OUTCOMES OF EARLY VERSUS LATE DIAGNOSIS OF LUPUS NEPHRITIS IN SLE PATIENTS
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Keywords
systemic lupus erythematosus, lupus nephritis, early diagnosis, renal survival, complete remission
Abstract
Systemic lupus erythematosus (SLE) is a chronic autoimmune disease with lupus nephritis (LN) as one of its most severe manifestations, influencing up to 70% of individuals and signifying an opportune adversely effect on mortality. Early detection of LN is important because delayed diagnosis will result in irreversible damage to the kidneys. The literature, to date, indicates that diagnosing LN earlier on is related to a better renal function and lower chronicity index but possibly higher remission rates; while the long-term survival outcomes have been mixed between studies. We conducted this retrospective cohort study at the Civil Hospital Karachi (CHK), Karachi, Pakistan, to compare the clinical, histopathologic and long-term outcomes of early LN diagnosis (≤1 year from SLE diagnosis) vs late LN diagnosis (> 1 year from SLE diagnosis). The study included 228 patients with biopsy-confirmed lupus nephritis (ISN/RPS classification), of whom 96 and 132 patients were classified as having early or late lupus nephritis. Data were collected from electronic health records and manual review of charts for demographic, clinical and laboratory parameters, biopsy indices, induction therapy and follow-up outcomes. The statistical analyses performed were Kaplan–Meier survival curves and unconditional Cox regression, as well as logistic regression for predictors of remission. Early LN patients were significantly younger (27.4 ± 7.1 vs. 30.9 ± 8.5 years, p = 0.002), with better renal function (median creatinine 0.9 vs. 1.8 mg/dL, p < 0.001; eGFR 98.3 vs. The complete remission was observed in 63.5% and 32.6% of early LN patients lived at six months (p < 0.001) as well as; In the twelve-month follow up, remission rates were; for the early LN group, 67.7%, and 36.4% (p < 0.001). Early LN significantly increased five-year renal survival (92.7% vs 74.2%, p < 0.001) and decreased the risk of progression to ESRD (7.3% vs 23.5%, HR = 3.14, p = 0.006). Data from a cohort of 200 adult patients with SLE, for example, came to the same conclusion: Routine surveillance and early biopsy in these patients are critical to maximizing renal outcomes.
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Umer Shabbir
Bahria University of Health Sciences/Midciti Hospital, Karachi
Imtiaz Manzoor
Chiniot General Hospital, Karachi
Muhammad Rehan
Dow University of Health Sciences/Civil Hospital, Karachi
Mamoon Zubair
Dow University of Health Sciences/Civil Hospital, Karachi
Akshay Kumar
I.Horbachevsky Ternopil National Medical University, Ternopil, Ukraine
Akshy Kumar
Liaquat University of Medical and Health Sciences, Jamshoro, Sindh
Bilquees Saba
Ziauddin University Hospital, Karachi
Tahir Ilyas
Tabba Kidney Institute, Karachi