A Study on the association of clinical profile with the outcomes of Lupus Nephritis.

Field: Medicine (Health Sciences)

INTRODUCTION : Sytemic lupus erythematosus is a paradigmatic autoimmune
disorder, the manifestations of which are protean sparing few organ systems if
any. Such diversity is attributed to its etiopathogenesis wherein antibodies to the
components of cell nucleus have been implicated. One major cause of morbidity
and utilization of health resources is renal involvement. More than half of the
mortality in SLE is due to renal involvement.
As with SLE, heterogeneity, both clinical as well as histological is
the hall mark of lupus nephritis. The disease usually is asymptomatic in its earlier
course thus vigilant screening of SLE patients for renal involvement remains the
important step in reducing the mortality and morbidity.
Even though recent treatments are effective and have reduced the
adverse outcomes the therapeutic options are limited and induce toxicities in the
long term. Hence there is a need to identify patients who may have a worse
prognosis so that aggressive treatment can be instituted early.
Prognosis and therefore treatment decisions vary greatly according
to the clinical and pathological forms of lupus nephritis. Each individual has a
unique combination of these. Even though individual factors vary in their impact,
the greater the number of factors with worse prognosis, the less the patient is likely
to respond to therapy and hence needs aggressive therapy.
AIMS AND OBJECTIVES : 1. To study the outcomes of lupus nephritis in 50 patients during the study period.
2. To study the association of demographic, clinical, laboratory, histopathologic
and treatment profile of these patients with the outcome. 3. To compare the results with the standard data available.
MATERIALS AND METHODS : 50 adult cases of new onset lupus nephritis
satisfying the inclusion and exclusion criteria. Inclusion Criteria : Adult SLE patients who satisfy the 1997 revised American College of Rheumatology classification criteria with new onset lupus nephritis. Exclusion Criteria : 1. Childhood lupus nephritis, 2. End stage renal disease, 3. Relapsed lupus nephritis, 4. Other causes of chronic kidney disease.
RESULTS : A total of 50 patients were enrolled as part of the study and followed up for a
period of 2 years (Mean : 17.3 months ;range :1week-24months). Among these
forty four were females and six were males. The mean age of the patients was
25.44 years±7.21.The range of age was 16- 47 years. Three patients lost follow up and in one patient the outcome could not be assessed as the patient was not willing for biopsy and was irregular in follow up. The mean age of patients who achieved complete response was 25.34 years (16-47). The mean age of patients who were refractory or dead was 28.75 (range
20-41). On an average, patients who achieved complete response were 3 years younger than those who remained refractory or died. On multistep logistic regression analysis age emerged as an important risk factor influencing the final outcome with p value of 0.047. CONCLUSION : 1. Among fifty patients 64% achieved complete response,4% achieved partial
response , 8% improved while 12% remained refractory and 4% died.
2. Lower age, female sex, lower disease activity, good initial renal function (low s.creatinine, high initial eGFRwere important factors associated with favourable outcome.
3. Presenting symptoms, disease duration, extra renal disease activity, presence of
hypertension, haemoglobin, platelet counts, serum albumin levels, treatment
protocols and biopsy class did not significantly influence the outcome.
4. Among patients who achieved complete response initial serum creatinine
positively correlated with time taken for outcome (statistically significant).
5. Higher age, disease activity, ESR and initial proteinuria positively correlated
with time taken to complete response (not statistically significant).
6. Hemoglobin, platelet count, albumin, GFR showed negative correlation with
time to complete response (not statistically significant).
7. In south Indian patients long term studies are needed to analyze the correlation
between clinical features and outcomes in lupus nephritis.