Author(s): Al Arfaj AS, Khalil N, Al Saleh S, Al Arfaj AS, Khalil N, Al Saleh S
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Abstract The aim of this article is to study the prevalence, clinicolaboratory features, WHO histological types, therapy and renal outcome of lupus nephritis (LN) in Saudi Arabia. During the 27-year-period (1980-2006), 299 (47.9\%) cases of LN were identified among the 624 cases of systemic lupus erythematosus (SLE) follow-up at King Khalid University Hospital, Riyadh. The female:male ratio in LN was 8.3:1, with a mean age of 32 years and a mean age of onset of 23 years. The WHO renal histological types were; Class I (1\%), Class II (18.1\%), Class III (10\%), Class IV (37.1\%), Class V (11.7\%), and Class VI (2.7\%). Azathioprine was given to 43.1\% and pulse cyclophosphamide to 65.6\% in combination with other drugs. Remission was seen in 226 (75.6\%) patients, renal flares in 14 (4.7\%), end stage renal disease (ESRD) in 27 (9.0\%), death in 18 (6.0\%), and 14 (4.7\%) lost follow-up. The 5- and 10-year patient survival rates in our whole LN cohort by Kaplan-Meier analysis were 96\% and 95\%, respectively. The survival did not differ significantly in different LN classes nor did it differ significantly during the three periods of presentation (1980-1990, 1991-2000, and 2001-2006; P > 0.05). The risk factors for poor survival were found to be older age at onset (>50-years age; P = 0.034), ESRD (P = 0.000), and low C3 (P = 0.022). The risk factors for progression to ESRD were older age at onset (>50-years age; P = 0.037), hypertension (P = 0.009), elevated serum creatinine (P = 0.000), and proliferative LN (Classes III, IV; P = 0.013, P = 0.039). Different treatment modalities did not have significant effect on survival in the whole LN cohort (P = >0.05). However, pulse cyclophosphamide favored remission in Classes II, III, IV, and V (P = 0.023). The main causes of death were renal failure (50\%) and infections (44.4\%).
This article was published in Rheumatol Int
and referenced in Lupus: Open Access