Characteristics and outcomes of a Hispanic lupus nephritis cohort from Mexico

Abstract Objectives To characterize the clinical presentation and outcomes of LN in a Hispanic cohort from Mexico. Methods We studied 440 subjects with systemic lupus erythematosus and biopsy-proven LN followed for >36 months. We obtained demographic, clinical, laboratory, histopathological and t...

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Published in:Rheumatology (Oxford, England) England), 2023-03, Vol.62 (3), p.1136-1144
Main Authors: Zavala-Miranda, María Fernanda, Perez-Arias, Abril Alicia, Márquez-Macedo, Sofía E, Comunidad-Bonilla, Roque A, Romero-Diaz, Juanita, Morales-Buenrostro, Luis E, Mejía-Vilet, Juan M
Format: Article
Language:English
Subjects:
Adult
Creatinine
Female
Follow-Up Studies
Hispanic or Latino
Humans
Kidney - pathology
Kidney Failure, Chronic - complications
Lupus Nephritis - drug therapy
Male
Mexico
Prognosis
Retrospective Studies
Young Adult
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Summary:Abstract Objectives To characterize the clinical presentation and outcomes of LN in a Hispanic cohort from Mexico. Methods We studied 440 subjects with systemic lupus erythematosus and biopsy-proven LN followed for >36 months. We obtained demographic, clinical, laboratory, histopathological and treatment variables. All outcomes were analysed by survival analysis and included response to therapy, renal relapses, progression of kidney disease (decline in eGFR ≥ 30%, doubling of serum creatinine, end-stage kidney disease) and patient survival. Results The median age of the study cohort was 29 years (IQR 23–37) and 96% were female. The median eGFR at inclusion was 81 mL/min/1.73m2 (IQR 48–118) and 24 h-uPCR was 3.4 g/g (IQR 1.9–5.6). Mixed class LN (III/IV+V) was the most frequently observed (69%). Over a median follow-up of 79 months, complete response rates were 22.3%, 40.5% and 51.6%, at 6, 12 and 24 months, respectively. Renal relapse rates were 32.3% and 50.6% at 3 and 5 years. By 3 and 5 years, 20.7% and 31.4% had decline in eGFR ≥30%, 14.4% and 22.5% doubled their serum creatinine, and 9.1% and 17.7% progressed to ESKD. The factors associated with loss of kidney function were age, eGFR at presentation, the histologic chronicity index in the kidney biopsy, and the type of response to therapy. Patient survival was 98.2% and 97.1% at 3 and 5 years. Conclusion Although the response to treatment and patient survival in this Latin American cohort is comparable to that observed in other regions, there is still a high rate of renal relapses and progression to decline in kidney function.
ISSN:1462-0324
1462-0332
DOI:10.1093/rheumatology/keac407