Abstract

Clinical spectrum and short-term outcomes of lupus nephritis: Experience from a state run tertiary care centre in southern India

Author(s):Shivaprasad S. M, Umesh L, Ravi S, Niranjan M. R and Shivanagouda R. P

Lupus nephritis (LN) occurs in up to 40-50% of patients with systemic lupus erythematosus (SLE). Renal involvement remains the strongest predictor of morbidity and mortality among patients with SLE. To Study the clinical features and histopathology of patients with lupus nephritis and also to look for risk factors, prognostic markers and short term renal outcomes. This study is a ongoing prospective observational clinical study between February 2012 to February 2016. Patients with clinical features of lupus nephritis satisfying at least four of the ARA criteria for SLE. And newly diagnosed at the time of renal biopsy were included. Descriptive statistics, One-way ANOVA and Chi square test was applied during analysis. Total 100 patients were studied, The mean age at presentation was 27.3±9.8. Majority were females (F: M= 8:1). Arthritis (78%), rash (62%), and fever (68%) were the most common clinical manifestations at the onset. The mean duration of symptoms prior to diagnosis was 12±6.41 months. One third of the patients were hypertensives at the time of presentation. Leucopenia (21%), thrombocytopenia (18%), nephrotic range proteinuria (34%) serum creatinine (2.12±1.70), low C3(77%), low C4(38%), eGFR 49.11±15.15, activity index (7.45±11.53), chronicity index (1.56±1.68), serum albumin (2.27±0.70) at presentation and (2.83±0.72) at 6 months. Majority belonged to class IV(76%) lupus nephritis followed by class III (10%), class II(4%), class V (4%) class V+VI(3%) V+III(3%). Majority (53%) presented with an eGFR between >60 ml/min, 10% with eGFR 15-30 ml/min and 8 % patients presented with an eGFR of <15 ml/min. Among outcomes, 41(%) complete remission, (27%) partial remission and (32%) no remission to treatment. Eight patients had crescents in the histopathology and two patients had thrombotic microangiopathy and three patients had APLA syndrome. All achieved only partial remission. Eight patients reached ESRD. Mortality was seen in 10% secondary to infection due poor follow up. An younger age at diagnosis, low GFR and high serum creatinine at presentation, high activity with chronicity indeces and class IV±V lupus in histopatholgy were considered to be a poor prognostic marker. The outcome of lupus nephritis with standard immunosuppressive regimens is reasonable, but immunosuppression is associated with a high rate of infection. Early identification of risk factors and prognostic markers helps to initiate aggressive treatment at disease onset to obtain the best response.

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