In:
Annals of the Rheumatic Diseases, BMJ, Vol. 77, No. 9 ( 2018-09), p. 1318-1325
Abstract:
To evaluate changes in demographic, clinical and histological presentation, and prognosis of lupus nephritis (LN) over time. Patients and methods We studied a multicentre cohort of 499 patients diagnosed with LN from 1970 to 2016. The 46-year follow-up was subdivided into three periods (P): P1 1970–1985, P2 1986–2001 and P3 2002–2016, and patients accordingly grouped based on the year of LN diagnosis. Predictors of patient and renal survival were investigated by univariate and multivariate proportional hazards Cox regression analyses. Survival curves were compared using the log-rank test. Results A progressive increase in patient age at the time of LN diagnosis (p 〈 0.0001) and a longer time between systemic lupus erythematosus onset and LN occurrence (p 〈 0.0001) was observed from 1970 to 2016. During the same period, the frequency of renal insufficiency at the time of LN presentation progressively decreased (p 〈 0.0001) and that of isolated urinary abnormalities increased (p 〈 0.0001). No changes in histological class and activity index were observed, while chronicity index significantly decreased from 1970 to 2016 (p=0.023). Survival without end-stage renal disease (ESRD) was 87% in P1, 94% in P2% and 99% in P3 at 10 years, 80% in P1 and 90% in P2 at 20 years (p=0.0019). At multivariate analysis, male gender, arterial hypertension, absence of maintenance immunosuppressive therapy, increased serum creatinine, and high activity and chronicity index were independent predictors of ESRD. Conclusions Clinical presentation of LN has become less severe in the last years, leading to a better long-term renal survival.
Type of Medium:
Online Resource
ISSN:
0003-4967
,
1468-2060
DOI:
10.1136/annrheumdis-2017-212732
DOI:
10.1136/annrheumdis-2017-212732.supp1
DOI:
10.1136/annrheumdis-2017-212732.supp2
DOI:
10.1136/annrheumdis-2017-212732.supp3
Language:
English
Publisher:
BMJ
Publication Date:
2018
detail.hit.zdb_id:
1481557-6
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