Risk of chronic kidney disease in 260 patients with lupus nephritis: analysis of a nationwide multicentre cohort with up to 35 years of follow-up

Abstract

Objectives: To compare proliferative (PLN) and membranous (MLN) lupus nephritis (LN) regarding clinical and laboratory presentation and long-term outcomes, and to investigate predictors of progression to chronic kidney disease (CKD).

Methods: Multicentre observational study, with retrospective analysis of a prospective cohort, using data from the Rheumatic Diseases Portuguese Registry - Reuma.pt. Patients with biopsy-proven PLN, MLN and mixed LN were included. Cox regression survival analysis was used to investigate predictors of CKD.

Results: A total of 260 patients were included. Median follow-up was 8 years (IQR 11; minimum 1, maximum 35 years). MLN patients presented with significantly lower serum creatinine [0.70 (IQR 0.20; minimum 0.50, maximum 1.30) mg/dl vs 0.80 (IQR 0.31; minimum 0.26, maximum 2.60) in PLN, P = 0.003]. Proteinuria levels did not differ between groups (P = 0.641). Levels of complement were reduced in PLN but nearly normal in MLN patients, and there were fewer patients with positive anti-dsDNA antibodies in the MLN group (P < 0.001). One year after the beginning of treatment, 62% of the patients achieved EULAR/ERA-EDTA complete response, with a further 5% achieving partial response. Patients with lower proteinuria at diagnosis were more likely to achieve a complete renal response at one year; however, proteinuria at diagnosis or at one year did not predict long-term CKD. Estimated glomerular filtration rate (eGFR) ≤75 mL/min/1.73 m2 at one year was the strongest predictor of progression to CKD (HR 23 [95% CI 8-62], P < 0.001). Other possible predictors included the use of azathioprine for induction of remission, older age at diagnosis and male sex.

Conclusion: Proteinuria levels did not predict LN histologic class in our cohort. eGFR cutoff of 75 mL/min/1.73 m2 after one year of treatment was strongly predictive of progression to CKD.

Keywords: chronic kidney disease; membranous lupus nephritis; proliferative lupus nephritis; survival analysis; systemic lupus erythematosus.