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Factors associated with poor outcomes in patients with lupus nephritis

Acute Dialysis Unit Jackson Memorial Hospital, University of Miami Miller School of Medicine, Miami, FL, USA, gcontrer{at}med.miami.edu

V Pardo

Electron Microscopy VAMC, University of Miami, Miami, FL, USA

C Cely

Department of Surgery, Division of Critical Care, Veterans Affairs Medical Center, Miami, FL, USA

E Borja

University of Miami Miller School of Medicine, Miami, FL, USA

A Hurtado

University of Miami Miller School of Medicine, Miami, FL, USA

C De La Cuesta

University of Miami Miller School of Medicine, Miami, FL, USA

K Iqbal

Division of Nephrology and Hypertension, University of Miami Miller School of Medicine, Miami, FL, USA

O Lenz

Division of Nephrology and Hypertension, University of Miami Miller School of Medicine, Miami, FL, USA

A Asif

Division of Nephrology and Hypertension, University of Miami Miller School of Medicine, Miami, FL, USA

N Nahar

University of Miami Miller School of Medicine, Miami, FL, USA

B Leclerq

Division of Nephrology and Hypertension, University of Miami Miller School of Medicine, Miami, FL, USA

C Leon

University of Miami Miller School of Medicine, Miami, FL, USA

I Schulman

Division of Nephrology and Hypertension, University of Miami Miller School of Medicine, Miami, FL, USA

F Ramirez-Seijas

University of Miami Miller School of Medicine, Miami, FL, USA

A Paredes

University of Miami Miller School of Medicine, Miami, FL, USA

A Cepero

University of Miami Miller School of Medicine, Miami, FL, USA

T Khan

University of Miami Miller School of Medicine, Miami, FL, USA

F Pachon

University of Miami Miller School of Medicine, Miami, FL, USA

E Tozman

University of Miami Miller School of Medicine, Miami, FL, USA

G Barreto

University of Miami Miller School of Medicine, Miami, FL, USA

D Hoffman

University of Miami Miller School of Medicine, Miami, FL, USA

M Almeida Suarez

University of Miami Miller School of Medicine, Miami, FL, USA

J C Busse

University of Miami Miller School of Medicine, Miami, FL, USA

M Esquenazi

University of Miami Miller School of Medicine, Miami, FL, USA

A Esquenazi

University of Miami Miller School of Medicine, Miami, FL, USA

L Garcia Mayol

University of Miami Miller School of Medicine, Miami, FL, USA

H Garcia Estrada

University of Miami Miller School of Medicine, Miami, FL, USA

The objective of this study was to identify the factors associated with important clinical outcomes in a case-control study of 213 patients with lupus nephritis. Included were 47% Hispanics, 44% African Americans and 9% Caucasians with a mean age of 28 years. Fifty-four (25%) patients reached the primary composite outcome of doubling serum creatinine, end-stage renal disease or death during a mean follow-up of 37 months. Thirty-four percent African Americans, 20% Hispanics and 10% Caucasians reached the primary composite outcome (P < 0.05). Patients reaching the composite outcome had predominantly proliferative lupus nephritis (WHO classes: 30% III, 32% IV, 18% V and 5% II, P < 0.025) with higher activity index score (7 ± 6 versus 5 ± 5, P<0.05), chronicity index (CI) score (4 ± 3 versus 2 ± 2 unit, P<0.025), higher baseline mean arterial pressure (MAP) (111 ± 21 versus 102 ± 14 mmHg, P<0.025) and serum creatinine (1.9 ± 1.3 versus 1.3 ± 1.0 mg/dL, P<0.025), but lower baseline hematocrit (29 ± 6 versus 31 + 5%, P<0.025) and complement C3 (54 ± 26 versus 65 + 33 mg/dL, P<0.025) compared to controls. More patients reaching the composite outcome had nephrotic range proteinuria compared to controls (74% versus 56%, P<0.025). By multivariate analysis, CI (hazard ratio [95% CI] 1.18 [1.07-1.30] per point), MAP (HR 1.02 [1.00-1.03] per mmHg), and baseline serum creatinine (HR 1.26 [1.04-1.54] per mg/dL) were independently associated with the composite outcome. We concluded that hypertension and elevated serum creatinine at the time of the kidney biopsy as well as a high CI are associated with an increased the risk for chronic renal failure or death in patients with lupus nephritis.

Key Words: chronic renal failure • death and predictors • lupus nephritis

Lupus, Vol. 14, No. 11, 890-895 (2005)
DOI: 10.1191/0961203305lu2238oa


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