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| ORIGINAL ARTICLE |
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| Year : 2022 |
Volume
: 33 | Issue : 1 | Page
: 90-105 |
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Assessment of Lupus Nephritis in a Multicenter Retrospective Egyptian Cohort: Initial Characteristics, Influence of Age and Gender, Outcome, and Potential Association with Disease Damage
Basma M Medhat1, Ahmed Elmaghraby1, Yomna Farag2, Huda Marzouk2, Noha Mostafa2, Iman Khalifa3, AbdelAal Mohammed4, Marwa Elkhalifa5, Eman Hassan ElSayed Hassan5, Waleed A Hassan6
1 Rheumatology and Rehabilitation Department, Kasr Alainy Faculty of Medicine, Cairo University, Cairo, Egypt
2 Pediatric Rheumatology Department, Kasr Alainy Faculty of Medicine, Cairo University, Cairo, Egypt
3 Pediatric Department, Faculty of Medicine, Helwan University, Helwan, Egypt
4 Internal Medicine Department, Kasr Alainy Faculty of Medicine, Cairo University, Cairo, Egypt
5 Internal Medicine Department, Rheumatology Unit, Faculty of Medicine, Alexandria University, Alexandria, Egypt
6 Rheumatology, Rehabilitation, and Physical Medicine Department, Faculty of Medicine, Benha University, Benha, Egypt
Correspondence Address:
Basma M Medhat
Department of Rheumatology and Rehabilitation, Kasr Alainy Faculty of Medicine, Cairo University, Cairo
Egypt
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/1319-2442.367830
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The study aimed to evaluate the association of demographic, clinical, and histopathologic characteristics with renal and disease outcomes. Persistent lack of partial or complete remission despite sequential induction therapy, chronic kidney disease (CKD) or endstage renal disease (ESRD), and/or mortality were determined as poor renal outcomes. Disease damage was investigated through the Systemic Lupus International Collaborating Clinics/ American College of Rheumatology Damage Index (SDI). Of 201 biopsy-proven lupus nephritis patients, a poor outcome was present in 56 (27.9%) patients, with nine (4.5%), 22 (10.9%), and 29 (14.4%) patients demonstrating lack of response, CKD, and ESRD, respectively, and the prevalence of mortality was 5.5% (11/201). The outcome was poor among males [29/201 (14.4%)] [P = 0.008; odds ratio (OR): 2.8; 95% confidence interval (CI): 1.2–6.4], yet comparable between adult- and juvenile-onset patients [80/201 (39.8%) (≤16 years)] (P = 0.6; OR: 0.8; 95% CI: 0.4–1.6). Hypertension (P <0.001; OR: 6.3; 95% CI: 2.6–14.9), elevated creatinine (P <0.001; OR: 5.2; 95% CI: 2.6–10.3), and hematuria (P <0.001; OR: 3.7; 95% CI: 1.9–7.5) at presentation, and fibrinoid necrosis [P <0.001; odds ratio (OR): 4.1; 95% confidence interval (CI): 2.1–8.1], wire loops (P = 0.006; OR: 2.4; 95% CI: 1.2–4.6), crescents (P <0.001; OR: 5.4 95% CI: 2.8–10.5), interstitial fibrosis (P = 0.001; OR: 2.7; 95% CI: 1.4–5.1), and acute vascular lesions (P = 0.004; OR: 3.6; 95% CI: 1.4–9.4) on biopsy were associated with a poor outcome. Chronic glomerular (P = 0.003) and acute vascular lesions (P <0.001), and a higher chronicity index (r = 0.1; P = 0.006) on biopsy, and frequent renal (r = 0.3; P <0.001) and extra-renal flares (r = 0.2; P <0.001) were associated with higher SDI scores. Among the studied renal and extra-renal parameters, independent predictors of higher disease damage solely included frequent renal flares (ᵝ= 1; P <0.001). To conclude, a poor renal outcome (27.9%) was associated with distinct features. Disease damage was associated with frequent renal flares.
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