Arthritis & Rheumatism, Volume 63,
November 2011 Abstract Supplement
Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Chicago, Illinois November 4-9, 2011.
Long-Term Outcome of Lupus Nephritis in Asian Indians Using Standard Therapy.
Dhir, Varun, Aggarwal, Amita, Lawrence, Able, Agarwal, Vikas, Misra, Ramnath
Lupus nephritis is an important complication in SLE. There have been impressive gains in outcome with current immunosuppressive regimens in developed countries. However, there is sparse data on the long-term outcome from developing countries including India. This study looked at outcome in Asian-Indians.
Retrospective study of SLE patients (fulfilling ACR 1997) with nephritis (unexplained proteinuria >=500mg with or without active sediments) seen at single Indian center over 20 years. They were treated as per standard regimens. Treatment response assessed by remission at 1 year (proteinuria<=2g/day with at least 50% reduction from baseline, no active sediments and serum creatinine<=1.5mg/dl). Primary outcome was development of chronic renal failure (CRF, serum creatinine>1.5mg/dl) or death. Secondary outcome was end-stage renal disease or death. Survival analysis was done using Kaplan-Meier and differences in survival by log rank test. Risk factors for poor outcome were assessed by cox-proportional hazards.
The study included 188 patients of lupus nephritis, female: male ratio 11:1, mean age 23.6±10.5 years. Of these 136 patients had renal biopsy. Renal histology was: class II in 22, class III in 36, class IV in 61, class V in 16 and class VI in 1. Intravenous cyclophosphamide pulses (NIH) used as induction in most cases of proliferative nephritis: class III (85.3%), class IV (94.8%) and non-biopsied (71.1%). Most with non-proliferative nephritis received steroids with or without azathioprine: class II (73.7%) and class V (80%). The 1-year remission rate was 84.6%, with no statistical difference by class of nephritis. Median duration of follow up was 6 years (IQR 39). Survival with normal renal function was 84, 69 and 57% at 5, 10 and 15 years as shown in the figure (N= numbers at risk).
Survival curves were not different for various histological classes, however non-biopsied patients had lower survival compared to class II and class III or IV (p<0.05). Risk factors and hazard ratio (95% CI) for primary outcome on univariate analysis was number of infections 1.5 (1.12.0), initial serum creatinine 1.8 (1.42.2), hypertension 2.3 (1.05.1), hematuria 2.8 (1.36.1), low C3 3.0 (1.17.6) and absence of remission 13.8 (5.236.7). Only hematuria and absence of remission were significant on multivariate analysis. Renal survival at 5, 10 and 15 years was 91, 81 and 76%. Of 130 patients analyzed for complications, 45 (34.6%) had at least one serious infection, including tuberculosis in 17 (13.1%). There were 16 deaths, half due to infections (half of these were due to TB).
Outcome of lupus nephritis in Asian-Indians on standard treatment is comparable to developed nations. Lack of remission at 1 year and hematuria were risk factors for poor outcome. There was a high rate of infections especially tuberculosis; these were also a major cause of death.
To cite this abstract, please use the following information:
Dhir, Varun, Aggarwal, Amita, Lawrence, Able, Agarwal, Vikas, Misra, Ramnath; Long-Term Outcome of Lupus Nephritis in Asian Indians Using Standard Therapy. [abstract]. Arthritis Rheum 2011;63 Suppl 10 :1402