos-Casals 27 , Guillermo Ruiz-Irastorza 28 , S Sam Lim 29 , Thomas Stoll 30 , Murat Inanc 31 , Kenneth C Kalunian 32 , Diane L Kamen 33 , Peter Maddison 34 , Christine A Peschken 35 , Soren Jacobsen 36 , Anca Askanase 37 , Chris Theriault 38 , Kara Thompson 38 , Vernon Farewell 3
1 Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada, john.hanly@cdha.nshealth.ca.
2 Department of Statistical Science, University College London, London.
3 MRC Biostatistics Unit, Institute of Public Health, University Forvie Site, Cambridge, UK.
4 Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto, Toronto, ON, Canada.
5 Instituto Nacional de Ciencias Medicas y Nutrición, Mexico City, Mexico.
6 Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.
7 Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea.
8 Divisions of Rheumatology and Clinical Epidemiology, McGill University Health Centre.
9 Division of Rheumatology, University of Calgary, Alberta, Canada.
10 Cedars-Sinai/David Geffen School of Medicine at UCLA, Los Angeles, CA.
11 Department of Clinical Pharmacology, Oklahoma Medical Research Foundation, Oklahoma City, OK, USA.
12 Centre for Rheumatology, Department of Medicine, University College London, UK.
13 Department of Medicine, SUNY Downstate Medical Center, Brooklyn, NY, USA.
14 Division of Rheumatology, Centre Hospitalier Universitaire de Québec et Université Laval, Quebec City, Canada.
15 Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
16 Arthritis Research UK Epidemiology Unit, Institute of Inflammation and Repair, Manchester Academic Health Sciences Centre, The University of Manchester, Manchester, UK, NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK.
17 Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, NC.
18 Northwestern University and Feinberg School of Medicine, Chicago, IL.
19 Feinstein Institute for Medical Research, Manhasset, NY.
20 Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
21 Center for Rheumatology Research, Landspitali University Hospital, Reykjavik, Iceland.
22 Department of Rheumatology, University Hospital Lund, Lund, Sweden.
23 Division of Rheumatology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
24 Lupus Research Unit, The Rayne Institute, St Thomas' Hospital, King's College London School of Medicine, London, UK.
25 Unit for Clinical Therapy Research, Karolinska Institute, Stockholm, Sweden.
26 Lanarkshire Centre for Rheumatology, Hairmyres Hospital, East Kilbride, Scotland, UK.
27 Josep Font Autoimmune Diseases Laboratory, IDIBAPS, Department of Autoimmune Diseases, Hospital Clínic, Barcelona, Spain.
28 Autoimmune Diseases Research Unit, Department of Internal Medicine, BioCruces Health Research Institute, Hospital Universitario Cruces, University of the Basque Country, Barakaldo, Spain.
29 Emory University School of Medicine, Division of Rheumatology, Atlanta, Georgia, USA.
30 Kantonsspital Geissbergstr, Schaffhausen, Switzerland.
31 Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey.
32 UCSD School of Medicine, La Jolla, CA.
33 Medical University of South Carolina, Charleston, SC, USA.
34 Ysbyty Gwynedd Bangor, Gwynedd, North Wales, UK.
35 University of Manitoba, Winnipeg, Manitoba, Canada.
36 Department of Rheumatology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
37 Hospital for Joint Diseases, NYU, Seligman Centre for Advanced Therapeutics, New York, NY, USA and.
38 Department of Medicine, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada.
DOI: 10.1093/rheumatology/kev311
Objective: To determine nephritis outcomes in a prospective multi-ethnic/racial SLE inception cohort.
Methods: Patients in the Systemic Lupus International Collaborating Clinics inception cohort (≤15 months of SLE diagnosis) were assessed annually for estimated glomerular filtration rate (eGFR), proteinuria and end-stage renal disease (ESRD). Health-related quality of life was measured by the Short Form (36 questions) health survey questionnaire (SF-36) subscales, mental and physical component summary scores.
Results: There were 1827 patients, 89% females, mean (s.d.) age 35.1 (13.3) years. The mean (s.d.) SLE duration at enrolment was 0.5 (0.3) years and follow-up 4.6 (3.4) years. LN occurred in 700 (38.3%) patients: 566/700 (80.9%) at enrolment and 134/700 (19.1%) during follow-up. Patients with nephritis were younger, more frequently men and of African, Asian and Hispanic race/ethnicity. The estimated overall 10-year incidence of ESRD was 4.3% (95% CI: 2.8%, 5.8%), and with nephritis was 10.1% (95% CI: 6.6%, 13.6%). Patients with nephritis had a higher risk of death (HR = 2.98, 95% CI: 1.48, 5.99; P = 0.002) and those with eGFR <30 ml/min at diagnosis had lower SF-36 physical component summary scores (P < 0.01) and lower Physical function, Physical role and Bodily pain scores. Over time, patients with abnormal eGFR and proteinuria had lower SF-36 mental component summary (P ≤ 0.02) scores compared to patients with normal values.
Conclusion: LN occurred in 38.3% of SLE patients, frequently as the initial presentation, in a large multi-ethnic inception cohort. Despite current standard of care, nephritis was associated with ESRD and death, and renal insufficiency was linked to lower health-related quality of life. Further advances are required for the optimal treatment of LN.
Keywords: inception cohort; lupus; nephritis; outcomes research; systemic lupus erythematosus.
© The Author 2015. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oup.com.
Disease Progression
Ethnicity*
Lupus Nephritis / diagnosis
Lupus Nephritis / ethnology*
Outcome Assessment, Health Care*
Survival Rate / trends
MC_U105261167/MRC_/Medical Research Council/United Kingdom
R01 AR043727/AR/NIAMS NIH HHS/United States
UL1 TR001422/TR/NCATS NIH HHS/United States
AR43727/AR/NIAMS NIH HHS/United States